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Phase 3 Trials of Ixekizumab in Moderate-to-Severe Plaque Psoriasis

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TLDR
In three phase 3 trials involving patients with psoriasis, ixekizumab was effective through 60 weeks of treatment and the benefits need to be weighed against the risks of adverse events.
Abstract
BackgroundTwo phase 3 trials (UNCOVER-2 and UNCOVER-3) showed that at 12 weeks of treatment, ixekizumab, a monoclonal antibody against interleukin-17A, was superior to placebo and etanercept in the treatment of moderate-to-severe psoriasis. We report the 60-week data from the UNCOVER-2 and UNCOVER-3 trials, as well as 12-week and 60-week data from a third phase 3 trial, UNCOVER-1. MethodsWe randomly assigned 1296 patients in the UNCOVER-1 trial, 1224 patients in the UNCOVER-2 trial, and 1346 patients in the UNCOVER-3 trial to receive subcutaneous injections of placebo (placebo group), 80 mg of ixekizumab every 2 weeks after a starting dose of 160 mg (2-wk dosing group), or 80 mg of ixekizumab every 4 weeks after a starting dose of 160 mg (4-wk dosing group). Additional cohorts in the UNCOVER-2 and UNCOVER-3 trials were randomly assigned to receive 50 mg of etanercept twice weekly. At week 12 in the UNCOVER-3 trial, the patients entered a long-term extension period during which they received 80 mg of ixeki...

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Citations
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Psoriasis Pathogenesis and Treatment.

TL;DR: The role of genetics, associated epigenetic mechanisms, and the interaction of the skin flora in the pathophysiology of psoriasis is described, which includes a comprehensive review of well-established widely available therapies and novel targeted drugs.
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TL;DR: Clinical trial data for mAbs against IL‐17 signaling and newer IL‐23p19 antagonists underscore the central role of these cytokines as predominant drivers of psoriatic disease.
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Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.

TL;DR: The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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IL-17 Signaling: The Yin and the Yang

TL;DR: This review discusses both the activators and the inhibitors of IL-17 signal transduction, and also the physiological implications of these events, and highlights the surprisingly diverse means by which these regulators control expression ofIL-17-dependent inflammatory genes, as well as the major target cells that respond to IL- 17 signaling.
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The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies

TL;DR: Current understanding of the AD immune map in both patients with early-onset and those with chronic disease is discussed, with a focus on a systemic treatment approach in patients with moderate-to-severe disease.
References
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Journal ArticleDOI

A distinct lineage of CD4 T cells regulates tissue inflammation by producing interleukin 17

TL;DR: In vivo, antibody to IL- 17 inhibited chemokine expression in the brain during experimental autoimmune encephalomyelitis, whereas overexpression of IL-17 in lung epithelium caused Chemokine production and leukocyte infiltration, indicating a unique T helper lineage that regulates tissue inflammation.
Journal ArticleDOI

Mechanisms of Disease: Psoriasis.

TL;DR: Anti-TNF strategies have three variants: a humanized chimeric anti–TNF- α monoclonal antibody, a fully human monocolonal anti-T NF- α antibody, and a human p75 TNF-receptor Fc fusion protein.
Journal ArticleDOI

Psoriasis causes as much disability as other major medical diseases.

TL;DR: Different aspects of psoriasis are related to the different dimensions of HRQL supporting the need for multidimensional treatment models, similar to that of other major medical diseases.
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