DTA

Digital Theses Archive

 

Tesi etd-11112021-184016

Type of thesis
Corsi integrativi
Author
MANZO MARGIOTTA, FLAVIA
URN
etd-11112021-184016
Title
REAL LIFE EXPERIENCE ON THE USE OF ANTI IL-17 AND IL-23 MONOCLONAL ANTIBODIES IN THE TREATMENT OF MODERATE TO SEVERE PSORIASIS
Structure
Cl. Sc. Sperimentali - Medicina
Course
SCIENZE MEDICHE - SCIENZE MEDICHE
Committee
relatore Prof. PASSINO, CLAUDIO
Relatore Prof. Marco Romanelli
Relatore Prof.ssa Valentina Dini
Relatore Dott. Salvatore Panduri
Membro Prof. EMDIN, MICHELE
Membro Prof. LIONETTI, VINCENZO
Membro Prof. RECCHIA, FABIO ANASTASIO
Membro Prof. COCEANI, FLAVIO
Membro Prof. GIANNONI, ALBERTO
Membro Prof.ssa ANGELONI, DEBORA
Membro Dott.ssa CASIERI, VALENTINA
Keywords
  • IL-17
  • IL-23
  • monoclonal antibodies
  • psoriasis biologic therapy
Exam session start date
20/12/2021;
Availability
parziale
Abstract
Psoriasis is a chronic inflammatory skin disease whose systemic implications are progressively emerging in the scientific community. The central role of Th1 and interleukin (IL) 17/23 axis in psoriasis pathogenesis represents the rationale of using monoclonal antibodies (mAb) anti IL-17 for the treatment of moderate to severe forms. The aim of our study is to provide a real-life experience on the use of those classes of mAb extrapolating clinical and managerial considerations. We have then set a single-center observational, descriptive study whose objective can be broken down into three fundamental sub-objectives. The first one is to evaluate the putative clinical risk factors that lead to the need for therapeutic change in psoriatic patients treated with Secukinumab and Ixekizumab, both anti IL-17 mAb. The second one is to provide a real-life experience of the role of Guselkumab in the clinical management of moderate to severe psoriasis, analyzing the most important clinical and anamnestic features of our population. The third one is to elaborate a comparison of maximal therapeutic response between bio-naive and bio-experienced patients undergoing anti IL-17 and IL-23 mAb therapy for moderate and severe psoriasis. Our results demonstrated that family history of psoriasis was associated with a lower risk of switching therapy from Ixekizumab or Secukinumab both at the univariate and multivariate analysis [p-value 0.004; Hazard Ratio (HR) 0.274]. Moreover, we found out that the timelines of clinical efficacy for patients undergoing therapy with Guselkumab are in line with those obtained from previous studies [Psoriasis Area Severity Index (PASI), PASI 75,90, and 100 achieved on average on weeks 14,19,21 respectively], thus confirming that Guselkumab is an excellent choice in terms of security, long-term efficacy and overall tolerance. Finally, we showed that bio-naive patients were more likely to overall achieve PASI 75, PASI 90 and PASI 100 rather than bio-experienced patient, even in shorter times [HR 1,339 (p-value 0,034); HR 1,365 (p-value 0,031); HR 1,596 (p-value 0,007), respectively]. To conclude, our experience to the real life studies on the clinical efficacy of interleukin 17 and 23 inhibitors, suggesting new clinical factors for the optimization of therapy and for the maintenance of long-term results.
Files