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Effectiveness of TNF-α blockers and IL-12/IL-23 blockers in the treatment of Psoriasis. Preliminary observations.

Presentation during International Medical Student Congress in Poznań. 1st award in dermatology session.

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Effectiveness of TNF-α blockers and IL-12/IL-23 blockers in the treatment of Psoriasis. Preliminary observations.

  1. 1. Effectiveness of TNF-α blockers and IL-12/IL-23 blockers in the treatment of Psoriasis. Preliminary observations. Wojciech Francuzik, Kinga Byczkowska Student working group at The Clinic of Skin Diseases and Medical Mycology, Poznań University of Medical Sciences. Supervisor: Professor Zygmunt Adamski MD PhD
  2. 2. Biological Agents ● Used in dermatology, rheumatology and gastroenterology ● Block pathways of inflammtion pharmatching.com
  3. 3. Interleukin IL-12 in the pathogenesis of psoriasis Dendritic Cells Macrophages Keratinocytes Mast cells Granulocytes Th0 Th1 NK Other cytokines IgG IL-12
  4. 4. Interleukin IL-23 in the pathogenesis of psoriasis Langerhans C Macrophages Keratinocytes Th17 Th17 activ e Induce s CD8+ cytotoxicit y IL-23
  5. 5. TNF-α in the pathogenesis of psoriasis Langerhans C Macrophages Keratinocytes Mast cells ● Elevated concentration in changed skin ● Induces migration of macrophages ● Stimulates LC maturation ● Stimulates proinflammatory cytokines production ● Induces proliferation of keratinocytes
  6. 6. Structure of cytokines important in the pathogenesis of psoriasis Nature Reviews Immunology TNF-α Acts trough: TNF-RI TNF-RII Current Protocols.com
  7. 7. The agents used in the treatment of psoriasis Infliximab Etanercept Adalimumab Ustekinumab Chimeric antibody Human antibody Human fusion protein Human antibody TNF-α blockers IL-12, IL-23 Blocker p40 subunit i.v. 5mg/kg 0-2-4-8 w Than every 8 w s.c. 50 mg Every week i.m. 40 mg Every 2 weeks s.c. 45mg 0-4-12 w Than every 12 w
  8. 8. Aim of this study: To verify which biologic agent (infliximab, adalimumab, etanercept, ustekinumab) used in the treatment of psoriasis is the most effective in reducing skin changes.
  9. 9. Materials and methods: 51 psoriatic patients Infliximab Etanercept Adalimumab Ustekinumab 15 12 11 13 PASI 0 (at day 0) PASI 0 (at day 0) PASI 0 (at day 0) PASI 0 (at day 0) After 4 weeks of therapy PASI 4 PASI 4 PASI 4 PASI 4 After 12 weeks of therapy PASI 12 PASI 12 PASI 12 PASI 12
  10. 10. ● Calculating a percentile PASI reduction after 4 weeks of therapy ● Calculating a percentile PASI reduction after 12 weeks of therapy Materials and methods: Pred4= PASI 4 PASI 0 Pred12= PASI 12 PASI 0
  11. 11. Results: ● There is a difference beetween means in the 4 agents groups during fist 4 weeks of treatment P=0.0196 (Kruskal-Wallis test) I: infliximab, E: etanercept, A: adalimumab, U: ustekinumab
  12. 12. Results: ● There was a difference beeteween means of Pred4 between groups treated with etanercept and adalimumab P=0.0074 (Mann Whitney test) Etanercept group mean = 51,42% Adalimumab group mean = 72,00% ● There was a difference beeteween means of Pred4 between groups treated with etanercept and infliximab P=0.0089 (Mann Whitney test) Infliximab group mean = 73,07% Etanercept group mean = 51,42%
  13. 13. Results: ● There was NO difference beeteween means of Pred4 inside each group considering common psoriasis and psoriatic arthritis patients ● There was NO difference beeteween means of Pred4 inside each group considering patients with family history of psoriasis and those without ● There was NO difference beeteween means of Pred12 between all groups P=0.5238 (Kruskal-Wallis test)
  14. 14. Results: ● There was difference beeteween means of Pred4 between male and female patients in infliximab group P=0,0077 (Mann Whitney test) Im: infliximab in males, Ik: ifliximab in females
  15. 15. Results: ● There was difference beteween means of Pred4 between male patients in all groups. ● Significant difference was observed between infliximab, etanercept and adalimumab groups. I: infliximab, E: etanercept, A: adalimumab, U: ustekinumab, m for male patients
  16. 16. Infliximab treated group
  17. 17. Adalimumab treated group
  18. 18. Conclusion ● The effectiveness of reducing PASI score was most rapidly seen in infliximab group ● Etanercept group had longer response to therapy time ● All agents were equally effective in reducing skin changes during 12 weeks of treatment ● Male patients seamed to respond faster to Infliximab than female patients. ● Male patients showed more varied response to different agents than female patients
  19. 19. Thanks to: ● Professor Zygmunt Adamski MD PhD ● Staff of the Skin Disease Department of The Regional Hospital in Poznań Immunologia, Gołąb J, Jakóbisiak M, Lasek W (red.). PWN Warszawa 2004 Tracey D, Klareskog L, Sasso EH et al. Tumor necrosis factor antagonist mechanism of action: a comprehensive review. Pharmacol Ther 2008; 117:224-79 Krueger JG. The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 2002; 25: 20-33 Liebwohl MG, Use of Etanercept in the dermatology setting. Am J Acad Dermatol 2005; 6: 49-59

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  • darayang1

    Jan. 26, 2015
  • wqs226

    May. 27, 2015
  • KanchanHucche

    Apr. 8, 2018

Presentation during International Medical Student Congress in Poznań. 1st award in dermatology session.

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