Relapse, rebound, and psoriasis adverse events: An advisory group report

Carey, Wayne; Glazer, Scott D.; Gottlieb, Alice B.; Lebwohl, Mark; Leonardi, Craig L.; Menter, Alan; Papp, Kim; Rundle, Amy Chen; Toth, Darryl

doi:10.1016/j.jaad.2005.10.029

Cited by 132 publications

(148 citation statements)

References 35 publications

(38 reference statements)

Supporting

Mentioning

138

Contrasting

Unclassified

Order By: Relevance

“…Generalized inflammatory flare occurs in the first 6–10 weeks of treatment in about 5% of patients [13,14,15] and requires interruption of efalizumab and addition of a ‘rescue therapy’ (usually cyclosporine, narrow-band ultraviolet B phototherapy or methotrexate) [23,24,25]. Furthermore, responders can experience fluctuation in disease, varying from mild localized eruption to relapses (defined as the loss of more than 50% of response), which may reflect actual disease fluctuation or be associated with stressful events, such as infections and psychological distress.…”

Section: Discussionmentioning

confidence: 99%

“…Relapse was defined as a reduction of at least 50% in the improvement achieved in the Psoriasis Area and Severity Index (PASI) score between baseline and week 12 [14]. …”

Section: Methodsmentioning

confidence: 99%

“…worsening of psoriasis or onset of new psoriasis morphologies) during treatment with efalizumab [14,15,16]. In addition, efalizumab is associated with an inflammatory flare reaction in approximately 5% of patients, requiring cessation of therapy [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Short-Term Cyclosporine Treatment to Control Psoriasis-Related Events during Efalizumab Therapy

Costanzo

Talamonti²,

Spallone³

et al. 2008

Dermatology

View full text Add to dashboard Cite

Efalizumab is a recombinant humanized anti-CD11a monoclonal antibody that blocks the activation, adhesion and trafficking of T cells and has been approved for the treatment of moderate-to-severe plaque psoriasis. To document management of the fluctuations in symptom control that patients with psoriasis sometimes experience during treatment, we performed a retrospective analysis of our experience using cyclosporine as an intercurrent treatment to control psoriasis-related adverse events (AEs) in 10 patients who had received continuous efalizumab therapy for 20–200 weeks prior to recurrence of symptoms. Combination therapy with cyclosporine and efalizumab was generally well tolerated and controlled the relapse effectively. There were no reports of severe AEs during combination treatment, and no clinically significant changes were noted in clinical and laboratory values. Although mild, localized psoriasis recurred in most of these patients after cyclosporine termination, no patient experienced rebound or psoriasis flare and all continued with long-term efalizumab treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Relapse was defined as a reduction of at least 50% in the improvement achieved in the Psoriasis Area and Severity Index (PASI) score between baseline and week 12 [14]. …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Short-Term Cyclosporine Treatment to Control Psoriasis-Related Events during Efalizumab Therapy

Costanzo

Talamonti²,

Spallone³

et al. 2008

Dermatology

View full text Add to dashboard Cite

show abstract

“…Return (relapse) or worsening (rebound) of the disease could occur when a therapy is discontinued or even during the treatment (76,77), which will require initiation of alternative therapies. Disease return or rebound could be associated with elevated cytokine expressions and CYP enzymes inhibition, possibly to a greater extent than the pretreatment state, resulting in increased exposure of small molecule drugs.…”

Section: Other Considerationsmentioning

confidence: 99%

Biological Products for the Treatment of Psoriasis: Therapeutic Targets, Pharmacodynamics and Disease-Drug-Drug Interaction Implications

Wang

Ahn

2014

AAPS J

View full text Add to dashboard Cite

Abstract. Psoriasis is a chronic inflammatory skin disease condition that involves altered expression of a broad spectrum of proinflammatory cytokines which are associated with activation of T cells and proliferation of keratinocytes. Currently approved biological products for psoriasis treatment fall into two main classes: cytokine modulators and biologics targeting T cells. In psoriatic patients, elevated levels of proinflammatory cytokines are observed. Elevated proinflammatory cytokines can suppress some cytochrome P450 (CYP) enzymes, and the treatment of psoriasis with biological products can reduce proinflammatory cytokine levels. Therefore, the exposure of CYP substrate drugs is anticipated to be affected by the psoriasis disease resulting in a higher exposure than in healthy state (named disease-drug interaction) as well as by the biological treatments due to disease improvements resulting in a decrease in exposure (named disease-drug-drug interaction, disease-DDI). However, the quantitative impact on CYP substrate exposure due to disease or due to treatment with biological products remains to be evaluated. The objective of the current review is to provide an overview of the therapeutic targets and cytokinerelated pharmacodynamic effects of biological products in psoriasis treatment with a particular focus on their implications for disease-DDI. The clinical study design considerations for psoriasis disease-DDI evaluation are also discussed.

show abstract

“…123 In clinical trials, serious disease flares characterized by inflammatory, pustular and erythrodermic psoriasis affected 0.7% of patients. 124 Based on a small trial, inflammatory flares associated with efalizumab appear to respond best to cyclosporine or methotrexate, as compared to oral steroids or retinoids. 125 Efalizumab must be used with caution among patients with a history of systemic malignancy or at increased risk for infection.…”

Section: Inhibitors Of T-cell Activationmentioning

confidence: 99%

Update on the Natural History and Systemic Treatment of Psoriasis

Richardson

Gelfand

2008

Advances in Dermatology

View full text Add to dashboard Cite

Psoriasis is a common inflammatory disease of the skin and joints. Its etiology remains unknown, however, it has been linked to complex interactions between predisposing genes and the environment. The pathophysiology of psoriasis is characterized by epidermal hyperproliferation, enhanced antigen presentation, Th-1 cytokine production, T cell expansion, and angiogenesis. Tremendous advances in our understanding of this disorder has led to the development of novel therapeutics and the FDA approval of more systemic agents for its treatment in the last 5 years than in the previous 50 years combined. Our improved understanding of the pathogenesis of psoriasis has led to epidemiologic studies that have contributed towards further characterizing its natural history. In this review we focus on specific advances in our understanding of the pathogenesis, natural history, and systemic treatment of psoriasis which are of major clinical relevance to the clinician. KEY ADVANCES IN THE PATHOGENESIS OF PSORIASISThe biologic basis of psoriasis informs its natural history and treatment options. Here, we briefly review key discoveries in the pathogenesis of psoriasis relevant to the clinician and refer the reader to several comprehensive reviews for a more detailed discussion. 1-4 Psoriasis Corresponding author: Joel M. Gelfand, MD, MSCE, 3600 Spruce Street 2 Maloney Building, Philadelphia, PA 19104, Phone: 215-614-0635, FAX: 215-615-4966, email: Joel.Gelfand@uphs.upenn.edu. Co-author address: Stephen K Richardson, MD, 1714 Mahan Center Boulevard, Tallahassee, FL 32308, Phone: 850-320-3406 Editorial Comments Dr Richardson and Gelfand deliver a scientific overview of the fast moving advances in our understanding and treatment of psoriasis. Scaling, red, itchy, burning, fissured, visually disturbing are all components of the "heartbreak of psoriasis". In a series of studies Dr Gelfand and his collaborators have redefined psoriasis as a systemic disease with adverse impacts on the heart, brain, endocrine system and indeed life itself. Recognition that it is an independent risk factor for myocardial infarction, stroke, diabetes, lymphoma and mortality will assist physicians in educating and promoting preventative care for affected patients. At the same time a revolution in our ability to treat severe disease with an ever increasing array of innovative agents as occurred. Weather these targeted drugs modify the above risks while they provide relief of the skin signs is a story waiting to unfold. I think you will enjoy this outstanding review! William D. James MD Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to t...

show abstract

Relapse, rebound, and psoriasis adverse events: An advisory group report

Cited by 132 publications

References 35 publications

Efficacy of Short-Term Cyclosporine Treatment to Control Psoriasis-Related Events during Efalizumab Therapy

Efficacy of Short-Term Cyclosporine Treatment to Control Psoriasis-Related Events during Efalizumab Therapy

Biological Products for the Treatment of Psoriasis: Therapeutic Targets, Pharmacodynamics and Disease-Drug-Drug Interaction Implications

Update on the Natural History and Systemic Treatment of Psoriasis

Contact Info

Product

Resources

About