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Dermatoses of Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Hannah J. Anderson, Dana Correale, Jason B. Lee
When IH is insufficiently controlled with CS alone, the next therapeutic option is cyclosporine A (CsA). Doses of 3–10 mg/kg/day have been reported in the treatment of IH [60–62]. Again, medication should be tapered to the lowest possible dose that results in control of the disease. The mechanism of action is inhibition of calcineurin with resultant decrease in interleukin-2 production by CD4+ T cells. CsA also inhibits interferon-γ production by T cells. CsA is pregnancy category C. The most serious adverse effects are renal dysfunction and hypertension [16]. Renal function and blood pressure should be monitored during therapy. In a study of transplant recipients treated with CsA during pregnancy there was no evidence of teratogenicity [63]. However, 44.5% of infants were born at less than 37 weeks’ gestation and 44.3% weighed less than 2500 g at birth [63]. CsA is excreted in human breast milk and breastfeeding should be avoided during therapy. Biologic therapies may be considered as an alternative to cyclosporine or next-in-line therapy. Tumor necrosis factor (TNF) α inhibitors and ustekinumab are pregnancy category B drugs. As no significant pregnancy adverse outcomes have been observed, TNFα inhibitors such as infliximab may be considered, even as the first-line therapy [64]. No human safety data during pregnancy are available for newer biologic agents such as brodalumab, ixekizumab, guselkumab, secukinumab, and tildrakizumab, but animal studies showed no adverse effects [16].
Psoriasis
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Stamatis Gregoriou, Eftychia Platsidaki, Dimitris Rigopoulos
Ixekizumab treatment (a fully humanized monoclonal anti-IL-17A drug) and its effect on psoriatic nail disease were evaluated in a post hoc analysis of a phase 2 study comprising a 20-week randomized, placebo-controlled period and 48 weeks of an open-label extension period.61 There were 142 patients with moderate-to-severe plaque psoriasis who were randomized to receive placebo, 10, 25, 75, or 150 mg of ixekizumab injected subcutaneously at weeks 0, 2, 4, 8, 12, and 16. In week 48, all patients received 120 mg ixekizumab every 4 weeks. Patients with nail psoriasis in the 75 and 150 mg groups had significant improvements from baseline NAPSI. By week 48, 51.0% of patients with nail psoriasis experienced complete resolution of lesions, suggesting ixekizumab as a possible option for the treatment of patients with skin and nail psoriasis. A poster on the results of the IXORA-S trial suggested superior efficacy of ixekizumab over ustekinumab in nail psoriasis.62
Psoriatic arthritis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Secukinumab is a fully human monoclonal antibody and is effective in the treatment of both psoriasis and PsA. It is also effective in nail psoriasis and has been found to retard radiological progression [65]. Ixekizumab has recently been approved for psoriasis [66].
Ixekizumab is effective in the long-term management in moderate-to-severe plaque psoriasis: results from an Italian retrospective cohort study (the LOTIXE study)
Published in Journal of Dermatological Treatment, 2023
Andrea Chiricozzi, Matteo Megna, Alessandro Giunta, Carlo Giovanni Carrera, Paolo Dapavo, Anna Balato, Piergiorgio Malagoli, Stella Mazzoccoli, Aurora Parodi, Silvia Sabatino, Carlotta Buzzoni, Chu-Han Huang, Alessandra Narcisi
Common first-line treatments for moderate-to-severe plaque psoriasis are phototherapy and conventional systemic therapies. However, the advent of biologics has changed the paradigm of treatment in recent years, as they usually attain higher efficacy compared with conventional systemic agents, along with greater patient satisfaction and compliance (7–10). Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, thus inhibiting the master cytokine mediating the key inflammatory loops driving the development of psoriasis phenotype (11). The efficacy and safety of ixekizumab were assessed and established in three randomized, double-blind, placebo-controlled phase III studies in adult patients with moderate-to-severe plaque psoriasis who were candidates for phototherapy or systemic therapy (UNCOVER-1, UNCOVER-2, and UNCOVER-3) (12–15). Long-term extension of these trials also demonstrated efficacy and safety of ixekizumab up to 5 years in psoriasis patients (16,17).
Real-life experience with ixekizumab in plaque psoriasis: a multi-center, retrospective, 3-year study
Published in Expert Opinion on Biological Therapy, 2023
Giacomo Caldarola, A Chiricozzi, M Megna, P Dapavo, A Giunta, M Burlando, P Malagoli, V Dini, M Mariani, G Fabbrocini, P Quaglino, L Bianchi, A Parodi, K Peris, C De Simone
A retrospective analysis was performed on a cohort of patients with chronic moderate-to-severe plaque psoriasis, with or without psoriatic arthritis. Patients who received at least one dose of Ixekizumab before December 2018 were enrolled. The study population consisted of patients who referred to the outpatient clinics of seven Dermatologic Italian centers (Policlinico Gemelli, Rome, Policlinico Tor Vergata, Rome, University of Naples, Naples, Ospedale San Martino di Genova, Genua, Policlinico di Torino, Turin, Università di Pisa, Pisa, Ospedale San Donato di Milano, Milan). Clinical and demographic data were obtained by reviewing patient charts generated from the database of each center involved in this study. All data were extracted from patients’ records and were anonymized. Each individual study center was the owner of the dataset used in this study.
Healthcare resource utilization and costs among patients with psoriasis treated with ixekizumab or adalimumab over 2 years of follow-up in real-world settings
Published in Journal of Medical Economics, 2022
Andrew Blauvelt, Nianwen Shi, Mwangi J. Murage, Scott A. Kern, Najwa Somani, Russel Burge, Terri L. Ridenour, Carolyn R. Lew, Nicole M. Zimmerman, Baojin Zhu
Psoriasis is a chronic systemic inflammatory disease leading to global burden of the healthcare system1,2 and affects ∼7.4 million people in the United States3,4. It has a significant impact on patient quality-of-life and work productivity, and is associated with an increased risk for developing comorbidities, including psoriatic arthritis, depression, anxiety, cardiovascular disease, and diabetes mellitus5. Moderate-to-severe psoriasis is often managed with biologic therapies6,7 and most patients frequently inter-switch between them8. The common biologic classes include tumor necrosis factor (TNF) inhibitors and interleukin (IL)-17A inhibitors7,9. Adalimumab (ADA), a TNF inhibitor, has been the most commonly prescribed biologic therapy for psoriasis10. Ixekizumab (IXE), a newer biologic for psoriasis, inhibits IL-17A, a key effector cytokine in psoriasis pathogenesis11. Although both biologics are effective in treating psoriasis, no clinical trial studies have directly compared these two drugs.