New entity of adult ultra-short coeliac disease: the first international cohort and case–control study

Background: Ultra-short coeliac disease (USCD) is defined as villous atrophy only present in the duodenal bulb (D1) with concurrent positive coeliac serology. We present the first, multicentre, international study of patients with USCD. Methods: Patients with USCD were identified from 10 tertiary hospitals (6 from Europe, 2 from Asia, 1 from North America and 1 from Australasia) and compared with age-matched and sex-matched patients with conventional coeliac disease. Findings: Patients with USCD (n=137, median age 27 years, IQR 21–43 years; 73% female) were younger than those with conventional coeliac disease (27 vs 38 years, respectively, p<0.001). Immunoglobulin A-tissue transglutaminase (IgA-tTG) titres at index gastroscopy were lower in patients with USCD versus conventional coeliac disease (1.8×upper limit of normal (ULN) (IQR 1.1–5.9) vs 12.6×ULN (IQR 3.3–18.3), p<0.001). Patients: with USCD had the same number of symptoms overall (median 3 (IQR 2–4) vs 3 (IQR 1–4), p=0.875). Patients with USCD experienced less iron deficiency (41.8% vs 22.4%, p=0.006). Both USCD and conventional coeliac disease had the same intraepithelial lymphocytes immunophenotype staining pattern; positive for CD3 and CD8, but not CD4. At follow-up having commenced a gluten-free diet (GFD) (median of 1181 days IQR: 440–2160 days) both USCD and the age-matched and sex-matched controls experienced a similar reduction in IgA-tTG titres (0.5 ULN (IQR 0.2–1.4) vs 0.7 ULN (IQR 0.2–2.6), p=0.312). 95.7% of patients with USCD reported a clinical improvement in their symptoms. Interpretation: Patients with USCD are younger, have a similar symptomatic burden and benefit from a GFD. This study endorses the recommendation of D1 sampling as part of the endoscopic coeliac disease diagnostic workup

Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey

Item does not contain fulltextBACKGROUND: Available literature on psoriasis and psoriatic arthritis (PsA) demonstrates a tremendous burden of disease and suggests underdiagnosis and undertreatment. OBJECTIVE: To obtain real-world physician perspectives on the impact of psoriasis and PsA and its treatment on patients' daily lives, including perceptions of, and satisfaction with, current therapies. METHODS: The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) surveyed dermatologists (n = 391) and rheumatologists (n = 390) in North America (Canada and the United States) and Europe (France, Germany, Italy, Spain and United Kingdom). RESULTS: Dermatologists classified 20.3% and 25.7% of their patients as having severe psoriasis and severe PsA respectively; rheumatologists indicated that 48.4% of their PsA patients had active disease. Of the psoriasis patients complaining of joint pain, only 33.0% had a diagnosis of PsA. An impact on daily activities or social/emotional well-being was recognized by 57.2% to 79.3% of physicians. In patients with moderate-to-severe psoriasis, dermatologists reported 74.9% were receiving topical therapy, 19.5% conventional oral therapy and 19.6% biologics. Dermatologists and rheumatologists reported similar rates of topical ( approximately 45%) and biologic ( approximately 30%) therapy utilization for their PsA patients; conventional oral therapy was more often prescribed by rheumatologists (63.4%) vs. dermatologists (35.2%). Reasons for not initiating or maintaining systemic therapies were related to concerns about long-term safety, tolerability, efficacy and costs (biologics). CONCLUSION: Physicians in North America and Europe caring for patients with psoriasis and PsA acknowledge unmet treatment needs, largely concerning long-term safety/tolerability and efficacy of currently available therapies; evidence suggests underdiagnosis of PsA and undertreatment of psoriasis among dermatologists

Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis:pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2) through 148 weeks

Altres ajuts: This publication was funded by Almirall R&D, Barcelona, Spain. K.R. has served as an advisor and/or paid speaker for and/or participated in clinical trials sponsored by AbbVie, Affibody, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Hakko Kirin, LEO Pharma, Lilly, Medac, Merck Sharp & Dohme, Miltenyi Biotec, Novartis, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB, Valeant and Xenoport. R.B.W. has received grants and/or honoraria from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, LEO Pharma, Novartis, Pfizer, Sanofi, UCB Pharma and Xenoport. L.I. has served as a consultant and/or paid speaker for and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Centocor, Eli Lilly, Janssen-Cilag, Kyowa, LEO Pharma, MSD, Novartis, Pfizer and UCB. L.P. has received grants or research support from or participated in clinical trials (paid to the institution) for AbbVie, Almirall, Amgen, Boehringer Ingelheim, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB; has received honoraria or consultation fees from AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, LEO Pharma, Lilly, Merck-Serono, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Regeneron, Roche, Samsung Bioepis, Sandoz, Sanofi and UCB; and has participated in company-sponsored speakers' bureaus for Celgene, Janssen, Lilly, Merck Sharp & Dohme, Novartis and Pfizer. A.I. has received honoraria for serving on advisory boards from Maruho, Janssen, AbbVie, Novartis, Eli Lilly Japan, Celgene and Sun Pharma Japan. M.O. has received honoraria for serving on advisory boards from Maruho, Janssen, AbbVie, Novartis, Eli Lilly Japan, Celgene, Eisai, Kyowa Hakko Kirin, LEO Pharma, Pfizer Japan, Mitsubishi Tanabe Pharma, Boehringer Ingelheim, Bristol-Myers Squibb Company and Sun Pharma Japan. I.P.-C. and M.F. are employees of Almirall. M.H. has served as a statistical consultant for Almirall. S.R. is an employee of Sun Pharmaceuticals. M.G.L. has received research funds (paid to the institution) from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Kadmon, LEO Pharma, Medimmune/AstraZeneca, Novartis, Ortho-dermatologics, Pfizer, Sciderm, UCB5 and Vidac; and is a consultant for Allergan, Aqua, Arcutis, Boehringer Ingelheim, Bristol-Myers Squibb, LEO Pharma, Menlo, Mitsubishi Pharma/Neuroderm LTD, Promius/Dr Reddy, Regeneron, Theravance Biopharma and Verrica. W.C. has received honoraria or fees for serving on advisory boards or as a speaker from Sun Pharmaceuticals, Lilly, Novartis and Janssen. A.B. has served as a scientific adviser and/or clinical study investigator for AbbVie, Aclaris, Akros, Allergan, Almirall, Amgen, Arena, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermavant, Dermira, Inc., Eli Lilly and Company, FLX Bio, Galderma, Genentech/Roche, GlaxoSmithKline, Janssen, LEO, Meiji, Merck Sharp & Dohme, Novartis, Pfizer, Purdue Pharma, Regeneron, Revance, Sandoz, Sanofi Genzyme, Sienna Pharmaceuticals, Sun Pharma, UCB Pharma, Valeant and Vidac; and as a paid speaker for Janssen, Regeneron and Sanofi Genzyme. D.T. has received honoraria or fees for serving on advisory boards, or as a speaker or consultant, from AbbVie, Almirall, Bioskin, Boehringer Ingelheim, Celgene, Dignity, Galapagos, GlaxoSmithKline, Janssen, LEO Pharma, Lilly, Medac, Merck Sharp & Dohme, Morphosys, Novartis, Pfizer, Regeneron, Samsung, Sandoz-Hexal, Sanofi, Sun Pharmaceuticals and UCB; and has received grants from Celgene and Novartis.Tildrakizumab is a specific anti-interleukin-23p19 monoclonal antibody approved for the treatment of plaque psoriasis. To evaluate the long-term efficacy and safety of tildrakizumab treatment for patients with moderate-to-severe psoriasis for up to 148 weeks. Pooled analysis from two double-blind, randomized controlled trials: re 1 and re 2. Efficacy was assessed for responders (≥ 75% improvement in Psoriasis Area and Severity Index; 75) and partial responders ( 50-75) to tildrakizumab 100 mg and 200 mg at week 28 who were maintained on the same dose (administered every 12 weeks), and for partial responders or nonresponders ( < 50) to etanercept 50 mg at week 28 who, after a 4-week washout, were switched to tildrakizumab 200 mg (administered at weeks 32 and 36, and every 12 weeks thereafter). Safety was assessed in the all-patients-as-treated population. Three different methods of imputing missing data were used: nonresponder imputation (), multiple imputation and observed cases. The Clinicaltrials.gov numbers are 01722331 (re 1) and 01729754 (re 2). At week 148 (), 72·6%, 53·8% and 28·9% of tildrakizumab 100-mg responders and 80·2%, 59·9% and 32·6% of tildrakizumab 200-mg responders had 75, 90 and 100 responses, respectively. For partial responders to tildrakizumab 100 mg and 200 mg, the proportions of patients achieving 75, 90 and 100 responses were 32·5%, 25·0% and 10·0%; and 47·1%, 27·5% and 12·8%, respectively. For patients who were partial responders or nonresponders to etanercept, the proportions of patients achieving 75, 90 and 100 responses were 66·9%, 43·8% and 14·9% at week 148. Rates of discontinuations due to adverse events [tildrakizumab 100 mg: 1·7 per 100 patient-years (s); tildrakizumab 200 mg: 1·2 per 100 s] and exposure-adjusted rates of serious adverse events (5·9 per 100 s; 5·5 per 100 s), severe infections (1·1 per 100 s; 1·1 per 100 s), malignancies (0·6 per 100 s; 0·4 per 100 s) and major adverse cardiovascular events (0·4 per 100 s; 0·5 per 100 s) were low. Tildrakizumab was well tolerated and efficacy was well maintained in week 28 responders who continued tildrakizumab treatment through 3 years, or improved among etanercept partial responders or nonresponders who switched to tildrakizumab. What's already known about this topic? What does this study add? available onlin

Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis : pooled analyses of two randomized phase clinical trials (re 1 and re 2) through 148 weeks

Altres ajuts: This publication was funded by Almirall R&D, Barcelona, Spain. K.R. has served as an advisor and/or paid speaker for and/or participated in clinical trials sponsored by AbbVie, Affibody, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Hakko Kirin, LEO Pharma, Lilly, Medac, Merck Sharp & Dohme, Miltenyi Biotec, Novartis, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB, Valeant and Xenoport. R.B.W. has received grants and/or honoraria from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, LEO Pharma, Novartis, Pfizer, Sanofi, UCB Pharma and Xenoport. L.I. has served as a consultant and/or paid speaker for and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Centocor, Eli Lilly, Janssen-Cilag, Kyowa, LEO Pharma, MSD, Novartis, Pfizer and UCB. L.P. has received grants or research support from or participated in clinical trials (paid to the institution) for AbbVie, Almirall, Amgen, Boehringer Ingelheim, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB; has received honoraria or consultation fees from AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, LEO Pharma, Lilly, Merck-Serono, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Regeneron, Roche, Samsung Bioepis, Sandoz, Sanofi and UCB; and has participated in company-sponsored speakers' bureaus for Celgene, Janssen, Lilly, Merck Sharp & Dohme, Novartis and Pfizer. A.I. has received honoraria for serving on advisory boards from Maruho, Janssen, AbbVie, Novartis, Eli Lilly Japan, Celgene and Sun Pharma Japan. M.O. has received honoraria for serving on advisory boards from Maruho, Janssen, AbbVie, Novartis, Eli Lilly Japan, Celgene, Eisai, Kyowa Hakko Kirin, LEO Pharma, Pfizer Japan, Mitsubishi Tanabe Pharma, Boehringer Ingelheim, Bristol-Myers Squibb Company and Sun Pharma Japan. I.P.-C. and M.F. are employees of Almirall. M.H. has served as a statistical consultant for Almirall. S.R. is an employee of Sun Pharmaceuticals. M.G.L. has received research funds (paid to the institution) from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Kadmon, LEO Pharma, Medimmune/AstraZeneca, Novartis, Ortho-dermatologics, Pfizer, Sciderm, UCB5 and Vidac; and is a consultant for Allergan, Aqua, Arcutis, Boehringer Ingelheim, Bristol-Myers Squibb, LEO Pharma, Menlo, Mitsubishi Pharma/Neuroderm LTD, Promius/Dr Reddy, Regeneron, Theravance Biopharma and Verrica. W.C. has received honoraria or fees for serving on advisory boards or as a speaker from Sun Pharmaceuticals, Lilly, Novartis and Janssen. A.B. has served as a scientific adviser and/or clinical study investigator for AbbVie, Aclaris, Akros, Allergan, Almirall, Amgen, Arena, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermavant, Dermira, Inc., Eli Lilly and Company, FLX Bio, Galderma, Genentech/Roche, GlaxoSmithKline, Janssen, LEO, Meiji, Merck Sharp & Dohme, Novartis, Pfizer, Purdue Pharma, Regeneron, Revance, Sandoz, Sanofi Genzyme, Sienna Pharmaceuticals, Sun Pharma, UCB Pharma, Valeant and Vidac; and as a paid speaker for Janssen, Regeneron and Sanofi Genzyme. D.T. has received honoraria or fees for serving on advisory boards, or as a speaker or consultant, from AbbVie, Almirall, Bioskin, Boehringer Ingelheim, Celgene, Dignity, Galapagos, GlaxoSmithKline, Janssen, LEO Pharma, Lilly, Medac, Merck Sharp & Dohme, Morphosys, Novartis, Pfizer, Regeneron, Samsung, Sandoz-Hexal, Sanofi, Sun Pharmaceuticals and UCB; and has received grants from Celgene and Novartis.Tildrakizumab is a specific anti-interleukin-23p19 monoclonal antibody approved for the treatment of plaque psoriasis. To evaluate the long-term efficacy and safety of tildrakizumab treatment for patients with moderate-to-severe psoriasis for up to 148 weeks. Pooled analysis from two double-blind, randomized controlled trials: re 1 and re 2. Efficacy was assessed for responders (≥ 75% improvement in Psoriasis Area and Severity Index; 75) and partial responders ( 50-75) to tildrakizumab 100 mg and 200 mg at week 28 who were maintained on the same dose (administered every 12 weeks), and for partial responders or nonresponders ( < 50) to etanercept 50 mg at week 28 who, after a 4-week washout, were switched to tildrakizumab 200 mg (administered at weeks 32 and 36, and every 12 weeks thereafter). Safety was assessed in the all-patients-as-treated population. Three different methods of imputing missing data were used: nonresponder imputation (), multiple imputation and observed cases. The Clinicaltrials.gov numbers are 01722331 (re 1) and 01729754 (re 2). At week 148 (), 72·6%, 53·8% and 28·9% of tildrakizumab 100-mg responders and 80·2%, 59·9% and 32·6% of tildrakizumab 200-mg responders had 75, 90 and 100 responses, respectively. For partial responders to tildrakizumab 100 mg and 200 mg, the proportions of patients achieving 75, 90 and 100 responses were 32·5%, 25·0% and 10·0%; and 47·1%, 27·5% and 12·8%, respectively. For patients who were partial responders or nonresponders to etanercept, the proportions of patients achieving 75, 90 and 100 responses were 66·9%, 43·8% and 14·9% at week 148. Rates of discontinuations due to adverse events [tildrakizumab 100 mg: 1·7 per 100 patient-years (s); tildrakizumab 200 mg: 1·2 per 100 s] and exposure-adjusted rates of serious adverse events (5·9 per 100 s; 5·5 per 100 s), severe infections (1·1 per 100 s; 1·1 per 100 s), malignancies (0·6 per 100 s; 0·4 per 100 s) and major adverse cardiovascular events (0·4 per 100 s; 0·5 per 100 s) were low. Tildrakizumab was well tolerated and efficacy was well maintained in week 28 responders who continued tildrakizumab treatment through 3 years, or improved among etanercept partial responders or nonresponders who switched to tildrakizumab. What's already known about this topic? What does this study add? available onlin