198 results on '"Yves Poulin"'
Search Results
2. Use of Systemic Therapies for Treatment of Psoriasis in People Living with Controlled HIV: Inference-Based Guidance from a Multidisciplinary Expert Panel
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Kim A. Papp, Jennifer Beecker, Curtis Cooper, Mark G. Kirchhof, Anton L. Pozniak, Juergen K. Rockstroh, Jan P. Dutz, Melinda J. Gooderham, Robert Gniadecki, Chih-ho Hong, Charles W. Lynde, Catherine Maari, Yves Poulin, Ronald B. Vender, and Sharon L. Walmsley
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Psoriasis ,Human immunodeficiency virus ,HIV ,Immunosuppression ,Immunodeficiency ,Immunotherapy ,Dermatology ,RL1-803 - Abstract
Abstract Background People living with human immunodeficiency virus (PLHIV) have a similar prevalence of psoriasis as the general population, though incidence and severity correlate with HIV viral load. Adequately treating HIV early renders the infection a chronic medical condition and allows PLHIV with a suppressed viral load (PLHIV-s) to live normal lives. Despite this, safety concerns and a lack of high-level data have hindered the use of systemic psoriasis therapies in PLHIV-s. Objectives We aim to provide a structured framework that supports healthcare professionals and patients discussing the risks and benefits of systemic psoriasis therapy in PLHIV-s. Our goal was to address the primary question, are responses to systemic therapies for the treatment of psoriasis in PLHIV-s similar to those in the non-HIV population? Methods We implemented an inference-based approach relying on indirect evidence when direct clinical trial data were absent. In this instance, we reviewed indirect evidence supporting inferences on the status of immune function in PLHIV. Recommendations on systemic treatment for psoriasis in PLHIV were derived using an inferential heuristic. Results We identified seven indirect indicators of immune function informed by largely independent bodies of evidence: (1) functional assays, (2) vaccine response, (3) life expectancy, (4) psoriasis manifestations, (5) rate of infections, (6) rate of malignancies, and (7) organ transplant outcomes. Conclusions Drug-related benefits and risks when treating a patient with systemic psoriasis therapies are similar for non-HIV patients and PLHIV with a suppressed viral load and normalized CD4 counts. Prior to initiating psoriasis treatment in PLHIV, HIV replication should be addressed by an HIV specialist. Exercise additional caution for patients with a suppressed viral load and discordant CD4 responses on antiretroviral therapy.
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- 2022
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3. Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II
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Stephanie Ghazal, Zainab Ridha, Kathleen D'Aguanno, David Nassim, Andrea Quaiattini, Elena Netchiporouk, Yves Poulin, Sunil Kalia, Danielle Marcoux, Vincent Piguet, and Carolyn Jack
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dupilumab ,treatment guideline ,atopic dermatitis ,systematic review ,quality appraisal ,AGREE-II ,Medicine (General) ,R5-920 - Abstract
IntroductionSince its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear.ObjectiveWe aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST).Materials and MethodsA literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared.ResultsAGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50–96); stakeholder involvement, 54% (28–85); rigor of development, 39% (21–63); clarity of presentation, 85% (69–100); applicability, 27% (6–51); and editorial independence, 76% (42–100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG.Conclusion and RelevanceDupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.
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- 2022
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4. Serious infections in patients with self-reported psoriatic arthritis from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) treated with biologics
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Christopher T. Ritchlin, Mona Stahle, Yves Poulin, Jerry Bagel, Soumya D. Chakravarty, Shelly Kafka, Bhaskar Srivastava, Wayne Langholff, and Alice B. Gottlieb
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PSOLAR ,Psoriasis ,Psoriatic arthritis ,Serious infections ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Patients with psoriatic arthritis (PsA) have increased risk of adverse events, including serious infections (SI), compared with psoriasis patients. Methods Patients eligible for, or receiving conventional systemic and biologic agents for psoriasis were followed prospectively using PSOLAR. Cohorts included: ustekinumab, tumor necrosis factor (TNF) inhibitors; infliximab; etanercept; adalimumab; non-biologic/methotrexate (MTX) (reference group); and non-biologic/non-MTX. Multivariate analyses using Cox hazard regression were used to identify factors associated with time to first SI. Rates of SI in PSOLAR psoriasis patients with self-reported PsA and possible risks with biologic therapy were evaluated. Results PSOLAR enrolled 4315 psoriasis patients with self-reported PsA. The overall population (N = 2401) included patients (n): 628 ustekinumab; 1413 TNF inhibitors; 258 infliximab; 481 etanercept; 674 adalimumab; 54 other biologics, 98 non-biologic/MTX; 208 non-biologic/non-MTX. Overall, 138 SI were reported with incidence rates per 100 patient-years as follows: a) ustekinumab: 1.00; b) TNF inhibitors: 2.22; c) infliximab: 2.12; d) etanercept: 2.58; e) adalimumab: 1.99; f) non-biologic/MTX: 3.01; g) and non-biologic/non-MTX: 2.31. Age, time-dependent disease activity Physician’s Global Assessment (PGA) of 4, 5, history of infection, and diabetes were associated with increased risk for SI (p
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- 2019
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5. A Review of the Efficacy and Safety for Biologic Agents Targeting IL-23 in Treating Psoriasis With the Focus on Tildrakizumab
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Feras M. Ghazawi, Farhan Mahmood, Leon Kircik, Yves Poulin, Marc Bourcier, Ronald Vender, Marni C. Wiseman, Charles Lynde, and Ivan V. Litvinov
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psoriais ,treatment ,tildrakizumab ,guselkumab ,IL-23 ,risankizumab ,Medicine (General) ,R5-920 - Abstract
Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth.
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- 2021
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6. Ixekizumab Results in Persistent Clinical Improvement in Moderate-to-Severe Genital Psoriasis During a 52 Week, Randomized, Placebo-Controlled, Phase 3 Clinical Trial
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Lyn Guenther, Alison Potts Bleakman, Jamie Weisman, Yves Poulin, Lynda Spelman, Russel Burge, Janelle Erickson, Kristin Todd, Clinton C. Bertram, and Caitriona Ryan
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ixekizumab ,genital psoriasis ,ixora-q ,clinical trial ,sexual impact ,itch ,Dermatology ,RL1-803 - Abstract
Ixekizumab was efficacious in treating moderate-to-severe genital psoriasis over 12 weeks. We evaluated the long-term efficacy and safety of ixekizumab for up to 52 weeks. Patients were randomized to 80 mg ixekizumab every 2 weeks or to placebo through Week 12, then received 80 mg open-label ixekizumab every 4 weeks through Week 52. In patients initially randomized to ixekizumab, clear or almost clear genital skin was achieved for 73% of patients at Week 12 and 75% at Week 52. Persistent improvements were also observed for overall psoriasis, genital itch, and the impact of genital psoriasis on the frequency of sexual activity. The safety profile was consistent with studies of ixekizumab in patients with moderate-to-severe plaque psoriasis. Ixekizumab provided rapid and persistent improvements in the signs and symptoms of genital psoriasis for up to 52 weeks of treatment.
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- 2020
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7. Management of chronic spontaneous urticaria (CSU): a treat to target approach using a patient reported outcome
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Hermenio Lima, Melinda Gooderham, Jan Dutz, Charles Lynde, Hugo Chapdelaine, Anne Ellis, Martin Gilbert, Vincent Ho, Kim Papp, Yves Poulin, and Gordon Sussman
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Chronic spontaneous urticaria ,Chronic idiopathic urticaria ,Urticaria ,Urticaria Activity Score ,CSU ,CIU ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Background Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists, and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU, and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases.
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- 2017
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8. Practical and Relevant Guidelines for the Management of Psoriasis: An Inference-Based Methodology
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Kim A. Papp, Melinda J. Gooderham, Charles W. Lynde, Yves Poulin, Jennifer Beecker, Jan P. Dutz, Chih-ho Hong, Robert Gniadecki, Mark G. Kirchhof, Catherine Maari, and Ronald B. Vender
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Study Protocol ,Inference ,Psoriasis ,Dermatology ,Guidelines ,Expert elicitation - Abstract
Introduction Psoriasis (Pso) is a common, immune-mediated, chronic-relapsing, inflammatory skin disease. While a great deal is known about Pso and its treatment, there remain several treatment scenarios unaddressed by clinical studies. To be effective, treatment for Pso must alter the activity of one or more immunological pathways important in the pathogenesis of the disease. While the benefit of blocking these pathways may be apparent, there remain uncertainties regarding safety, such as infections, malignancies, and the potential for off-target effects. Existing guidelines and treatment recommendations rely primarily on clinical trial or observational data, none of which adequately address specific clinical challenges. This document describes a methodological framework for generating practical and clinically relevant guidance for situations where direct evidence is rare or absent. Guidelines implementing this framework are currently ongoing. Methods We develop a knowledge synthesis approach to guideline development, utilizing clinical trial data where available, and a formalized inferential decision-making process that considers indirect data coupled with structured expert opinion and analysis. This approach is best suited for situations where direct, high-level evidence is lacking. Support for each resultant recommendation is expressed as a quantified assessment of confidence. Results The topics to be addressed by this set of guidelines are ranked by clinicians and patients as areas of concern, with an emphasis on topics where high-level evidence may have limited availability. Conclusion Through this novel approach, we will derive practical, informative recommendations using the best evidence available in combination with structured expert opinion to guide best practices in complex, real-world settings. Supplementary file2 (MP4 98653 kb) Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00642-5., Plain Language Summary Clinical guidelines aim to assist doctors in managing their patients’ medical conditions. A limitation of current guidelines is that they are frequently based on randomized clinical research trials—often considered the gold standard in medical research. Clinical trials are designed to estimate the safety and effectiveness of treatment. Outside of clinical trials, doctors encounter a range of patient cases excluded from clinical trials. Our group aims to create guidelines for those clinical scenarios not adequately addressed by clinical trials. Examples include patients excluded from clinical trials, the elderly, patients with human immunodeficiency virus (HIV), and pregnant or breastfeeding women. When clinical trial data is limited, doctors must make decisions nonetheless. In certain clinical situations they are left to their own resources to consult with experts, review the data, and make inferences based on the limited data available. Instead of concluding that there is no data, the topic of interest can be broken down into components that are answerable by different types of research studies. This inference-based approach uses expert opinion and indirect evidence to support an inference-based position on topics where direct clinical data is sparse or insufficient to answer the question. This approach can be used as a complement to clinical trial data informing disease management guidelines. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00642-5.
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- 2021
9. Phase 2 Trial of Topical Thykamine in Adults With Mild to Moderate Atopic Dermatitis
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Charles Lynde, Yves Poulin, Jerry Tan, Mark Lomaga, Wei-jing Loo, Diane Carbonneau, Isabelle Delorme, Doria Grimard, and John Sampalis
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Adult ,Treatment Outcome ,Emollients ,Pruritus ,Quality of Life ,Humans ,General Medicine ,Severity of Illness Index ,Dermatitis, Atopic ,Immunoglobulin A - Abstract
Atopic dermatitis is a common skin disorder for which there remains an unmet need for topical pharmacotherapies that are safe and effective. This phase 2 study assessed the efficacy and safety of 3 dosages of PUR 0110 (Thykamine; Devonian Health Group Inc.) cream (0.05%, 0.1%, and 0.25%) compared to vehicle for treatment of adults with mild to moderate atopic dermatitis. The primary efficacy endpoint was the proportion of patients with an Investigatorrsquo;s Global Assessment (IGA) of clear/almost clear and with a decrease from baseline score of at least 2 grades at day 29. Key secondary efficacy endpoints included change from baseline to day 29 in IGA, percent body surface area (%BSA) affected, Eczema Area and Severity Index (EASI) score, pruritus, and quality of life. Safety outcomes included the incidence of local and systemic adverse events. The primary efficacy endpoint was met with PUR 0110 cream 0.10% compared to vehicle (30.8% vs 6.7%, respectively, P=.014). Most secondary endpoints also favored PUR 0110 cream 0.10% vs vehicle, including change from baseline to day 29 in IGA score, %BSA affected, pruritus, and patient-reported quality of life. Adverse events occurred at a similar rate in all treatment groups; most were mild to moderate in intensity and were infrequently associated with study withdrawal. PUR 0110 cream 0.10% demonstrated rapid improvement in signs and symptoms of atopic dermatitis. This observation, along with its favorable safety and tolerability profile, could make it a useful therapeutic option for the treatment of atopic dermatitis. J Drugs Dermatol. 2022;21(10):1091-1097. doi:10.36849/JDD.6729.
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- 2022
10. Psoriasis Prevalence and Severity by Expert Elicitation
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Melinda Gooderham, Jennifer Beecker, Catherine Maari, Robert Gniadecki, Chih-Ho Hong, Jan P. Dutz, Yves Poulin, Mark G. Kirchhof, C Lynde, Ronald Vender, and Kim A. Papp
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BSA ,Population ,Dermatology ,Disease ,Expert elicitation ,Bayesian ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis ,Prevalence ,Credible interval ,Medicine ,education ,Disease severity ,Body surface area ,education.field_of_study ,business.industry ,Brief Report ,Incidence (epidemiology) ,medicine.disease ,Confidence interval ,030220 oncology & carcinogenesis ,business ,Demography - Abstract
Introduction An estimated 2–4% of Western populations are thought to have psoriasis, with a regional incidence ranging from 0.09% to 11.43%. Variance in estimates is a result of differences in study populations, methodology, regional differences, and definitions of disease. Reliable prevalence estimates of plaque psoriasis are challenging to establish. Further, the distribution of psoriasis severity in the population is unknown. This study aims to establish the utility of expert elicitation (EE) as a method for estimating unknown parameters in dermatology by (1) estimating the prevalence of psoriasis in the adult population, and (2) estimating previously unknown disease severity distribution. Methods An expert panel of 11 Canadian dermatologists with demonstrated expertise in psoriasis was formed. A proof-of-concept EE exercise estimated psoriasis prevalence in the general population in Canada, followed by estimation of psoriasis disease severity distribution by body surface area (BSA). Expert estimates were consolidated using Bayesian methods to statistically model the data and represent uncertainty. Results The median prevalence of psoriasis in the adult population using the Bayesian estimate was 3.0% (95% credibility interval, 2.7–3.3%), compared with the estimated mean prevalence of 3.4% (95% confidence interval, 2.2–4.9%). By EE, the estimated cumulative distribution of disease severity assessed by BSA suggests that approximately 50% of patients have a BSA of 50%. Conclusion The EE approach resulted in prevalence estimates that had a narrow distribution and were consistent with published literature, supporting its value in dermatology as a complementary method to help guide decision-making in areas where evidence is scarce or uncertain. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00518-8., Plain Language Summary Psoriasis is a common skin disease that affects 2–4% of the population. Prevalence estimates vary depending on factors such as study type and population studied. The distribution of disease severity (what proportion of patients have mild, moderate, or severe psoriasis) is not known. In this study, 11 dermatologists with expertise in psoriasis used an approach called expert elicitation to make educated guesses about prevalence and disease severity distribution in the real world. Using a statistical approach called Bayesian estimation, experts can represent the level of certainty in what they know and do not know and make inferences or assumptions about a population. Bayesian estimates are not based on the amount of data; rather, each datum contributes to a statistically meaningful result. The median prevalence of psoriasis in the adult population using the Bayesian estimate was 3.0%, which is in the expected range based on prior literature and supports the use of this expert elicitation method. This study provides the first expert estimate of disease severity distribution in the population assessed by body surface area affected by psoriasis. Approximately 50% of psoriasis patients have mild disease (
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- 2021
11. Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR): A nested case-control analysis
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Richard G. Langley, Kimberly Parnell Lafferty, Bhaskar Srivastava, Matthias Augustin, Wayne Langholff, Yves Poulin, and Steven Fakharzadeh
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Male ,medicine.medical_specialty ,Dermatology ,Systemic therapy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Internal medicine ,Psoriasis ,Ustekinumab ,medicine ,Humans ,Registries ,Aged ,Tumor Necrosis Factor-alpha ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Methotrexate ,Case-Control Studies ,030220 oncology & carcinogenesis ,Nested case-control study ,Female ,Observational study ,Dermatologic Agents ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background The effects of systemic therapy on mortality risk among patients with psoriasis are not fully understood. Objective To evaluate the impact of systemic treatment on mortality risk in patients enrolled in the Psoriasis Longitudinal Assessment and Registry. Methods Nested case-control analyses were performed to estimate mortality risk. Cases were defined as patients who died while participating in the Psoriasis Longitudinal Assessment and Registry. Cases were matched (1:4) with controls by age, race, sex, and geographic region. Evaluated treatments included methotrexate, ustekinumab, and tumor necrosis factor α inhibitors. Exposure was defined as at least 1 dose of treatment within 3 months before death and was stratified by duration of therapy. Results Among 12,090 patients, 341 deaths occurred, matched to 1364 controls. Biologic treatment within the preceding 3 months was protective against mortality versus no exposure: odds ratio (OR) for exposure of less than 1 year, 0.08 (95% confidence interval [CI], 0.03-0.23); OR for exposure of 1 year or longer, 0.09 (95% CI, 0.06-0.13). Methotrexate was protective against mortality only with exposure for 1 year or longer (OR, 0.08; 95% CI, 0.02-0.28). Limitations Observational studies are subject to unmeasured confounding. Conclusions Biologic therapy was associated with reduced mortality risk in patients with moderate to severe psoriasis, regardless of treatment duration; methotrexate reduced risk only with exposure for 1 year or longer.
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- 2021
12. Long‐term efficacy of certolizumab pegol for the treatment of plaque psoriasis: 3‐year results from two randomized phase III trials (CIMPASI‐1 and CIMPASI‐2)
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F Brock, Yves Poulin, Alice B. Gottlieb, Richard B. Warren, Andrew Blauvelt, M Boehnlein, C. Leonardi, Kenneth B. Gordon, Kristian Reich, Diamant Thaçi, and C Ecoffet
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Adult ,medicine.medical_specialty ,Phase iii trials ,Dermatology ,Placebo ,Severity of Illness Index ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Psoriasis Area and Severity Index ,law ,Internal medicine ,Psoriasis ,Severity of illness ,Humans ,Medicine ,Certolizumab pegol ,Tumor Necrosis Factor-alpha ,business.industry ,medicine.disease ,humanities ,Clinical trial ,Treatment Outcome ,Certolizumab Pegol ,business ,medicine.drug - Abstract
Background Certolizumab pegol (CZP) is an Fc-free, PEGylated anti-tumour necrosis factor biologic. Objectives To report the 3-year efficacy of CZP in plaque psoriasis, pooled from the CIMPASI-1 (NCT02326298) and CIMPASI-2 (NCT02326272) phase III trials. Methods Adults with moderate-to-severe psoriasis for ≥ 6 months were randomized 2 : 2 : 1 to CZP 200 mg, CZP 400 mg or placebo, every 2 weeks (Q2W) for up to 48 weeks. Patients entering the open-label period (weeks 48-144) from double-blinded CZP initially received CZP 200 mg Q2W. Patients not achieving ≥ 50% improvement in Psoriasis Area and Severity Index (PASI 50) at week 16 entered an open-label CZP 400 mg Q2W escape arm (weeks 16-144). Dose adjustments based on PASI response were permitted during open-label treatment. Outcomes included PASI 75, PASI 90 and Physician's Global Assessment (PGA) 0/1 responder rates, based on a logistic regression model (missing data imputed using Markov Chain Monte Carlo methodology). Results In total, 186 patients were randomized to CZP 200 mg Q2W and 175 to CZP 400 mg Q2W. At week 48, PASI 75/90 was achieved by 72·7%/51·3% of patients randomized to CZP 200 mg and 84·4%/62·7% randomized to CZP 400 mg. Patients entering the open-label period at week 48, from blinded treatment, received CZP 200 mg Q2W. At week 144, PASI 75/90 was achieved by 70·6%/48·7% patients randomized to CZP 200 mg and 72·9%/42·7% randomized to CZP 400 mg. At week 16, 72 placebo-randomized patients entered the CZP 400 mg Q2W escape arm; 75.7%/58.5% achieved PASI 75/90 at week 144. Conclusions Both CZP 200 mg and 400 mg Q2W demonstrated sustained, durable efficacy, with numerically higher responses for some outcomes with 400 mg Q2W.
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- 2020
13. Efficacy and safety of risankizumab vs. secukinumab in patients with moderate‐to‐severe plaque psoriasis (IMMerge): results from a phase III, randomized, open‐label, efficacy–assessor‐blinded clinical trial*
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T Wu, Ziqian Geng, Richard B. Warren, Carle Paul, S Beeck, M Kelly, Yves Poulin, and Andrew Blauvelt
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medicine.medical_specialty ,Dermatology ,Antibodies, Monoclonal, Humanized ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Psoriasis Area and Severity Index ,law ,Internal medicine ,Severity of illness ,medicine ,Humans ,Psoriasis ,Dosing ,Skin ,Risankizumab ,business.industry ,Antibodies, Monoclonal ,Original Articles ,Clinical Trial ,Confidence interval ,Clinical trial ,Secukinumab ,business - Abstract
Summary Background Patients with plaque psoriasis treated with biologic therapies need more efficacious, safe and convenient treatments to improve quality of life. Risankizumab and secukinumab inhibit interleukin‐23 and interleukin‐17A, respectively, and are effective in adult patients with moderate‐to‐severe plaque psoriasis but have different dosing regimens. Objectives To compare directly the efficacy and safety of risankizumab vs. secukinumab over 52 weeks. Methods IMMerge was an international, phase III, multicentre, open‐label, efficacy–assessor‐blinded, active‐comparator study, in which adult patients with chronic, moderate‐to‐severe plaque psoriasis were randomized in a 1 : 1 ratio to treatment with risankizumab 150 mg or secukinumab 300 mg. Primary efficacy endpoints were the proportions of patients achieving ≥ 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) at week 16 (noninferiority comparison with margin of 12%) and week 52 (superiority comparison). Results In total 327 patients from nine countries were treated with risankizumab (n = 164) or secukinumab (n = 163). Risankizumab was noninferior to secukinumab in the proportion of patients achieving PASI 90 at week 16 [73·8% vs. 65·6%; difference of 8·2%, 96·25% confidence interval (CI)−2·2 to 18·6; within the 12% noninferiority margin] and superior to secukinumab at week 52 (86·6% vs. 57·1%; difference of 29·8%, 95% CI 20·8–38·8; P < 0·001), thus meeting both primary endpoints. All secondary endpoints (PASI 100, static Physician's Global Assessment 0 or 1, and PASI 75) at week 52 demonstrated superiority for risankizumab vs. secukinumab (P < 0·001). No new safety concerns were identified. Conclusions At week 52, risankizumab demonstrated superior efficacy and similar safety with less frequent dosing compared with secukinumab., What is already known about this topic? The need remains for treatments with sustained efficacy and a more convenient dosing schedule in moderate‐to‐severe psoriasis.Risankizumab and secukinumab are indicated for the treatment of adults with moderate‐to‐severe plaque psoriasis and target interleukin‐23 and interleukin‐17, respectively.To date, risankizumab and secukinumab have not been directly compared. What does this study add? IMMerge directly compared the safety and efficacy of risankizumab and secukinumab in patients with moderate‐to‐severe plaque psoriasis using ≥ 90% improvement in Psoriasis Area and Severity Index at weeks 16 (noninferiority) and 52 (superiority) as primary endpoints.In terms of efficacy risankizumab was noninferior to secukinumab at week 16 and superior to secukinumab at week 52 of treatment based on primary endpoint analyses. The two medications had a similar safety profile. Linked Comment: Schmitt-Egenolf. Br J Dermatol 2021; 184: 3–4. Plain language summary available online
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- 2020
14. Real-World Experience With Apremilast in the Treatment of Adults With Moderate to Severe Plaque Psoriasis in Québec: A Claims-Based Analysis of Drug Utilization and Healthcare Resource Utilization
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Yves Poulin, Fei Fei Liu, Catherine Beauchemin, Anne-Julie Gaudreau, Clarabella Yim, Jean Lachaine, and Catherine Royer
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Adult ,Male ,Moderate to severe ,Drug Utilization ,medicine.medical_specialty ,Dermatology ,Insurance Claim Review ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Psoriasis ,Medicine ,Intensive care medicine ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,Plaque psoriasis ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Biologic therapies ,Quebec ,Middle Aged ,Patient Acceptance of Health Care ,Thalidomide ,Female ,Surgery ,Apremilast ,business ,Resource utilization ,medicine.drug - Abstract
Background In Québec, targeted biologic therapies for moderate to severe plaque psoriasis are restricted to patients who have not responded to phototherapy or conventional systemic treatment, primarily due to high drug costs. Apremilast, an oral treatment for plaque psoriasis, was added to the Québec provincial health insurance plan (Régie de l’assurance maladie du Québec; RAMQ) formulary in 2015, making this the only province in Canada with public drug plan reimbursement for apremilast. Objectives The aim of this study is to describe patients’ characteristics, treatment patterns, healthcare resource utilization (HCRU), and associated costs and to measure real-world budget impact of using apremilast before biologics in plaque psoriasis. Methods This study was performed using RAMQ drug claims and medical services data. Patients diagnosed with psoriasis between January 2015 and December 2017 were identified. Medical services and prescription claims were categorized as all-cause and psoriasis-related. Using RAMQ database estimates, a 3-year budget impact analysis was developed comparing treatment cost with and without the addition of apremilast to the formulary. Results In all, 540 patients were identified (apremilast: n = 92; biologics: n = 448). Comorbidity burden and treatment persistence and adherence were comparable between apremilast and biologic users. The year following the index date, all-cause HCRU was lower for apremilast versus biologic users (CAN$19 763 vs CAN$28 025; P < .01), mainly driven by drug cost. Using apremilast before biologics resulted in an estimated RAMQ net savings of CAN$49 290 (2015), CAN$746 856 (2016), and CAN$1 216 512 (2017), and a total savings of CAN$2 012 658 since apremilast’s addition to the formulary. Conclusion Adding apremilast to the drug formulary of other Canadian provinces could result in significant healthcare savings.
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- 2020
15. Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper
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Melinda Gooderham, Perla Lansang, Jensen Yeung, Irina Turchin, Kim A. Papp, Ronald Vender, Yves Poulin, Chih-Ho Hong, and Parbeer Grewal
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Adult ,medicine.medical_specialty ,Consensus ,Reproductive age ,Dermatology ,Chronic inflammatory disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Psoriasis ,Internal medicine ,medicine ,Humans ,Maternal-Fetal Exchange ,Skin ,030203 arthritis & rheumatology ,Plaque psoriasis ,business.industry ,Biologic therapies ,Antibodies, Monoclonal ,medicine.disease ,Biological Therapy ,Pregnancy Complications ,Practice Guidelines as Topic ,Child bearing ,Female ,Surgery ,Patient Safety ,business ,Dermatologists - Abstract
Background Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. Objectives To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. Methods A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. Results and implications After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.
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- 2020
16. Phase 2B randomized study of nemolizumab in adults with moderate-to-severe atopic dermatitis and severe pruritus
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Jean-David Bouaziz, Grazyna Pulka, Jonathan I. Silverberg, Andreas Pinter, Andreas Wollenberg, Dedee F. Murrell, Christophe Piketty, Alan Clucas, Yves Poulin, Lisa Lindsey, Andrew F Alexis, and Faiz Ahmad
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Time Factors ,Nemolizumab ,Adolescent ,Immunology ,anti–IL-31 receptor ,Antibodies, Monoclonal, Humanized ,Placebo ,Severity of Illness Index ,Eczema Area and Severity Index ,Gastroenterology ,Dermatitis, Atopic ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Dosing ,Aged ,Aged, 80 and over ,humanized mAb ,Intention-to-treat analysis ,atopic dermatitis ,business.industry ,Pruritus ,Atopic dermatitis ,Dermatology Life Quality Index ,Middle Aged ,medicine.disease ,030104 developmental biology ,Female ,business - Abstract
Background: Nemolizumab targets the IL-31 receptor a subunit involved in atopic dermatitis (AD) pathogenesis. Objective: We sought to evaluate a new dosing strategy of nemolizumab in patients with AD. Methods: We performed a 24-week, randomized, double-blind, multicenter study of nemolizumab (10, 30, and 90 mg) subcutaneous injections every 4 weeks versus placebo, with topical corticosteroids in adults with moderate-to-severe AD, severe pruritus, and inadequate control with topical treatment (n 5 226). The Eczema Area and Severity Index (EASI), the peak pruritus (PP) numeric rating scale (NRS), and the Investigator’s Global Assessment (IGA) were assessed. Standard safety assessments were performed. Results: Nemolizumab improved EASI, IGA, and/or NRS-itch scores, with the 30-mg dose being most effective. Nemolizumab (30 mg) reduced EASI scores versus placebo at week 24 (268.8% vs 252.1%, P 5 .016); significant differences were observed by week 8 (P _4-point decrease) were greater for 30 mg of nemolizumab versus placebo at week 16 (P
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- 2020
17. Serious infections in patients with self-reported psoriatic arthritis from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) treated with biologics
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Mona Ståhle, Bhaskar Srivastava, Soumya D. Chakravarty, S. Kafka, Wayne Langholff, Christopher T. Ritchlin, Alice B. Gottlieb, Yves Poulin, and Jerry Bagel
- Subjects
0301 basic medicine ,musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Population ,PSOLAR ,Etanercept ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Psoriasis ,Internal medicine ,Ustekinumab ,medicine ,Adalimumab ,education ,skin and connective tissue diseases ,030203 arthritis & rheumatology ,education.field_of_study ,Serious infections ,business.industry ,medicine.disease ,Infliximab ,030104 developmental biology ,lcsh:RC925-935 ,business ,Research Article ,medicine.drug - Abstract
Background Patients with psoriatic arthritis (PsA) have increased risk of adverse events, including serious infections (SI), compared with psoriasis patients. Methods Patients eligible for, or receiving conventional systemic and biologic agents for psoriasis were followed prospectively using PSOLAR. Cohorts included: ustekinumab, tumor necrosis factor (TNF) inhibitors; infliximab; etanercept; adalimumab; non-biologic/methotrexate (MTX) (reference group); and non-biologic/non-MTX. Multivariate analyses using Cox hazard regression were used to identify factors associated with time to first SI. Rates of SI in PSOLAR psoriasis patients with self-reported PsA and possible risks with biologic therapy were evaluated. Results PSOLAR enrolled 4315 psoriasis patients with self-reported PsA. The overall population (N = 2401) included patients (n): 628 ustekinumab; 1413 TNF inhibitors; 258 infliximab; 481 etanercept; 674 adalimumab; 54 other biologics, 98 non-biologic/MTX; 208 non-biologic/non-MTX. Overall, 138 SI were reported with incidence rates per 100 patient-years as follows: a) ustekinumab: 1.00; b) TNF inhibitors: 2.22; c) infliximab: 2.12; d) etanercept: 2.58; e) adalimumab: 1.99; f) non-biologic/MTX: 3.01; g) and non-biologic/non-MTX: 2.31. Age, time-dependent disease activity Physician’s Global Assessment (PGA) of 4, 5, history of infection, and diabetes were associated with increased risk for SI (p Conclusions PSOLAR psoriasis patients with self-reported PsA in the TNF inhibitors, infliximab, adalimumab, etanercept, and MTX cohorts had numerically higher SI rates than the ustekinumab cohort, although not statistically significant. Age, PGA 4, 5, history of infection, and diabetes were associated with an increased risk for SI, irrespective of biologic exposure. Trial registration NCT00508547; Registered July 30, 2007.
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- 2019
18. Deucravacitinib, an oral, selective tyrosine kinase 2 inhibitor, versus placebo and apremilast in moderate to severe plaque psoriasis: analysis of body surface area involvement in the phase 3 POETYK PSO-1 and PSO-2 trials
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Jo Lambert, Carle Paul, Alice Gottlieb, and Yves Poulin
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Dermatology - Abstract
N/A
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- 2022
19. A Review of the Efficacy and Safety for Biologic Agents Targeting IL-23 in Treating Psoriasis With the Focus on Tildrakizumab
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Marni C. Wiseman, Marc Bourcier, Leon H Kircik, Ivan V. Litvinov, Ronald Vender, Charles Lynde, Yves Poulin, Feras M. Ghazawi, and Farhan Mahmood
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Medicine (General) ,Tildrakizumab ,Disease ,Review ,risankizumab ,Bioinformatics ,ustekinumab ,Pathogenesis ,R5-920 ,IL-23 ,Psoriasis ,Ustekinumab ,tildrakizumab ,Interleukin 23 ,Medicine ,mirikizumab ,Risankizumab ,treatment ,business.industry ,General Medicine ,medicine.disease ,guselkumab ,Guselkumab ,psoriais ,business ,medicine.drug - Abstract
Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth.
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- 2021
20. Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders
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Yves Poulin, Charles Lynde, and Lyn Guenther
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medicine.medical_specialty ,Administration, Topical ,Calcineurin Inhibitors ,Dermatology ,Vitiligo ,Lichen sclerosus ,Skin Diseases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Pimecrolimus ,0302 clinical medicine ,Seborrheic dermatitis ,Psoriasis ,medicine ,Humans ,skin and connective tissue diseases ,integumentary system ,business.industry ,Off-Label Use ,medicine.disease ,Tacrolimus ,Calcineurin ,030220 oncology & carcinogenesis ,Surgery ,Oral lichen planus ,business ,medicine.drug - Abstract
Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.
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- 2019
21. Adalimumab for nail psoriasis: efficacy and safety over 52 weeks from a phase‐3, randomized, placebo‐controlled trial
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B. Calimlim, Jeffrey J. Crowley, Phoebe Rich, Ziqian Geng, O. Reyes Servin, Yves Poulin, C.S. Baker, Martin M. Okun, and Boni E. Elewski
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Population ,Placebo-controlled study ,Dermatology ,Placebo ,Severity of Illness Index ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Nail Diseases ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,Psoriasis ,medicine ,Adalimumab ,Humans ,education ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,Clinical trial ,Infectious Diseases ,Treatment Outcome ,Nails ,Nail disease ,Original Article ,Female ,business ,medicine.drug - Abstract
Background Few clinical trials have evaluated long‐term treatment of nail psoriasis with biologics. Objective Safety and efficacy of adalimumab [ADA; Humira AbbVie Inc, North Chicago, IL, USA)] long‐term treatment (52 weeks) was evaluated in a phase‐3, randomized trial in patients with moderate‐to‐severe plaque psoriasis and concomitant moderate‐to‐severe fingernail psoriasis. Results from the first 26 weeks (Period A) have been reported. Methods Patients receiving 40 mg ADA every other week or placebo in Period A, continued with or switched to 40 mg ADA every‐other‐week treatment in the subsequent 26‐week open‐label extension (OLE) period. Main efficacy evaluations were ≥75% improvement in total‐fingernail modified Nail Psoriasis Severity Index (mNAPSI 75) and achievement of Physician's Global Assessment for Fingernail Psoriasis of clear or minimal disease (PGA‐F 0/1) with a ≥2‐grade improvement from baseline, across the trial for patients who continued ADA from Period A through the OLE (Continuous‐ADA Population). Safety was evaluated during the OLE and for patients receiving ADA at any time during the study (All‐ADA Population). Results Of the 217 patients initially randomized in Period A, 188 (86.6%; 94 in each treatment group) entered the OLE after completion of or early escape from Period A. For the Continuous‐ADA Population (N = 109), endpoint achievement rates improved from OLE entry (Week 26) to Week 52, including total‐fingernail mNAPSI 75 (47.4–54.5%); PGA‐F 0/1 (51.1–55.6%) and total‐fingernail mNAPSI = 0 (6.6–17.9%). Serious adverse event and serious infection rates for the All‐ADA Population (N = 203) were 6.9% and 3.4%, respectively. Conclusions In this population of psoriasis patients with concomitant, moderate‐to‐severe nail psoriasis, long‐term efficacy and improvement in signs and symptoms of nail disease were demonstrated after every‐other‐week ADA treatment, including incremental improvements in rate of total clearance of nail disease. No new safety risks were identified for patients receiving at least one ADA dose across 52 weeks., Linked Commentary: D. Rigopoulos. J Eur Acad Dermatol Venereol 2019; 33: 2014–2015. https://doi.org/10.1111/jdv.15988.
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- 2019
22. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations
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Alexa B. Kimball, Alain Brassard, Yves Poulin, Tara Jaleel, Dennis P. Orgill, Robert G. Micheletti, Paul G. Hazen, Craig N. Burkhart, Angela Miller, Alice B. Gottlieb, Joslyn S. Kirby, Christopher Sayed, Michelle A. Lowes, Daniel B. Eisen, Karen Crowell, Afsaneh Alavi, Raed Alhusayen, Iltefat H. Hamzavi, Haley B. Naik, and Ali Alikhan
- Subjects
medicine.medical_specialty ,MEDLINE ,Disease ,Dermatology ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Health care ,medicine ,Adalimumab ,Hidradenitis suppurativa ,Intensive care medicine ,Surgical approach ,business.industry ,Dermatology Life Quality Index ,Guideline ,Evidence-based medicine ,medicine.disease ,Comorbidity ,Infliximab ,030220 oncology & carcinogenesis ,business ,medicine.drug - Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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- 2019
23. A Phase 2 Randomized Trial of Apremilast in Patients with Atopic Dermatitis
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Eric L. Simpson, Kunal Malik, Nilam Shah, Xiangyu Peng, Benjamin Ungar, Ana B. Pavel, Yves Poulin, Hui Xu, Lisa Zhou, Yeriel Estrada, Kristine E. Nograles, Mayte Suárez-Fariñas, Shinichi Imafuku, Mindy Chen, Emma Guttman-Yassky, and Huei Chi Wen
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Administration, Oral ,Dermatology ,Placebo ,Risk Assessment ,Severity of Illness Index ,Biochemistry ,Eczema Area and Severity Index ,Drug Administration Schedule ,Dermatitis, Atopic ,law.invention ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Double-Blind Method ,Japan ,Randomized controlled trial ,law ,Internal medicine ,Severity of illness ,medicine ,Humans ,Adverse effect ,Molecular Biology ,Analysis of Variance ,Dose-Response Relationship, Drug ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Age Factors ,Cell Biology ,Atopic dermatitis ,Middle Aged ,medicine.disease ,Thalidomide ,Treatment Outcome ,030104 developmental biology ,030220 oncology & carcinogenesis ,Pharmacodynamics ,North America ,Female ,Apremilast ,business ,Follow-Up Studies ,medicine.drug - Abstract
A phase 2, double-blind, placebo-controlled trial evaluated apremilast efficacy, safety, and pharmacodynamics in adults with moderate to severe atopic dermatitis. Patients were randomly assigned to receive placebo, apremilast 30 mg twice daily (APR30), or apremilast 40 mg twice daily (APR40) for 12 weeks. During weeks 12-24, all patients received APR30 or APR40. A biopsy substudy evaluated atopic dermatitis-related biomarkers. Among 185 randomly assigned intent-to-treat patients at week 12, a dose-response relationship was observed; APR40 (n = 63), but not APR30 (n = 58), led to statistically significant improvements (vs. placebo, n = 64) in Eczema Area and Severity Index (mean [standard deviation] percent change from baseline = -31.6% [44.6] vs. -11.0% [71.2], P 0.04; primary endpoint). mRNA expression of T helper type 17/T helper type 22-related markers (IL-17A, IL-22, and S100A7/A8; P0.05) showed the highest reductions with APR40, with minimal changes in other immune axes. Safety with APR30 was largely consistent with apremilast's known profile (common adverse events: nausea, diarrhea, headache, and nasopharyngitis). With APR40, adverse events were more frequent, and cellulitis occurred (n = 6). An independent safety monitoring committee discontinued the APR40 dosage. APR40 showed modest efficacy and decreased atopic dermatitis-related biomarkers in moderate to severe atopic dermatitis patients. Adverse events, including cellulitis, were more frequent with APR40, which was discontinued during the trial. Clinical Trial Registration Number: NCT02087943 (clinicaltrials.gov).
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- 2019
24. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section V: Consensus Statements on the Assessment and Management of Adult Patients With Moderate-to-Severe Atopic Dermatitis
- Author
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Robert Bissonnette, Parbeer Grewal, Gordon Sussman, Perla Lansang, Jensen Yeung, Mark G. Kirchhof, Kim A. Papp, C Lynde, Robert Gniadecki, Marni C. Wiseman, Lorne Albrecht, Ian Landells, Irina Turchin, Melinda Gooderham, Yves Poulin, Chih-Ho Hong, and Gurbir Dhadwal
- Subjects
Adult ,Moderate to severe ,Document section ,medicine.medical_specialty ,Consensus ,Adult patients ,business.industry ,Treatment options ,Comorbidity ,Dermatology ,Atopic dermatitis ,medicine.disease ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Health care ,medicine ,Humans ,Surgery ,business ,Intensive care medicine ,Adult atopic dermatitis - Abstract
This document is a concise, current, and practical guide for dermatologists and other health care providers managing adult patients with moderate-to-severe atopic dermatitis (AD). The recommendations made here are based on a consensus of specialists with extensive experience managing patients with AD. Topics reviewed in this publication include AD pathophysiology, assessment, comorbidities, and treatment options.
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- 2018
25. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section IV: Treatment Options for the Management of Atopic Dermatitis
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Yves Poulin, Jensen Yeung, Robert Gniadecki, Chih-Ho Hong, Gurbir Dhadwal, Melinda Gooderham, and Lorne Albrecht
- Subjects
Adult ,Document section ,medicine.medical_specialty ,Consensus ,Dermatology ,Administration, Cutaneous ,Systemic therapy ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,030212 general & internal medicine ,Skin barrier function ,Emollients ,integumentary system ,Adult patients ,business.industry ,Treatment options ,Atopic dermatitis ,Phototherapy ,medicine.disease ,Quality of Life ,Surgery ,business - Abstract
The objectives of therapy for atopic dermatitis (AD) are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL). Treatments can be classified as moisturizing and basic care, topical therapy, phototherapy, and systemic therapy. In this review, we summarize the treatments for AD and recommendations for their use.
- Published
- 2018
26. Tralokinumab for moderate‐to‐severe atopic dermatitis: results from two 52‐week, randomized, double‐blind, multicentre, placebo‐controlled phase III trials (ECZTRA 1 and ECZTRA 2)
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A. Lesiak, Louise Abildgaard Steffensen, Yves Poulin, Ketty Peris, Andrew Blauvelt, Pedro Herranz, Hidehisa Saeki, Leon H Kircik, A. Wollenberg, Lynda Spelman, Jean-Philippe Lacour, Eric L. Simpson, T.N. Jensen, Michael J. Cork, E. Guttman-Yassky, S.H. Cho, Alexandra Kuznetsova, C Lynde, M.L. Østerdal, Norito Katoh, Bo Bang, and M. Worm
- Subjects
Adult ,medicine.medical_specialty ,Phase iii trials ,tralokinumab ,Eczema ,Dermatology ,Placebo ,Severity of Illness Index ,Dermatitis, Atopic ,law.invention ,Double blind ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,Severity of illness ,medicine ,Humans ,Clinical Trials ,atopic dermatitis ,business.industry ,Antibodies, Monoclonal ,Atopic dermatitis ,Original Articles ,medicine.disease ,Clinical Trial ,Clinical trial ,Treatment Outcome ,business ,Settore MED/35 - MALATTIE CUTANEE E VENEREE ,Tralokinumab - Abstract
Summary Background Tralokinumab, a fully human monoclonal antibody, specifically neutralizes interleukin‐13, a key cytokine driving peripheral inflammation in atopic dermatitis (AD). In phase II studies, tralokinumab combined with topical corticosteroids provided early and sustained improvements in AD signs and symptoms. Objectives To evaluate the efficacy and safety of tralokinumab monotherapy in adults with moderate‐to‐severe AD who had an inadequate response to topical treatments. Methods In two 52‐week, randomized, double‐blind, placebo‐controlled, phase III trials, ECZTRA 1 and ECZTRA 2, adults with moderate‐to‐severe AD were randomized (3 : 1) to subcutaneous tralokinumab 300 mg every 2 weeks (Q2W) or placebo. Primary endpoints were Investigator’s Global Assessment (IGA) score of 0 or 1 at week 16 and ≥ 75% improvement in Eczema Area and Severity Index (EASI 75) at week 16. Patients achieving an IGA score of 0 or 1 and/or EASI 75 with tralokinumab at week 16 were rerandomized to tralokinumab Q2W or every 4 weeks or placebo, for 36 weeks. The trials were registered with ClinicalTrials.gov: NCT03131648 and NCT03160885. Results At week 16, more patients who received tralokinumab vs. placebo achieved an IGA score of 0 or 1: 15·8% vs. 7·1% in ECZTRA 1 [difference 8·6%, 95% confidence interval (CI) 4·1–13·1; P = 0·002] and 22·2% vs. 10·9% in ECZTRA 2 (11·1%, 95% CI 5·8–16·4; P, What is already known about this topic? Atopic dermatitis (AD) is a chronic interleukin (IL)‐13‐mediated disease.There is a need for safe and effective long‐term treatment options for AD.Tralokinumab is a fully human monoclonal antibody that binds specifically to IL‐13 with high affinity, thereby preventing receptor interaction and subsequent downstream signalling.Tralokinumab combined with topical corticosteroids showed early and sustained efficacy and safety in a 12‐week, phase IIb trial in moderate‐to‐severe AD. What does this study add? These are the first pivotal phase III trials demonstrating that by specifically targeting IL‐13 alone, patients can achieve significant improvements in AD signs and symptoms and quality of life, and maintain these improvements over time without the requirement for topical corticosteroids.These trials provide evidence that tralokinumab offers a long‐term, well‐tolerated treatment option for patients with moderate‐to‐severe AD. Linked Comment: Morra and Drucker. Br J Dermatol 2021; 184:386–387. Plain language summary available online
- Published
- 2021
27. La gestion de projets de développement international et d’action humanitaire 2e édition
- Author
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Sophie Brière, Yvan Conoir, Yves Poulin, Stéphanie Maltais, and Isabelle Auclair
- Abstract
Concu dans une approche de gestion, cet ouvrage repertorie et documente toutes les etapes du cycle de vie d’un projet de developpement international ou d’action humanitaire. Ce guide propose une demarche rigoureuse qui permet a la fois d’integrer une vision complete et actuelle des concepts, methodes et outils d’application en matiere de gestion de projets et d’aborder de facon simultanee le developpement international et l’action humanitaire. L’accent a volontairement ete mis sur les competences et les roles des personnes qui proposent des projets, les gerent, en assurent le suivi ou en font l’evaluation. Cet ouvrage est une source d’enrichissement pour la formation et pour la pratique professionnelle des personnes qui veulent s’engager dans l’action humanitaire et le developpement international.
- Published
- 2021
28. Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond
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Melinda Gooderham, Jennifer Beecker, Catherine Maari, Lluís Puig, Mark G. Kirchhof, Chi-Ho Hong, Ronald Vender, Paolo Gisondi, Robert Gniadecki, Yves Poulin, Jan P. Dutz, C Lynde, C Cooper, and Kim Papp
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,viruses ,Guidelines and Position Statements ,Dermatitis ,Dermatology ,Risk Assessment ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Epidemiology ,Pandemic ,Humans ,Medicine ,Practice Patterns, Physicians' ,Position Statement ,Intensive care medicine ,skin and connective tissue diseases ,business.industry ,fungi ,COVID-19 ,Immunotherapy ,030104 developmental biology ,Infectious Diseases ,Position paper ,business ,Risk assessment - Abstract
Coronavirus disease 2019 (COVID‐19) is caused by SARS‐CoV‐2, a novel RNA virus that was declared a global pandemic on 11 March 2020. The efficiency of infection with SARS‐CoV‐2 is reflected by its rapid global spread. The SARS‐CoV‐2 pandemic has implications for patients with inflammatory skin diseases on systemic immunotherapy who may be at increased risk of infection or more severe infection. This position paper is a focused examination of current evidence considering the mechanisms of action of immunotherapeutic drugs in relation to immune response to SARS‐CoV‐2. We aim to provide practical guidance for dermatologists managing patients with inflammatory skin conditions on systemic therapies during the current pandemic and beyond. Considering the limited and rapidly evolving evidence, mechanisms of action of therapies, and current knowledge of SARS‐CoV‐2 infection, we propose that systemic immunotherapy can be continued, with special considerations for at risk patients or those presenting with symptoms.
- Published
- 2021
29. Disease activity and treatment efficacy using patient-level Psoriasis Area and Severity Index scores from tildrakizumab phase 3 clinical trials
- Author
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F T Murphy, Alan M. Mendelsohn, Paul S. Yamauchi, Charles N. Ellis, Jeffrey J. Crowley, Stephen J. Rozzo, Lynda Spelman, Kenneth B. Gordon, Kristian Reich, Neil J. Korman, Yves Poulin, and J. Parno
- Subjects
030203 arthritis & rheumatology ,Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Tildrakizumab ,Dermatology ,Disease ,medicine.disease ,Antibodies, Monoclonal, Humanized ,Severity of Illness Index ,Treatment efficacy ,Clinical trial ,Disease activity ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,Psoriasis Area and Severity Index ,Psoriasis ,Internal medicine ,medicine ,Humans ,business - Abstract
It is unclear whether primary efficacy outcomes in plaque psoriasis clinical trials represent residual disease during treatment.To evaluate supplementing dichotomous efficacy with residual disease activity.This post hoc analysis used pooled, patient-level data after tildrakizumab 100 mg (Median baseline Psoriasis Area and Severity Index (PASI) was 17.9 for patients receiving tildrakizumab 100 mg. At Week 12, median PASI was 2.9, whereas dichotomous PASI 90 response rate was 36.9%, and absolute PASI5.0,3.0, and1.0 were 64.0%, 50.8%, and 23.3%, respectively. At Week 28, median PASI was 1.7, whereas PASI 90 response rate was 51.9%, and absolute PASI5.0,3.0, and1.0 were 75.3%, 62.8%, and 38.0%, respectively. Dermatology Life Quality Index and PASI scores were correlated through Week 28 (Disease activity was more reliably estimated by PASI scores than percentage PASI improvement; this may partially explain efficacy disparities between clinical trials and practice. These results suggest supplementing dichotomous PASI improvement with PASI scores and consideration of patient treatment goals could facilitate clinical decisions.
- Published
- 2020
30. Ixekizumab Results in Persistent Clinical Improvement in Moderate-to-Severe Genital Psoriasis During a 52 Week, Randomized, Placebo-Controlled, Phase 3 Clinical Trial
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Yves Poulin, Alison Potts Bleakman, Lyn Guenther, Lynda Spelman, Russel Burge, J. Erickson, Jamie Weisman, Clinton C Bertram, Caitriona Ryan, and Kristin Todd
- Subjects
Adult ,Male ,Moderate to severe ,medicine.medical_specialty ,Phases of clinical research ,sexual impact ,Dermatology ,Antibodies, Monoclonal, Humanized ,Placebo ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,ixekizumab ,Psoriasis ,lcsh:Dermatology ,Humans ,Medicine ,Sex organ ,In patient ,Genitalia ,itch ,ixora-q ,business.industry ,genital psoriasis ,clinical trial ,General Medicine ,lcsh:RL1-803 ,medicine.disease ,Clinical trial ,Ixekizumab ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Dermatologic Agents ,business - Abstract
Ixekizumab was efficacious in treating moderate-to-severe genital psoriasis over 12 weeks. We evaluated the long-term efficacy and safety of ixekizumab for up to 52 weeks. Patients were randomized to 80 mg ixekizumab every 2 weeks or to placebo through Week 12, then received 80 mg open-label ixekizumab every 4 weeks through Week 52. In patients initially randomized to ixekizumab, clear or almost clear genital skin was achieved for 73% of patients at Week 12 and 75% at Week 52. Persistent improvements were also observed for overall psoriasis, genital itch, and the impact of genital psoriasis on the frequency of sexual activity. The safety profile was consistent with studies of ixekizumab in patients with moderate-to-severe plaque psoriasis. Ixekizumab provided rapid and persistent improvements in the signs and symptoms of genital psoriasis for up to 52 weeks of treatment.
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- 2020
31. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials
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Mary Flack, Andrew Blauvelt, Howard Sofen, Yves Poulin, Elizabeth H.Z. Thompson, Joaquin Mario Valdes, Lluís Puig, Kim A. Papp, Matthias Augustin, Ziqian Geng, Bruce Strober, Kenneth B. Gordon, Peter Foley, Yihua Gu, Mark Lebwohl, Hervé Bachelez, and Mamitaro Ohtsuki
- Subjects
Adult ,Male ,medicine.medical_specialty ,Injections, Subcutaneous ,Tildrakizumab ,Population ,Placebo ,Severity of Illness Index ,law.invention ,Placebos ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,Psoriasis ,Ustekinumab ,medicine ,Humans ,education ,education.field_of_study ,Risankizumab ,Tumor Necrosis Factor-alpha ,business.industry ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,medicine.disease ,Interleukin-12 ,Treatment Outcome ,Guselkumab ,Immunoglobulin G ,030220 oncology & carcinogenesis ,Interleukin-23 Subunit p19 ,Female ,Dermatologic Agents ,business ,medicine.drug - Abstract
Background Risankizumab is a humanised IgG1 monoclonal antibody that binds to the p19 subunit of interleukin-23, inhibiting this key cytokine and its role in psoriatic inflammation. We aimed to assess the efficacy and safety of risankizumab compared with placebo or ustekinumab in patients with moderate-to-severe chronic plaque psoriasis. Methods UltIMMa-1 and UltIMMa-2 were replicate phase 3, randomised, double-blind, placebo-controlled and active comparator-controlled trials done at 139 sites in Australia, Austria, Belgium, Canada, Czech Republic, France, Germany, Japan, Mexico, Poland, Portugal, South Korea, Spain, and the USA. Eligible patients were 18 years or older, with moderate-to-severe chronic plaque psoriasis. In each study, patients were stratified by weight and previous exposure to tumour necrosis factor inhibitor and randomly assigned (3:1:1) by use of interactive response technology to receive 150 mg risankizumab, 45 mg or 90 mg ustekinumab (weight-based per label), or placebo. Following the 16-week double-blind treatment period (part A), patients initially assigned to placebo switched to 150 mg risankizumab at week 16; other patients continued their originally randomised treatment (part B, double-blind, weeks 16-52). Study drug was administered subcutaneously at weeks 0 and 4 during part A and at weeks 16, 28, and 40 during part B. Co-primary endpoints were proportions of patients achieving a 90% improvement in the Psoriasis Area Severity Index (PASI 90) and a static Physician's Global Assessment (sPGA) score of 0 or 1 at week 16 (non-responder imputation). All efficacy analyses were done in the intention-to-treat population. These trials are registered with ClinicalTrials.gov, numbers NCT02684370 (UltIMMa-1) and NCT02684357 (UltIMMa-2), and have been completed. Findings Between Feb 24, 2016, and Aug 31, 2016, 506 patients in UltIMMa-1 were randomly assigned to receive 150 mg risankizumab (n= 304), 45 mg or 90 mg ustekinumab (n= 100), or placebo (n= 102). Between March 1, 2016, and Aug 30, 2016, 491 patients in UltIMMa-2 were randomly assigned to receive 150 mg risankizumab (n= 294), 45 mg or 90 mg ustekinumab (n= 99), or placebo (n= 98). Co-primary endpoints were met for both studies. At week 16 of UltIMMa-1, PASI 90 was achieved by 229 (75.3%) patients receiving risankizumab versus five (4.9%) receiving placebo (placebo-adjusted difference 70.3% [95% CI 64.0-76.7]) and 42 (42.0%) receiving ustekinumab (ustekinumab-adjusted difference 33.5% [22.7-44.3]; p
- Published
- 2018
32. Feasibility and Utility of the Psoriasis Symptom Inventory (PSI) in Clinical Care Settings:A Study from the International Psoriasis Council
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Bradley S. Stolshek, Mona L. Martin, Joelle M. van der Walt, Richard B. Warren, Bruce Strober, Andre V. E. de Carvalho, Peter C.M. van de Kerkhof, Claudia de la Cruz, Yves Poulin, and Kristina Callis Duffin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,International Cooperation ,Clinical Decision-Making ,Dermatology ,Severity of Illness Index ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Quality of life ,Surveys and Questionnaires ,Internal medicine ,Psoriasis ,Severity of illness ,Humans ,Medicine ,Patient Reported Outcome Measures ,Original Research Article ,Young adult ,Aged ,Aged, 80 and over ,Body surface area ,Physician-Patient Relations ,business.industry ,Communication ,General Medicine ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Treatment Outcome ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Quality of Life ,Feasibility Studies ,Female ,Observational study ,business - Abstract
Background The Psoriasis Symptom Inventory (PSI) is a patient-reported outcome measure designed to assess psoriasis signs and symptoms. Objectives The aim was to assess the usefulness of the PSI in enhancing patient care in the clinical setting. Methods Eight dermatology clinics in six countries enrolled adults representing the full spectrum of psoriasis severity who regularly received care at the clinic. Patients were administered the eight-item PSI (score range 0–32; higher scores indicate greater severity) while waiting for the physician; the physician conducted a static physician global assessment (sPGA) and estimated psoriasis-affected body surface area (BSA) at the same visit. Physicians completed a brief questionnaire after each patient visit, and were interviewed about the PSI after all patients were seen. Results The clinics enrolled 278 patients; mean [standard deviation (SD)] psoriasis-affected BSA was 7.6% (11.4). Based on BSA, 47.8% had mild psoriasis, 29.1% had moderate psoriasis, and 23.0% had severe psoriasis. Based on sPGA, 18.7% were clear/almost clear, 67.3% were mild/moderate, and 14.0% were severe/very severe. The mean (SD) PSI total score was 12.2 (8.3). Physicians spent a mean (SD) 4.9 (4.8) min discussing PSI findings with their patients (range 0–20 min). Key benefits of PSI discussions included the following: new information regarding symptom location and severity for physicians; prompting of quality-of-life discussions; better understanding of patient treatment priorities; change in treatment regimens to target specific symptoms or areas; and improvement of patient–physician relationship. Conclusions The PSI was useful for treated and untreated patients to enhance patient–physician communication, and influenced treatment decisions. Electronic supplementary material The online version of this article (10.1007/s40257-019-00458-2) contains supplementary material, which is available to authorized users.
- Published
- 2019
33. Efficacy of Secukinumab in the Treatment of Moderate to Severe Plaque Psoriasis in the North American Subgroup of Patients: Pooled Analysis of Four Phase 3 Studies
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Joel Schlessinger, Xiangyi Meng, Adriana Guana, Ronald Vender, Judit Nyirady, Yves Poulin, Richard G. Langley, Ellen Frankel, and David M. Pariser
- Subjects
Quality of life ,Moderate to severe ,medicine.medical_specialty ,Dermatology ,Pooled ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis Area and Severity Index ,Psoriasis ,Internal medicine ,medicine ,Secukinumab ,Original Research ,Plaque psoriasis ,Patient-reported outcomes ,business.industry ,Clear or almost clear skin ,medicine.disease ,Clinical trial ,Pooled analysis ,030220 oncology & carcinogenesis ,North America ,business - Abstract
Introduction Demographic and disease characteristics may impact response to psoriasis therapies. The objective of this study is to explore the safety and efficacy profile of secukinumab in North American (NA) versus non-NA patients with moderate to severe psoriasis. Methods Data were pooled from four phase 3 studies of secukinumab. Secukinumab (300 and 150 mg) was administered at baseline, weeks 1, 2, and 3, then every 4 weeks from week 4 to 48. Results Peak efficacy was observed at week 16 in NA and non-NA patients with secukinumab 300 mg and secukinumab 150 mg, and disease clearance was maintained to week 52. At week 52 with secukinumab 300 mg, Psoriasis Area and Severity Index (PASI) 90/100 response was achieved by 62.9%/37.9% of NA patients, respectively, and 70.2%/42.0% of non-NA patients, respectively. At week 52 with secukinumab 150 mg, PASI 90/100 response was achieved by 30.9%/17.5% of NA patients, respectively, and 53.9%/26.9% of non-NA patients, respectively. Response to secukinumab was rapid, and 50% reduction in mean PASI was achieved in both groups after 2.9 weeks with secukinumab 300 mg and 3.7 weeks with secukinumab 150 mg. Conclusion Despite differences in baseline characteristics, the efficacy and safety of secukinumab were similar among NA and non-NA patients. Funding Novartis Pharma AG. Plain Language Summary Plain language summary available for this article.
- Published
- 2017
34. A Treatment Algorithm for Moderate to Severe Atopic Dermatitis in Adults
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Charles Lynde, Melinda Gooderham, Gordon Sussman, Marc Bourcier, Lyn Guenther, Chih-Ho Hong, Kim A. Papp, Ronald Vender, and Yves Poulin
- Subjects
Adult ,Moderate to severe ,medicine.medical_specialty ,business.industry ,Inflammatory skin disease ,Dermatology ,Atopic dermatitis ,medicine.disease ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Practice Guidelines as Topic ,medicine ,Humans ,Surgery ,030212 general & internal medicine ,business ,Algorithms - Abstract
Background: Atopic dermatitis (AD) is a common and chronic inflammatory skin disease. Approximately 10% of adults with AD do not respond adequately to topical therapies and require phototherapy and/or systemic therapy. Objective: To provide a patient-focused approach to the identification and management of adults with AD who require systemic treatment. Methods: A working group of clinicians experienced in managing AD was convened to review and discuss current evidence on the identification and clinical management of adults with moderate to severe AD. Results: We propose a set of simple and practical clinical criteria for selecting candidates for systemic treatment of AD based on their response to first-line topical therapy and 4 clinical measures that are easily incorporated into routine practice. We also suggest a framework for evaluating systemic treatments according to attributes that are important from both a clinician’s and a patient’s perspective. An algorithm was developed proposing a pathway for treatment of moderate to severe AD in adults. Conclusion: Adults with moderate to severe AD that does not respond adequately to topical therapies currently have few safe and effective treatment options. A clinical algorithm could help guide treatment decisions.
- Published
- 2017
35. 26237 Baricitinib, an oral, reversible Janus kinase-1 and -2 inhibitor, for atopic dermatitis: Head and neck response from BREEZE-AD5
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Neil J. Korman, Yves Poulin, Jose Luis Rueda, Benjamin Lockshin, Na Lu, Orin Goldblum, Robert Bissonnette, and Yun-Fei Chen
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medicine.medical_specialty ,Janus kinase 1 ,business.industry ,Baricitinib ,Medicine ,Dermatology ,Atopic dermatitis ,business ,Head and neck ,medicine.disease - Published
- 2021
36. La gestion de projets de développement international et d’action humanitaire 2e édition
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Sophie Brière, Yvan Conoir, Yves Poulin, Stéphanie Maltais, Isabelle Auclair, Sophie Brière, Yvan Conoir, Yves Poulin, Stéphanie Maltais, and Isabelle Auclair
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- Humanitarian assistance--Planning, Economic development projects--Planning, Project management--Handbooks, manuals, etc
- Abstract
Conçu dans une approche de gestion, cet ouvrage répertorie et documente toutes les étapes du cycle de vie d'un projet de développement international ou d'action humanitaire. Ce guide propose une démarche rigoureuse qui permet à la fois d'intégrer une vision complète et actuelle des concepts, méthodes et outils d'application en matière de gestion de projets et d'aborder de façon simultanée le développement international et l'action humanitaire. L'accent a volontairement été mis sur les compétences et les rôles des personnes qui proposent des projets, les gèrent, en assurent le suivi ou en font l'évaluation. Cet ouvrage est une source d'enrichissement pour la formation et pour la pratique professionnelle des personnes qui veulent s'engager dans l'action humanitaire et le développement international.
- Published
- 2021
37. Impact of ixekizumab treatment on skin-related personal relationship difficulties in moderate-to-severe psoriasis patients: 12-week results from two Phase 3 trials
- Author
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Tadashi Terui, Richard B. Warren, A. Potts Bleakman, P.C.M. van de Kerkhof, Yves Poulin, Howard Sofen, Russel Burge, Kristian Reich, Baojin Zhu, Lyn Guenther, Jennifer Clay Cather, and Mark Lebwohl
- Subjects
Adult ,Male ,medicine.medical_specialty ,Dermatology ,Antibodies, Monoclonal, Humanized ,Placebo ,Severity of Illness Index ,Etanercept ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Psoriasis ,Humans ,Medicine ,030212 general & internal medicine ,business.industry ,Personal relationship ,Moderate to severe psoriasis ,Dermatology Life Quality Index ,Middle Aged ,medicine.disease ,Surgery ,Ixekizumab ,Infectious Diseases ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Female ,Dermatologic Agents ,business ,medicine.drug - Abstract
Item does not contain fulltext BACKGROUND: Psoriasis symptoms may decrease quality of life for patients. Skin-related personal relationship difficulties in psoriasis patients are common, under-reported and poorly understood. OBJECTIVE: To assess the effect of ixekizumab (IXE) treatment on skin-related personal relationship difficulties in patients with moderate-to-severe psoriasis. METHODS: Pooled data (N = 2570) on skin-related relationship problems were obtained from two large phase 3 trials (UNCOVER-2 and UNCOVER-3) in patients with moderate-to-severe plaque psoriasis randomized to subcutaneous placebo (PBO, N = 361), etanercept (ETN; 50 mg twice weekly, N = 740), or 80 mg IXE as one injection every 4 (IXEQ4W, N = 733) or 2 weeks (IXEQ2W, N = 736) for 12 weeks, following a 160-mg initial dose. The Dermatology Life Quality Index (DLQI) Personal Relationships Domain (PRD) (Items 8 and 9) was used to assess how much the skin caused any personal relationship difficulties at weeks 0, 2, 4 and 12. Improvement was compared for IXE vs PBO and ETN using logistic models. Factors associated with improvement were assessed using multiple linear regressions. DLQI Item 9, assessing sexual difficulties, was also analysed separately. RESULTS: PRD scores (mean +/- standard deviation) at baseline were similar across all treatment groups (PBO: 1.8 +/- 1.9; ETN: 1.7 +/- 1.8; IXEQ4W: 1.6 +/- 1.8; IXEQ2W: 1.7 +/- 1.8). Treatment with IXE rapidly and significantly improved the mean PRD score compared to PBO and ETN (P < 0.001 at all time points). Baseline PRD score was the strongest negative predictor of improvement. IXE enabled significantly more patients with moderate-to-severe plaque psoriasis to reduce their skin-related sexual difficulties at Week 12 compared to PBO (P < 0.001) or ETN (P < 0.001). CONCLUSION: Ixekizumab improves patient-reported skin-related PRD difficulties in patients with moderate-to-severe psoriasis.
- Published
- 2017
38. Management of Moderate to Severe Plaque Psoriasis: The Emerging Role of IL-17 Inhibition
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Melinda Gooderham, Kim A. Papp, Robert Bissonnette, Ian Landells, Yves Poulin, Marni C. Wiseman, Chih-Ho Hong, Marc Bourcier, Ronald Vender, and Charles Lynde
- Subjects
0301 basic medicine ,Moderate to severe ,Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Interleukin-17 ,Antibodies, Monoclonal ,Dermatology ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Psoriasis ,medicine ,Humans ,Surgery ,Interleukin 17 ,business - Published
- 2017
39. Early relapse of psoriasis after stopping brodalumab: a retrospective cohort study in 77 patients
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M. Masson Regnault, F. Amelot, Yves Poulin, Maria Polina Konstantinou, Marc Bourcier, A. Khemis, C. Bulai Livideanu, and Carle Paul
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Brodalumab ,Dermatology ,Antibodies, Monoclonal, Humanized ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Recurrence ,Psoriasis ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Antibodies, Monoclonal ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Discontinuation ,Surgery ,Clinical trial ,030104 developmental biology ,Infectious Diseases ,Joint pain ,Female ,Dermatologic Agents ,medicine.symptom ,business ,Cohort study - Abstract
Background Biological agents targeting IL-17 are very effective for clearing moderate to severe psoriasis. There is limited information regarding the frequency and pattern of psoriasis relapse upon treatment cessation. Objective To investigate the pattern of psoriasis recurrence in patients who were treated with brodalumab following Amgen's decision to stop the clinical program in June 2015. Materials and Methods Between June 2015 and March 2016, we constructed a retrospective multicenter cohort study including patients who were treated with brodalumab in Amgen's protocols after the abrupt interruption of the drug development program. The relapse was defined as the request of patient to initiate a new treatment after brodalumab withdrawal. Results Seventy seven patients were followed up. At the time brodalumab treatment was stopped, 67 (87%) patients had reached PASI 90. After brodalumab discontinuation, all 77 patients relapsed after a follow up of 9 months. The median time to relapse was 46 days (range 7 to 224 days). Concerning the type of relapse, 73 patients presented with plaque psoriasis, one patient presented with erythrodermic psoriasis and 3 patients experienced pustular psoriasis. In 7 patients who had no previous history of psoriatic arthritis (PsA), the relapse of psoriasis was associated with inflammatory joint pain suggestive of PsA. At week 36, eight patients who had a limited relapse were controlled with topical treatment, 43 patients received a biological agent, two patients were included in a clinical trial with an investigational drug and 15 patients were treated with conventional systemic agents. Conclusion Abrupt cessation of brodalumab is associated with a rapid relapse of psoriasis with some patients experiencing a rebound. It seems not advisable to stop treatment with IL-17 receptor antagonists abruptly even in patients who experience complete clearance of psoriasis. This article is protected by copyright. All rights reserved.
- Published
- 2017
40. Management of chronic spontaneous urticaria (CSU): a treat to target approach using a patient reported outcome
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Yves Poulin, Hugo Chapdelaine, Melinda Gooderham, Martin Gilbert, Kim A. Papp, Gordon Sussman, Charles Lynde, Hermenio C. Lima, Vincent T. Ho, Jan P. Dutz, and Anne K. Ellis
- Subjects
lcsh:Immunologic diseases. Allergy ,medicine.medical_specialty ,Urticaria ,Short Report ,Recurrent urticaria ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,CSU ,Intensive care medicine ,CIU ,business.industry ,Task force ,Urticaria Activity Score ,Treat to target ,General Medicine ,medicine.disease ,Chronic spontaneous urticaria ,Systematic review ,030228 respiratory system ,Rheumatoid arthritis ,Physical therapy ,Patient-reported outcome ,UAS ,Allergists ,Chronic idiopathic urticaria ,business ,lcsh:RC581-607 - Abstract
Background: Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods: Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists, and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results: The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion: Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU, and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases.
- Published
- 2017
41. Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document
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Charles Lynde, Ralph George, Wayne Gulliver, Sunil Kalia, Raed Alhusayen, Melinda Gooderham, Yves Poulin, Danielle Marcoux, Afsaneh Alavi, Isabelle Delorme, and Marc Bourcier
- Subjects
medicine.medical_specialty ,Consensus ,Delphi Technique ,media_common.quotation_subject ,Dermatologic Surgical Procedures ,Anti-Inflammatory Agents ,Modified delphi ,Dermatology ,Scientific evidence ,Retinoids ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Multidisciplinary approach ,Voting ,Humans ,Pain Management ,Medicine ,Medical physics ,Hidradenitis suppurativa ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Life Style ,media_common ,Patient Care Team ,Biological Products ,business.industry ,Androgen Antagonists ,medicine.disease ,Anti-Bacterial Agents ,Hidradenitis Suppurativa ,Surgery ,Treatment modality ,Practice Guidelines as Topic ,business - Abstract
Background: Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. Objectives: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. Methods: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. Results: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. Conclusions: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti–tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.
- Published
- 2017
42. Olumacostat glasaretil, a novel topical sebum inhibitor, in the treatment of acne vulgaris: A phase IIa, multicenter, randomized, vehicle-controlled study
- Author
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Yves Poulin, J. Drew, Jerry Tan, Hans Hofland, and Robert Bissonnette
- Subjects
Adult ,Male ,0301 basic medicine ,Sebaceous gland ,medicine.medical_specialty ,Adolescent ,Hamster ,Tretinoin ,Dermatology ,Administration, Cutaneous ,Severity of Illness Index ,Gastroenterology ,Drug Administration Schedule ,Lesion ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Reference Values ,Internal medicine ,Acne Vulgaris ,medicine ,Humans ,In patient ,Prospective Studies ,Dosing ,Adverse effect ,Acne ,Dose-Response Relationship, Drug ,business.industry ,Patient Selection ,Olumacostat glasaretil ,medicine.disease ,Sebum ,Treatment Outcome ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Background Olumacostat glasaretil (OG) inhibits acetyl-coenzyme A carboxylase, the enzyme responsible for the first, rate-limiting step in de novo fatty acid synthesis. OG inhibited in vitro human sebocyte lipid production and reduced in vivo sebaceous gland size in hamster ears. Objectives Safety and efficacy of OG 7.5% gel were evaluated in patients with moderate to severe facial acne vulgaris. Methods Patients were randomized (1:1) to twice-daily application of OG or vehicle for 12 weeks. Efficacy was measured through changes in lesion counts and improvement in acne severity scores. Results A total of 108 patients received OG (n = 53) or vehicle (n = 55); these groups had mean baseline counts of 29.7 and 28.6 inflammatory and 40.9 and 38.8 noninflammatory lesions, respectively. At week 12, OG treatment showed greater reductions from baseline in inflammatory lesions (−63.9% vs −45.9%; P = .0006) and noninflammatory lesions (−48.1% vs −28.8%; P = .0025), and more patients with greater than or equal to 2-grade improvement in investigator global assessment score (24.5% vs 7.3%; P = .0070) than vehicle. Application-site adverse events (typically mild or moderate intensity) were more common with OG. Limitations Larger trials are needed to optimize OG dosing and confirm the current results. Conclusion OG was well tolerated and showed evidence of efficacy, suggesting further development is warranted.
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- 2017
43. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis
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Laurent Eckert, Heribert Staudinger, Lisa A. Beck, Marius Ardeleanu, George D. Yancopoulos, Mette Deleuran, Eric L. Simpson, Yoko Kataoka, Abhijit Gadkari, Yuhwen Soo, Jonathan I. Silverberg, Neil M.H. Graham, Thomas Bieber, Andrew Blauvelt, Andreas Wollenberg, Margitta Worm, Yves Poulin, Jean-Philippe Lacour, Neil Stahl, Emma Guttman-Yassky, Gianluca Pirozzi, Külli Kingo, Vera Mastey, Michael J. Cork, and Bolanle Akinlade
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Nemolizumab ,Injections, Subcutaneous ,Clinical Trial, Phase III ,education ,Anti-Inflammatory Agents ,Placebo ,Eczema Area and Severity Index ,Dermatitis, Atopic ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,Journal Article ,medicine ,Humans ,Comparative Study ,Interleukin-13 ,business.industry ,Pruritus ,Antibodies, Monoclonal ,Crisaborole ,General Medicine ,Atopic dermatitis ,Middle Aged ,medicine.disease ,Dupilumab ,Surgery ,Multicenter Study ,Clinical trial ,030104 developmental biology ,Nasopharyngitis ,Randomized Controlled Trial ,Quality of Life ,Female ,Interleukin-4 ,business - Abstract
BACKGROUND\ud Dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha, inhibits\ud signaling of interleukin-4 and interleukin-13, type 2 cytokines that may be important\ud drivers of atopic or allergic diseases such as atopic dermatitis.\ud METHODS\ud In two randomized, placebo-controlled, phase 3 trials of identical design (SOLO 1\ud and SOLO 2), we enrolled adults with moderate-to-severe atopic dermatitis whose\ud disease was inadequately controlled by topical treatment. Patients were randomly\ud assigned in a 1:1:1 ratio to receive, for 16 weeks, subcutaneous dupilumab (300 mg)\ud or placebo weekly or the same dose of dupilumab every other week alternating\ud with placebo. The primary outcome was the proportion of patients who had both\ud a score of 0 or 1 (clear or almost clear) on the Investigator’s Global Assessment\ud and a reduction of 2 points or more in that score from baseline at week 16.\ud RESULTS\ud We enrolled 671 patients in SOLO 1 and 708 in SOLO 2. In SOLO 1, the primary\ud outcome occurred in 85 patients (38%) who received dupilumab every other week and\ud in 83 (37%) who received dupilumab weekly, as compared with 23 (10%) who received\ud placebo (P
- Published
- 2016
44. Apremilast, an oral phosphodiesterase 4 inhibitor, improves patient-reported outcomes in the treatment of moderate to severe psoriasis: results of two phase III randomized, controlled trials
- Author
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Alexandra B. Kimball, Peter Foley, Diamant Thaçi, Rongdean Chen, Steven R. Feldman, E. Levi, and Yves Poulin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health Status ,Population ,Work Capacity Evaluation ,Dermatology ,Placebo ,Severity of Illness Index ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Psoriasis Area and Severity Index ,Internal medicine ,Psoriasis ,medicine ,Humans ,Patient Reported Outcome Measures ,education ,education.field_of_study ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Dermatology Life Quality Index ,Middle Aged ,medicine.disease ,humanities ,Thalidomide ,Mental Health ,Infectious Diseases ,030220 oncology & carcinogenesis ,Quality of Life ,Physical therapy ,Original Article ,Female ,Phosphodiesterase 4 Inhibitors ,Apremilast ,business ,medicine.drug - Abstract
Background Apremilast, an oral phosphodiesterase 4 inhibitor, has an acceptable safety profile and is effective for treatment of plaque psoriasis and psoriatic arthritis. Objectives To evaluate the impact of apremilast on health-related quality of life (HRQOL), general functioning and mental health using patient-reported outcome (PRO) assessments among patients with moderate to severe plaque psoriasis in the ESTEEM 1 and 2 trials. Methods A total of 1255 patients were randomized (2 : 1) to apremilast 30 mg BID or placebo for 16 weeks; all received apremilast through Week 32. PRO assessments included the Dermatology Life Quality Index (DLQI), 36-Item Short-Form Health Survey version 2 mental/physical component summary scores (SF-36v2 MCS/PCS), Patient Health Questionnaire-8 (PHQ-8), EuroQol-5D (EQ-5D) and Work Limitations Questionnaire-25 (WLQ-25). Post hoc analyses examined relationships between Psoriasis Area and Severity Index (PASI) scores and PHQ-8 in the apremilast-treated population at Week 16. Results Treatment with apremilast improved all HRQOL PROs at Week 16 (vs. placebo), except the SF-36v2 PCS, and improvements were sustained through Week 32. Mean DLQI and SF-36v2 MCS improvements exceeded minimal clinically important differences. Changes at Week 16 in PHQ-8 and PASI were weakly correlated, and only 35.8% of patients who achieved a ≥75% reduction from baseline in PASI score (PASI-75) with apremilast treatment also achieved PHQ-8 scores of 0–4. Conclusions Apremilast led to improvements in HRQOL PROs vs. placebo in patients with moderate to severe plaque psoriasis.
- Published
- 2016
45. Persistance de l’amélioration clinique du psoriasis génital après un an de traitement par ixékizumab : résultats d’une étude clinique de phase 3 randomisée contrôlée versus placebo chez des patients atteints de psoriasis génital modéré à sévère (IXORA-Q)
- Author
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D.-I. Rioli, Caitriona Ryan, A.B. Potts, K. Todd, J. Weisman, C.C. Bertram, Yves Poulin, J. Erickson, Lynda Spelman, Russel Burge, and Lyn Guenther
- Subjects
Dermatology - Abstract
Introduction Le traitement par ixekizumab (IXE) a montre son efficacite a 12 semaines chez des patients atteints de psoriasis genital (GenPso) modere a severe. L’efficacite et la tolerance d’IXE a 52 semaines dans le GenPso sont rapportees dans cette etude. Materiel et methodes Durant les 12 premieres semaines de traitement en aveugle, les patients avec un GenPso modere a severe avaient ete randomises en 1 : 1, soit sous 80 mg d’IXE toutes les 2 semaines (Q2W, n = 75) soit sous placebo (PBO, n = 74). La premiere dose d’IXE etait de 160 mg. Puis, durant la periode en ouvert a long terme (PLT), de la semaine 12 a la semaine 52, les patients ont recu 80 mg d’IXE toutes les 4 semaines (Q4W), avec possibilite aux semaines 24, 28 ou 40 de passer a une dose bimensuelle d’IXE jusqu’a la semaine 52. Les criteres evalues etaient le pourcentage de patients avec un score sPGA de la zone genitale de 0 ou 1 (sPGA-G 0/1), un sPGA global de 0/1, des ameliorations ≥ 3 et ≥ 4 points du prurit genital (Genital Itch NRS) pour les patients avec un score ≥ 3 ou ≥ 4 a l’etat initial, et un score de 0 ou 1 pour l’item 2 du Sexual Frequency Questionnaire GenPso pour les patients avec un score a l’etat initial ≥ 2. Les resultats d’efficacite presentes ne prennent en compte que les patients randomises dans le groupe IXE (IXE Q2W/IXE Q4W) et dans le groupe PBO (PBO/IXE Q4W) ayant recu la dose recommandee IXE Q4W pendant la periode en ouvert a long terme. La methode NRI a ete utilisee. La tolerance a ete evaluee pour tous les patients ayant recu au moins une dose d’IXE (n = 140). Resultats Sur 149 patients randomises, 139 (93,3 %) ont participe a la PLT et 126 (84,6 %) ont termine l’etude a la semaine 52. Groupe IXE Q2W/IXE Q4W : maintien du sPGA-G 0/1 avec 73,3 % a S12, et 74,7 % a S52. A S52, maintien du sPGA global 0/1 avec 72,0 %, et reduction du Genital Itch NRS (≥ 3 : 72,6 % ; ≥ 4 : 73,2 %) et de l’item 2 SFQ GenPs 0/1 (75,7 %). Groupe PBO/IXE Q4W (n = 65) : 75,4 % ont atteint le sPGA-G 0/1 a la semaine 24 et maintien jusqu’a S52 (78,5 %). A S52, maintien pour le sPGA global 0/1 (73,8 %), le Genital Itch NRS (≥ 3 : 68,6 % ; ≥ 4 : 75,0 %) et l’item 2 SFQ GenPs 0/1 (77,1 %). Des evenements indesirables (EI) sont apparus sous traitement chez 107 (76,4 %) patients, 99 (70,7 %) de gravite legere a moderee, 8 (5,7 %) EI graves (EIG), 41 (29,3 %) imputes au traitement et 3 (2,1 %) ayant entraine l’interruption du traitement. Aucun deces n’est rapporte. Conclusion L’ixekizumab a permis des ameliorations cliniques durables dans le GenPso modere a severe sur 52 semaines. Le profil de securite etait conforme a celui observe lors des etudes precedentes sur le psoriasis.
- Published
- 2019
46. TYK2/JAK1 Inhibitor PF-06700841 in Patients with Plaque Psoriasis: Phase IIa, Randomized, Double-Blind, Placebo-Controlled Trial
- Author
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Christopher Tehlirian, Elizabeth Kieras, David M. Pariser, Steven A. Gilbert, Seth B Forman, Jocelyne Papacharalambous, Michael S. Vincent, Yves Poulin, Dahong Yu, Elena Peeva, and Ruolun Qiu
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,MedDRA ,Placebo-controlled study ,Dermatology ,Placebo ,Biochemistry ,Severity of Illness Index ,Drug Administration Schedule ,law.invention ,Placebos ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,Psoriasis Area and Severity Index ,law ,Internal medicine ,Psoriasis ,Clinical endpoint ,medicine ,Humans ,Adverse effect ,Molecular Biology ,Protein Kinase Inhibitors ,TYK2 Kinase ,Dose-Response Relationship, Drug ,business.industry ,Remission Induction ,Cell Biology ,Janus Kinase 1 ,Middle Aged ,medicine.disease ,030104 developmental biology ,Pyrimidines ,Treatment Outcome ,030220 oncology & carcinogenesis ,Pyrazoles ,Female ,business ,Follow-Up Studies - Abstract
Trial design We report results from a phase IIa study of efficacy and safety of PF-06700841, an oral TYK2/Jak1 inhibitor, in patients with moderate-to-severe plaque psoriasis ( NCT02969018 ). Methods Patients were randomized to PF-06700841 30 mg once daily (QD), 60 mg QD, or placebo (4-week induction), followed by 10 mg QD, 30 mg QD, 100 mg once weekly, or placebo (8-week maintenance). The primary endpoint was week 12 change from baseline in PASI score. Secondary endpoints were the proportion of patients achieving 75% and 90% reduction from baseline PASI at week 12. Results In total, 212 patients in 35 sites were treated; mean (SD) baseline PASI score was 20.8 (7.68). Decreases in PASI at week 12 were statistically significant compared with placebo in five treatment groups. The greatest change from baseline (least squares mean change –17.3 [95% confidence interval, –20.0 to –14.6]) was observed in the 30-mg QD continuous treatment group. Overall, 136 patients experienced treatment-emergent adverse events, including six serious adverse events in five patients and 13 discontinuations in treatment groups because of adverse events. No herpes zoster cases or major adverse cardiac events including thromboembolic events occurred. Conclusions PF-06700841 was generally effective and well tolerated in patients with moderate-to-severe plaque psoriasis.
- Published
- 2019
47. Checklist for the Systemic Treatment of Psoriasis Using Biologics: A Delphi Study
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Ben Whan Kim, Neil H. Shear, Melinda Gooderham, Marc Bourcier, Charles Lynde, Ronald Vender, Simone Fahim, Scott Walsh, Steven J. Glassman, Lyn Guenther, Wayne Gulliver, Yves Poulin, Melanie D. Pratt, and Christine Fahim
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Plaque psoriasis ,education.field_of_study ,medicine.medical_specialty ,Biological Products ,Canada ,Consensus ,Delphi Technique ,business.industry ,Population ,Delphi method ,Dermatology ,medicine.disease ,Checklist ,Biological Therapy ,Psoriasis ,medicine ,Humans ,Surgery ,Practice Patterns, Physicians' ,education ,business ,Psoriasis treatment - Abstract
Background: Despite the complexity of psoriasis treatment using biologic therapy, there does not exist a standardized synoptic reporting form for the initiation of this population. The purpose of this study was to use a modified Delphi approach to develop a standard checklist for the standardized documentation of patients receiving systemic biologic therapy for psoriasis. Methods: A modified Delphi survey was conducted over 3 rounds (February 2017 through January 2018). An expert panel generated a 51-item checklist that was proposed to participants. Items were rated on an anchored 1-7 Likert scale. Consensus was defined apriori as ≥ 70% agreement by respondents. Results: A total of 58, 17, and 18 dermatologists participated in 3 consecutive Delphi rounds, respectively. Only half of the dermatologists surveyed reported using a checklist for the management of psoriasis. The final checklist comprised 19, 5, 6, and 9 items pertaining to patient history; physical exam and history of systemic therapy; vaccinations; and lab investigations and bloodwork, respectively. Conclusions: Given the increasing availability and complexity of biologic agents for psoriasis treatment, there is a need to promote standardized documentation for this population. The Checklist for the Systemic Treatment of Psoriasis presents 38 items that should be considered when initiating patients with psoriasis on biologic therapy.
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- 2019
48. 14998 Reductions in absolute PASI over 144 weeks of treatment with certolizumab pegol in patients with plaque psoriasis: Pooled analysis from two phase 3 trials (CIMPASI-1 and CIMPASI-2)
- Author
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Marion Boehnlein, Yves Poulin, Fiona Brock, C Arendt, Diamant Thaçi, Andrew Blauvelt, Kristian Reich, and Alice B. Gottlieb
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Plaque psoriasis ,medicine.medical_specialty ,Pooled analysis ,business.industry ,Internal medicine ,medicine ,In patient ,Dermatology ,Certolizumab pegol ,business ,Gastroenterology ,medicine.drug - Published
- 2020
49. 15001 Durable efficacy of certolizumab pegol dosed at 400 mg every two weeks over 128 weeks in patients with plaque psoriasis enrolled in three phase 3 trials (CIMPASI-1, CIMPASI-2, and CIMPACT)
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Diamant Thaçi, Richard B. Warren, Marion Boehnlein, Kristian Reich, C Arendt, Andrew Blauvelt, Fiona Brock, Yves Poulin, Alice B. Gottlieb, and Kenneth B. Gordon
- Subjects
Plaque psoriasis ,medicine.medical_specialty ,Every Two Weeks ,business.industry ,Internal medicine ,medicine ,In patient ,Dermatology ,Certolizumab pegol ,business ,Gastroenterology ,medicine.drug - Published
- 2020
50. Efficacy and Safety of Tralokinumab Monotherapy in Adult Patients with Moderate-to-Severe Atopic Dermatitis: Results from Two 52-Week, Phase 3 Trials (ECZTRA 1 and ECZTRA 2)
- Author
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Yves Poulin, Andrew Blauvelt, Emma Guttman-Yassky, Hidehisa Saeki, Margitta Worm, Eric L. Simpson, Charles Lynde, and Andreas Wollenberg
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Moderate to severe ,medicine.medical_specialty ,Adult patients ,business.industry ,medicine ,Atopic dermatitis ,medicine.disease ,business ,Dermatology ,Tralokinumab - Abstract
not available.
- Published
- 2020
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