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      Efficacy and safety of ixekizumab treatment for Japanese patients with moderate to severe plaque psoriasis, erythrodermic psoriasis and generalized pustular psoriasis: Results from a 52‐week, open‐label, phase 3 study (UNCOVER‐J)

      research-article
      1 , 2 , 3 , , 3 , 3 , 3 , 4 , 4 , the Japanese Ixekizumab Study Group , , , , , , , , , , , , , , , , , , , , , , , , , ,
      The Journal of Dermatology
      John Wiley and Sons Inc.
      erythrodermic psoriasis, generalized pustular psoriasis, ixekizumab, Japan, plaque psoriasis

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          Abstract

          Psoriasis, a chronic, immune‐mediated skin disease characterized by red, scaly plaques, affects approximately 0.3% of the population in Japan. The aim of this open‐label study was to evaluate the long‐term efficacy and safety of ixekizumab, a humanized, anti‐interleukin‐17A monoclonal antibody, in Japanese patients with plaque psoriasis ( n = 78, including 11 psoriatic arthritis), erythrodermic psoriasis ( n = 8) and generalized pustular psoriasis ( n = 5). Ixekizumab was administrated s.c. at baseline (week 0, 160 mg), from weeks 2 to 12 (80 mg every 2 weeks), and from weeks 16 to 52 (80 mg every 4 weeks). At week 52, 92.3% of patients with plaque psoriasis achieved Psoriasis Area and Severity Index ( PASI) 75, 80.8% achieved PASI 90, 48.7% achieved PASI 100, and 52.6% had remission of plaques (by static Physician Global Assessment, sPGA [0]). Difficult to treat areas of psoriasis (nail or scalp) also responded to ixekizumab. All patients with psoriatic arthritis who were assessed (5/5) achieved an American College of Rheumatology 20 response. Most patients with erythrodermic psoriasis or generalized pustular psoriasis responded to ixekizumab and the clinical outcome was maintained over 52 weeks (75% and 60% of patients achieved sPGA [0, 1] at week 52, respectively). Mostly mild or moderate treatment‐emergent adverse events were reported by 79 of 91 patients; the most common were nasopharyngitis, eczema, seborrheic dermatitis, urticaria and injection site reactions. In conclusion, 52‐week ixekizumab treatment was efficacious and well tolerated in Japanese patients with plaque psoriasis. Efficacy was also observed in patients with erythrodermic psoriasis, generalized pustular psoriasis and psoriatic arthritis.

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          Most cited references13

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          Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus.

          The most commonly used tool for self-report of pruritus intensity is the visual analogue scale (VAS). Similar tools are the numerical rating scale (NRS) and verbal rating scale (VRS). In the present study, initiated by the International Forum for the Study of Itch assessing reliability of these tools, 471 randomly selected patients with chronic itch (200 males, 271 females, mean age 58.44 years) recorded their pruritus intensity on VAS (100-mm line), NRS (0-10) and VRS (four-point) scales. Re-test reliability was analysed in a subgroup of 250 patients after one hour. Statistical analysis showed a high reliability and concurrent validity (r>0.8; p<0.01) for all tools. Mean values of all scales showed a high correlation. In conclusion, high reliability and concurrent validity was found for VAS, NRS and VRS. On re-test, higher correlation and less missing values were observed. A training session before starting a clinical trial is recommended.
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            Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis.

            The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis. This scale is used to evaluate the severity of nail bed psoriasis and nail matrix psoriasis by area of involvement in the nail unit. The NAPSI will be useful during clinical trials for evaluating response to treatment of psoriatic nails. The scale is reproducible, and because there are few data points, statistical analysis is simplified.
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              Brodalumab, an anti-IL17RA monoclonal antibody, in psoriatic arthritis.

              We assessed the efficacy and safety of brodalumab, a human monoclonal antibody against interleukin-17 receptor A (IL17RA), in a phase 2, randomized, double-blind, placebo-controlled study involving patients with psoriatic arthritis. We randomly assigned patients with active psoriatic arthritis to receive brodalumab (140 or 280 mg subcutaneously) or placebo on day 1 and at weeks 1, 2, 4, 6, 8, and 10. At week 12, patients who had not discontinued their participation in the study were offered open-label brodalumab (280 mg) every 2 weeks. The primary end point was 20% improvement in American College of Rheumatology response criteria (ACR 20) at week 12. Of the 168 patients who underwent randomization (57 in the brodalumab 140-mg group, 56 in the brodalumab 280-mg group, and 55 in the placebo group), 159 completed the double-blind phase and 134 completed 40 weeks of the open-label extension. At week 12, the brodalumab 140-mg and 280-mg groups had higher rates of ACR 20 than the placebo group (37% [P=0.03] and 39% [P=0.02], respectively, vs. 18%); they also had higher rates of 50% improvement (ACR 50) (14% [P=0.05] and 14% [P=0.05] vs. 4%). Rates of 70% improvement were not significantly higher in the brodalumab groups. Similar degrees of improvement were noted among patients who had received previous biologic therapy and those who had not received such therapy. At week 24, ACR 20 response rates in the brodalumab 140-mg and 280-mg groups were 51% and 64%, respectively, as compared with 44% among patients who switched from placebo to open-label brodalumab; responses were sustained through week 52. At week 12, serious adverse events had occurred in 3% of patients in the brodalumab groups and in 2% of those in the placebo group. Brodalumab significantly improved response rates among patients with psoriatic arthritis. Larger studies of longer duration are necessary to assess adverse events. (Funded by Amgen; ClinicalTrials.gov number, NCT01516957 .).
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                Author and article information

                Contributors
                nakajo_ko@lilly.com
                Journal
                J Dermatol
                J. Dermatol
                10.1111/(ISSN)1346-8138
                JDE
                The Journal of Dermatology
                John Wiley and Sons Inc. (Hoboken )
                0385-2407
                1346-8138
                11 October 2016
                April 2017
                : 44
                : 4 ( doiID: 10.1111/jde.2017.44.issue-4 )
                : 355-362
                Affiliations
                [ 1 ] Department of DermatologyNippon Medical School TokyoJapan
                [ 2 ] Department of DermatologyThe Jikei University School of Medicine TokyoJapan
                [ 3 ] Lilly Research LaboratoriesEli Lilly Japan K.K. KobeJapan
                [ 4 ] Lilly Research LaboratoriesEli Lilly and Company Indianapolis IndianaUSA
                Author notes
                [*] [* ]Correspondence: Ko Nakajo, M.D., Lilly Research Laboratories, Eli Lilly Japan K.K., Sannomiya Plaza Building, 7‐1‐5 Isogamidori, Chuo‐ku, Kobe 651‐0086, Japan. Email: nakajo_ko@ 123456lilly.com
                [†]

                Members of the Japanese Ixekizumab Study Group are present in the Acknowledgments section.

                Article
                JDE13622
                10.1111/1346-8138.13622
                5412888
                27726163
                335fdeab-9116-48c2-be3f-7fec3a0cf039
                © 2016 Eli Lilly Japan K.K. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 10 February 2016
                : 18 August 2016
                Page count
                Figures: 3, Tables: 4, Pages: 8, Words: 5767
                Funding
                Funded by: Eli Lilly Japan K.K. ProScribe's services
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jde13622
                April 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:02.05.2017

                erythrodermic psoriasis,generalized pustular psoriasis,ixekizumab,japan,plaque psoriasis

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