Current advances in biological therapy of psoriasis: Efficacy of guselkumab in real clinical practice

Psoriasis is an immune-mediated, chronic inflammatory skin disease, which is currently regarded as a systemic process given its association with multiple comorbid conditions. In psoriasis, there is a complex interaction between T cells and keratinocytes. The pathogenesis of psoriasis is not fully understood, but the IL-23/Th17 pathway is known to play the key role in the development of the disease. With the advent of genetically engineered biological drugs (GEBD), the treatment of psoriasis has undergone significant changes due to their high efficacy through targeted effects. Guselkumab is the first drug for the treatment of moderate to severe psoriasis to target the p19 subunit of interleukin (IL) 23. The efficacy of guselkumab has been demonstrated in a number of clinical trials. To date, only a few case studies from actual clinical practice have been published in the literature reflecting the use of guselkumab in severe psoriasis, including long-term drug survival and continued efficacy in patients with comorbidities. The article reviews the results of key efficacy studies of guselkumab and presents its own clinical case studies of successful use of the drug. It is noted that guselkumab is able to replicate the results obtained in studies in real clinical practice. However, the cases presented are also of interest in view of their concomitant metabolic syndrome, obesity, which often makes it difficult to respond to therapy. This group of patients is usually characterised by a particularly torpid course of psoriasis and a certain refractoriness to the ongoing treatment. Thus, guselkumab has an effective and safe profile, in addition it is convenient to use, and the improvement in the quality of life of patients during therapy makes it promising as a first-line GEBD therapy in the treatment of psoriasis. © 2022, Remedium Group Ltd. All rights reserved

Vascular endothelial growth factor inhibitors for retinopathy of prematurity

O.V. Zhukova1, I.A.&nbsp;Mal’tseva2, A.V. Zolotarev1,2 1Samara State Medical University, Samara, Russian Federation 2T.I. Eroshevskiy Samara Regional Clinical Ophthalmological Hospital, Samara, Russian Federation The article addresses current treatment modalities for threshold retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP), in particular, intravitreal administration of vascular endothelial growth factor (VEGF) inhibitors. The results of multicenter clinical trials evaluating pegaptanib, bevacizumab, and ranibizumab are discussed. The clinical effect of intravitreal anti-VEGF drugs was compared to the efficacy of laser retinal photocoagulation. In children with ROP, anti-VEGF drugs are equal or even superior to the conventional laser retinal photocoagulation in terms of clinical efficacy. No negative effects of anti-VEGF drugs on ocular tissues or vasculature development in premature children were demonstrated. Moreover, several studies show the potential efficacy of intravitreal anti-VEGF drugs plus avascular zone photocoagulation for APROP. Finally, our experience with intravitreal ranibizumab for threshold ROP and plus d isease in a patient who was followed-up for subsequent 9 years is described. Keywords: retinopathy of prematurity, plus disease, aggressive posterior retinopathy of prematurity, anti-VEGF drugs, ranibizumab. For citation: Zhukova O.V., Mal’tseva I.A., Zolotarev A.V. Vascular endothelial growth factor inhibitors for retinopathy of prematurity. Russian Journal of Clinical Ophthalmology. 2020;20(4):216–220. DOI: 10.32364/2311-7729-2020-20-4-216-220. <br

Psoriasis: A personalized approach to therapy. the preferred choice of systemic agents considering comorbid pathologies

Psoriasis is a chronic inflammatory skin disease that is currently viewed as a systemic process due to its association with many comorbid conditions. With the appearance of genetically engineered biological drugs (GEBDs), the treatment of psoriasis has undergone significant changes due to their high efficiency and favorable safety profile. It has been clinically proven that the use of this type of therapy has a positive effect, including on comorbid diseases. However, it must be highlighted that some types of drugs can have a negative effect on the course of these conditions. The characteristics of each individual drug, such as the rate of onset of remission, long-term efficacy, safety profile and effect on comorbidities are different. A better understanding of these characteristics leads to the correct personalized choice of therapy, hence to improved survival of drugs, patient satisfaction and minimization of the impact of psoriasis on the quality of life of patients. This article examines the efficacy and safety of biological drugs in patients with psoriasis, discusses their effect on concomitant diseases pathogenetically associated with psoriasis. To date it is known that the signaling pathway IL-23 / IL-17 plays a key role in the pathogenesis of psoriasis. Promising results are shown by the use of a biological drug aimed at inhibiting IL-23, namely the IL-23 blocker guselkumab. In addition to the high level of therapeutic response in psoriasis, other properties oа the drug have been identified-it has also shown efficacy in patients with concomitant Crohn’s disease. Studies describe positive responses in the guselkumab treatment of psoriasis with “difficult” localisations, psoriatic arthritis and Hidradenitis Suppurativa, and its use in patients with cardiovascular risks did not lead to any manifestations of negative dynamics. Thus, further study of the effect of the IL-23 blocker on comorbid pathologies in psoriasis is a promising area. © 2020, Remedium Group Ltd. All rights reserved

Successful use of netakimab in the treatment of psoriasis accompanied by the psoriatic onychodystrophy

Psoriasis is a chronic immune-mediated disease that is accompanied by a significant number of comorbid pathologies. Damage to the nail plates (psoriatic onychodystrophy) is widespread among patients with psoriasis and is associated with significant func-tional as well as psychosocial impairments. Despite the fact that nails constitute a small percentage of the surface of the human body, the damage to this particular area can lead to a deterioration in the quality of life and irreversible disability. In addition, studies have shown that nail psoriasis is indicative of a more severe course of the disease and it can also be associated with psoriatic arthritis or it can be a predictor of its development. Current treatment options for psoriasis accompanied by the nail plates damage include many topical and systemic methods, however, patients often report dissatisfaction with the results of treatment due to low efficacy or many side effects. Achieving higher efficiency is possible with the use of biologic therapy. Currently, a wide range of biologics have been developed that modulate key elements in the immunopathogenesis of psoriasis. The pathogenesis of psoriasis is a multifactorial process, however, it is the IL23 / Th17 signaling pathway that is key in this process. Interleukin-17A is the principal effector of this pathway and overexpression of IL-17A leads to epidermal hyperplasia and an excessive inflammatory response seen in psoriasis. Therefore, interleukin-17A is a promising therapeutic target. Considering the critical pathogenetic role as well as the high efficacy and safety of IL-17A inhibitors, the study of their effect on the psoriatic onychodystrophy manifestations is of great clinical importance. Netakimab is the first Russian original IL-17 inhibitor which is a promising modern agent for the treatment of moderate-to-severe plaque psoriasis. The obtained real clinical data indicate the high efficacy and safety of the use of Netakimab in patients with both plaque psoriasis and «severe» psoriasis in difficult to treat localizations, such as damage of the nail plate. © 2020, Remedium Group Ltd. All rights reserved

General and dermatological morbidity of the rural population of cotton-sowing and horticultural regions

In order to develop the preventive measures and to plan the volume of medical services the data on morbidity in relation to environmental factors are of great importance. Consequently, the investigation of the population incidence including the skin and subcutaneous tissue diseases in people who are in direct contact with mineral fertilizers, as well as those living in the area of their usage is relevant. Objective. To conduct a comparative analysis of the rural residents’ incidence taking into accounts the load of mineral fertilizers per hectare of arable area. Material and methods. The object of the study was the population living in two rural areas of the Tashkent region — cotton sowing and horticultural. The research was used the materials of statistical reporting on the volume of mineral fertilizers used, the population’ interview results and examination of persons with skin manifestation, also medical-statistical and analytical methods. Results. Among the population of rural areas the most common were the diseases of the digestive system, musculoskeletal system and connective tissue, blood and hematopoietic organs. In the general structure of chronic conditions the diseases of the skin and subcutaneous tissue among the inhabitants of the horticultural region took the 8th place and the cotton-growing region — the 9th place. At the same time, the frequency of the skin and subcutaneous tissue diseases was 2.5 times higher in the main area than in the control one (p<0.05). The peculiarities of the structure of skin diseases in the surveyed areas consisted in the prevalence of allergic diseases. A comparative analysis of the clinical manifestations of dermatological diseases in residents of the two regions showed a stronger skin pathological process in the Chinaz region. Conclusion. The level and internal structure of the general and dermatological morbidity of the rural population depend on the amount of mineral fertilizers used and caused by the influence of exogenous social and endogenous biological factors. © 2021, Media Sphera Publishing Group. All rights reserved

Assessment of risk factors contributing to the dermatological morbidity, and analysis of concomitant conditions

A comprehensive analysis of unfavorable exogenous-social and endogenous-biological risk factors affecting the health makes it possible to determine their contribution to morbidity in the rural population under conditions of significant loads of mineral fertilizers. Objective. To determine the main exogenous-social and endogenous-biological risk factors that contribute to the dermatological morbidity, and to analyze the concomitant pathology of the population living in rural areas. Material and methods. Objects of the study - 91 out of 680 respondents with skin disease established by a doctor. The studies were carried out on the territory of Bostanlyk (fruit and vegetable) and Chinaz (cotton-growing) rural areas of the Tashkent region of the Republic of Uzbekistan. Results. When conducting a comparative assessment of social and hygienic living conditions, sanitary and hygienic working conditions, medical and biological factors and lifestyle of the rural population of the cotton-growing (main) and horticultural (control) districts of Tashkent region, statistically significant differences were revealed, criteria for identifying the contingent of the high-risk group were determined, and likelihood prognosis of dermatological pathology is given. Conclusion. The contingent of the high-risk group for dermatological morbidity was formed consistently, mainly due to such factors as professional activities related to agriculture, low level of physical activity, the presence of concomitant chronic diseases, irrational organization of recreation, non-use of personal protective equipment, unfavorable living conditions, low educational level, burdened dermatological history, working age, unfavorable working conditions, female gender, low level of medical care, underwear and clothes made of unnatural types of fabric. © 2021, Media Sphera Publishing Group. All rights reserved

Regional population patterns of congenital epidermolysis bullosa and prevention approaches

The prevalence of epidermolysis bullosa (EB) and the proportion of different types vary significantly in populations of various countries and con-stituent units of the Russian Federation, which determines approaches to follow-up, prevention, and symptomatic therapy. Objective. To perform an epidemiological analysis of EB in Dagestan and determine ways to its prevention and follow-up. Material and methods. Between 2019 and 2021, patients with confirmed and suspected EB were examined. Results and conclusion. By 2021, 130 BE patients were registered. Of these, 64% were diagnosed with simple type, 6% with borderline type, 28% with dystrophic type and 1% with Kindler syndrome. In the Republic of Dagestan, the percentages of patients with recessively and domi-nantly inherited mutations are approximately the same. In patients with dominant type, a thorough clinical examination is necessary, and in patients with recessive type, a detailed family history should be taken. Patients with a family history of EB or those included in the risk group should be closely monitored by a pediatrician and dermatologist until the age of 6—7 years. Considering that Dagestan is a southern region and the climate there is hot, a bunch of preventive measures during the summer is required. It is necessary to provide patients with EB to stay in a room with artificially cooled air, create a safe environment, reduce (exclude) physical activity, household chores. © 2022, Media Sphera Publishing Group. All rights reserved