William Abramovits M.D.

Gupta, A. K., S. G. Versteeg, W. Abramovits and K. D. Vincent (2018). “Ilumya(R) (Tildrakizumab): A Newly Approved Interluekin-23 Antagonist for the Treatment of Plaque Psoriasis.” Skinmed 16(5): 321-324.

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Ilumya is the second of probably three monoclonal antibodies against IL-23 to enter the market for plaque psoriasis treatment, and possibly for psoriatic arthritis. Studies comparing drugs in this class and with anti-IL-17 are underway. Tildrakizumab displayed higher treatment success rates in plaque psoriasis patients, with a long-lasting and expedient response with over 50% of tildrakizumab-treated patients reporting PGA scores of 0 or 1 by week 12. Administration of tildrakizumab (100 mg) at weeks 0 and 4, and every 12 weeks thereafter is recommended for the treatment of moderate-to-severe plaque psoriasis. Due to the impact of tildrakizumab on the IL-23, IL-17 and tumor necrosis factor (TNF) pathways, this IL-23 antagonist may also be a beneficial treatment for psoriatic arthritis and axial spondyloarthropathies. (Excerpt from text, p. 324; no abstract available.)

Blauvelt, A., K. Reich, S. Mehlis, F. Vanaclocha, H. Sofen, W. Abramovits, Y. Zhao, I. Gilloteau, E. Davenport, N. Williams, A. Guana and S. Tyring (2017). “Secukinumab demonstrates greater sustained improvements in daily activities and personal relationships than ustekinumab in patients with moderate-to-severe plaque psoriasis: 52-week results from the clear study.” J Eur Acad Dermatol Venereol: 2017 Jun [Epub ahead of print].

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BACKGROUND: Psoriasis can greatly impact patients’ lives by influencing clothing worn as well as by impairing sexual functioning. Secukinumab, a human monoclonal antibody selectively neutralizing interleukin-17A, has demonstrated good efficacy and safety in the treatment of moderate-to-severe psoriasis and psoriatic arthritis with a rapid onset of action and sustained response. OBJECTIVE: This analysis using the CLEAR study, a phase 3b double-blind study comparing the efficacy and safety of secukinumab versus ustekinumab in adults with moderate-to-severe plaque psoriasis, evaluated the treatment effects on patient’s daily activities and personal relationships. METHODS: Impact on daily activities (interference with home/shopping/garden, and influence on clothes worn) and impact on personal relationships (problems with partner/others, and sexual difficulties) as well as their corresponding subscales were selected from the Dermatology Life Quality Index scale and evaluated for patients treated with secukinumab vs. ustekinumab from the CLEAR study. Treatment differences in mean scores and proportions of responders (score = 0, indicating no impact) were evaluated through 52 weeks. Time to response was evaluated through week 16. RESULTS: Significant differences between secukinumab and ustekinumab were observed for daily activities and personal relationship at week 16 and sustained through Week 52 (Week 52 response rates for daily activities: 82.9% vs. 73.5%, including interference with home/shopping/garden: 88.5% vs. 78.2%, and influence on clothes worn: 85.6% vs. 74.4%; personal relationship: 86.1% vs. 73.7%, including problems with partner/others: 86.6% vs. 74.8%, and sexual difficulties: 88.5% vs. 74.3%; all P < 0.01). The median time to response was 4 weeks for secukinumab versus 8 weeks for ustekinumab for daily activities and personal relationships (both P < 0.05). CONCLUSION: Secukinumab treatment helps patients with moderate-to-severe plaque psoriasis have a more normal life faster when compared to ustekinumab, by providing greater and sustained improvement in clothing choice and sexual functioning.

Gupta, A. K., J. Carviel and W. Abramovits (2016). “Treating alopecia areata: Current practices versus new directions.” Am J Clin Dermatol: 2016 Oct [Epub ahead of print].

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Alopecia areata (AA) is non-scarring hair loss resulting from an autoimmune disorder. Severity varies from patchy hair loss that often spontaneously resolves to severe and chronic cases that can progress to total loss of scalp and body hair. Many treatments are available; however, the efficacy of these treatments has not been confirmed, especially in severe cases, and relapse rates are high. First-line treatment often includes corticosteroids such as intralesional or topical steroids for mild cases and systemic steroids or topical immunotherapy with diphenylcyclopropenone or squaric acid dibutylester in severe cases. Minoxidil and bimatoprost may also be recommended, usually in combination with another treatment. Ongoing research and new insights into mechanisms have led to proposals of innovative therapies. New directions include biologics targeting immune response as well as lasers and autologous platelet-rich plasma therapy. Preliminary data are encouraging, and it is hoped this research will translate into new options for the treatment of AA in the near future.

Gupta, A. K., J. L. Carviel and W. Abramovits (2016). “Efficacy of tofacitinib in treatment of alopecia universalis in two patients.” J Eur Acad Dermatol Venereol: 2016 June [Epub ahead of print].

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BACKGROUND: Autoimmune-triggered non-scarring hair loss is a feature of alopecia areata (AA). Initially patchy and often self-limited, severe hair loss forms include the complete loss of scalp hair or alopecia totalis (AT) and complete loss of all hair or alopecia universalis (AU). For AT and AU a reliable treatment has remained elusive. The targeted kinase inhibitor tofacitinib, in current use for treatment of other immune diseases, has been hypothesized as a viable option for AA, AT and AU therapy and a few case reports support this. OBJECTIVE: Our study aims to provide evidence for the effectiveness of tofacitinib in the treatment of AU. METHODS: Two patients diagnosed with long-term AU were prescribed tofacitinib citrate at a dosage of 5 mg twice daily and observed for eight months. RESULTS: In the first patient, beard growth was significant by 3 months of treatment. By 6 months of treatment, hair growth was apparent throughout the entire body. By 8 months of treatment, scalp hair continued to grow longer and thicker. In addition, eyelashes and eyebrows were established. In the second patient, a noticeable increase in scalp hair was present just 1 month into treatment. By 4 months into treatment, significant scalp regrowth was observed as well as eyelash, eyebrow and beard regrowth. Axillary hair regrowth and isolated leg hair was noted by 8 months. CONCLUSION: In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side-effects. We recommend that further study be required to establish safety and confirm efficacy.