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Medscape
29-05-2025
- Business
- Medscape
Spesolimab Provides Sustained Improvement of GPP and QOL
In a secondary analysis of phase 2b spesolimab data in generalized pustular psoriasis (GPP), nearly two-thirds of patients who received 300 mg monthly doses maintained clear or nearly clear skin through 48 weeks' follow-up, and nearly one quarter of treated patients maintained minimal GPP impact on quality of life (QOL). Nevertheless, investigators said, the presence of moderate QOL impairment despite clear or nearly clear skin at baseline highlighted the chronic nature of GPP and patients' need for effective long-term treatment. Similar observations emerged from a separate study that characterized GPP flares and treatment patterns. Skin Symptoms and QOL In the post hoc analysis of Effisayil 2 data, investigators led by Kenneth B. Gordon, MD, professor of dermatology, Medical College of Wisconsin, Milwaukee, found that overall, 20.0% of patients who received monthly subcutaneous spesolimab 300 mg (after a 600 mg subcutaneous loading dose) had sustained improvement in both GPP Physician Global Assessment (GPPGA) and Dermatology Life Quality Index (DLQI) scores through week 48 compared with 3.2% of the placebo cohort. Regarding skin manifestations, 63.3% of patients treated with spesolimab experienced sustained improvement, which investigators defined as having a GPPGA score of 0/1 at all Effisayil 2 study visits through week 48 without other investigator-prescribed medications. The corresponding figure among patients on placebo was 29.0%. The study recently appeared in the Journal of the American Academy of Dermatology ( JAAD ). As for QOL, 24.1% of spesolimab-treated patients maintained DLQI scores of 0/1 through week 48 vs 3.2% for placebo. Patients reported at baseline that GPP's biggest impact on QOL stemmed from itch, soreness, and pain; embarrassment; and the disease's effects on social activities and clothing choices. Although patients in Effisayil 2 had GPPGA 0/1 at baseline, Gordon and colleagues noted that the mean baseline DLQI scores of 11.1 and 7.2 in the 300 mg monthly and placebo groups, respectively, indicated that despite patients' having clear or nearly clear skin, moderate QOL burden persisted. Spesolimab, a monoclonal antibody that blocks interleukin (IL)-36 signaling known to be involved in GPP, was first approved by the US Food and Drug Administration in 2022 for treating flares in adults with GPP. Approval was expanded in 2024 for the treatment of GPP in adults and in pediatric patients aged ≥ 12 years who weigh ≥ 40 kg. Real-World Data In a separate study also recently published in JAAD , investigators found that among 638 eligible patients with GPP from the OMNY Health real-world data platform, 63% experienced at least one GPP flare between January 2017 and January 2023. The mean annualized flare rate was 0.91 per patient per year, with a mean inter-flare interval of 5.9 months. Patients who experienced flares were more likely to be women, younger than 65 years, non-White, Hispanic, or Latino, and had moderate or severe GPP and a history of infectious or parasitic disease. Treatment strategies were diverse, nonstandardized, and off-label, with patients frequently switching or discontinuing biologics and/or nonsteroidal systemic treatments. 'GPP patients continue to experience frequent flares with traditional off-label therapies in the real-world setting,' wrote authors led by Jamie W. Rhoads, MD, MS, of the University of Utah School of Medicine, Salt Lake City. Among patients who experienced multiple flares, they added, 66% had a second flare within 6 months of their first. Together, said James G. Krueger, MD, PhD, the D. Martin Carter professor in clinical investigation and co-director of the Center for Clinical and Translational Science at The Rockefeller University, New York City, the two papers examine how patients view their health status between flares and what the frequency of reflaring might be. He was not involved with the studies but provided comments in an interview with Medscape Medical News . Fear of Flaring Patients worry about GPP flares, said Krueger, because such flares constitute a medical emergency with potentially severe, life-threatening symptoms that could require hospitalization for weeks while receiving traditional immunosuppressants. And GPP is so rare that a practicing dermatologist may see only a few cases in their career. 'Given that almost no center takes in this type of patient,' he added, 'there's a lack of knowledge about the natural course of GPP and how best to manage patients with this disease.' James G. Krueger, MD, PhD Before spesolimab's approval for GPP, he said, broadly acting immunosuppressants targeted GPP indirectly. The fact that doctors could quell flares using such medications did not mean that patients' inflammation had resolved, Krueger added. 'It means their inflammatory state may have been suppressed to the point that they didn't need hospitalization. But many of these patients report significant symptoms or quality-of-life issues between flares.' Mechanistically, Krueger said, only around one quarter of patients with GPP possess a genetic mutation in a control protein called the IL-36 receptor antagonist, which normally would prevent the overblown IL-36 response that characterizes GPP. Nevertheless, he said, the mutation spotlights the IL-36 cytokine family as the most important, consistent aberration in causing GPP. 'This is one of the instances where a rare disease has a known genetic association, and that genetic problem can be fixed to a large extent by a therapeutic antibody. This antibody essentially replaces the function of the missing protein by binding to a receptor for IL-36 in a way that prevents it from being activated.' Accordingly, said Krueger, spesolimab approximates a molecular replacement therapy for GPP. 'And I believe that's why spesolimab works remarkably fast.' Ultimately, Krueger said, both articles mainly address medical dermatologists at referral centers who treat patients with more complicated GPP flares. 'The general practitioner should be aware that there are care pathways for acute and chronic GPP that may keep people under enough control that they can avoid recurrent emergency visits to either a dermatologist or an emergency room.' The new information about the likelihood that a patient will have lifelong disease 'helps with getting into the mindset that you're going to need to manage most of these patients over a long time period, not episodically,' he added. The spesolimab study was supported by Boehringer Ingelheim, maker of spesolimab; authors reported financial relationships with many companies that manufacture psoriasis drugs, including AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, and others. The second study was also supported by Boehringer Ingelheim. Rhoads had received consulting fees from Boehringer Ingelheim, Eli Lilly, and Genentech. Another author of the second study is an employee of OMNY Health, a contractor to Boehringer Ingelheim for the real-world study, and had received consulting fees from Boehringer Ingelheim, Eli Lilly, and Genentech. Two authors are Boehringer Ingelheim employees, and another author had received research grants and is a consultant to and had received honoraria from Boehringer Ingelheim. Krueger has been a consultant and lecturer for Boehringer Ingelheim and has analyzed biopsy samples from Effisayil 1 and 2 for future publications, but he is not an Effisayil author.
Time of India
20-05-2025
- Health
- Time of India
The shocking truth: 80% of sunscreens don't work and could harm your skin!
A recent study highlights a significant gap in sun protection practices among Americans, with many sunscreens offering inadequate protection or containing potentially harmful ingredients. Men are particularly lax in sunscreen application, while even women fall short of ideal usage. Fresh findings published in the Journal of the American Academy of Dermatology reveal a worrying gap between what Americans know they ought to do and what they actually do to protect their skin. 80% of sunscreens don't really work or have 'worrisome' ingredients, as per researchers working in the domain of skin. When scientists at the Centres for Disease Control and Prevention (CDC) asked how often people applied sunscreen before spending more than an hour in the sun, barely 14 percent of men said they reached for the SPF regularly. Women performed better, though still far from ideal, at 30 percent, leaving men more likely to admit they never bother with sun cream at all. Yet lax application is only part of the story. In its sunscreen guide (2015 edition), the Environmental Working Group (EWG) had evaluated more than 1,700 sun‑care products - including creams, lip balms and daily moisturisers and concluded that four out of five deliver sub‑par protection or contain ingredients of concern. Chief among those red flags is oxybenzone, a potential hormone disruptor, and the addition of vitamin A (retinyl palmitate), which some, though not all, studies suggest may increase photosensitivity. Neutrogena came under particular scrutiny. Despite marketing certain baby formulas as 'special protection from the sun and irritating chemicals' and proudly labelling them 'hypoallergenic', the products still include methylisothiazolinone, a preservative the European Commission's Scientific Committee on Consumer Safety has deemed unsuitable for leave‑on cosmetics. The brand also touts headline SPFs of 70 and even 100+, although the US Food and Drug Administration maintains that meaningful benefits plateau around SPF 50. (Neutrogena did not comment before publication.) EWG's report features a 'Hall of Shame' catalogue for the least reliable products, alongside a searchable database that lets consumers check their current sunscreen or hunt for a safer, more effective alternative. Dermatologists' summer survival checklist remains straightforward: choose a broad‑spectrum sunscreen with an SPF of at least 15, minimise direct sun exposure, especially at midday, cover up with clothing, and reapply your chosen sun cream every couple of hours (or immediately after swimming or heavy perspiration). Consistency, rather than an eye‑watering SPF number, is still the surest route to healthy, youthful skin. How to know which sunscreen to buy Choosing the right sunscreen goes beyond picking the highest SPF on the shelf. Dermatologists recommend looking for a broad-spectrum formula, which protects against both UVA rays (ageing) and UVB rays (burning). An SPF of 30 to 50 is ideal for most people, anything higher offers only marginally better protection. Check the ingredient list: physical (or mineral) sunscreens containing zinc oxide or titanium dioxide are often better for sensitive skin and provide immediate protection. Avoid chemical ingredients like oxybenzone, which has been linked to hormone disruption, and retinyl palmitate (vitamin A), which may increase sun sensitivity. Water resistance is also key, especially if you'll be swimming or sweating. Look for labels that state 'water-resistant (40 or 80 minutes)'. For daily use, especially under makeup, consider lightweight formulations like gel-based sunscreens or tinted moisturisers with SPF. If you're shopping for children or those with allergies, choose fragrance-free and hypoallergenic products but still double-check the ingredient list, as some brands misuse these terms. Finally, consult tools like the EWG's sunscreen database to review safety ratings and effectiveness. The best sunscreen is the one you will wear consistently, so find a formula that suits your skin type, lifestyle, and preferences. One step to a healthier you—join Times Health+ Yoga and feel the change
Medscape
15-05-2025
- Health
- Medscape
Psoriasis Tied to Kidney Disease in T2D, Despite Treatment
Patients with type 2 diabetes (T2D) who have psoriasis showed an increased risk for renal disease, including diabetic neuropathy, chronic kidney disease (CKD), end-stage renal disease (ESRD), and dialysis despite renoprotective therapy, while CKD risk had increased at 10 years after starting treatment among those receiving biologics. METHODOLOGY: Researchers conducted a retrospective cohort analysis using TriNetX data from 2014-2024, which included patients with T2D who started treatment with angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), or sodium-glucose cotransporter-2 inhibitors (SGLT2is). After propensity score matching, 27,044 patients were included in two cohorts — with and without psoriasis, diagnosed before starting renoprotective therapy. A total of 7771 patients with psoriasis received biologics, including interleukin (IL)-23, IL-17, IL-12/23, or tumor necrosis factor (TNF) alpha inhibitors. Study outcomes were diabetic nephropathy, CKD, ESRD, and need for dialysis at 3, 5, and 10 years. TAKEAWAY: At 3 years, patients with psoriasis demonstrated a significantly higher risk for diabetic nephropathy (absolute risk increase [ARI], 1.31; P < .0001), CKD (ARI, 1.80; P < .0001), ESRD (ARI, 0.38; P < .0001), and dialysis (ARI, 0.28; P < .0001). < .0001), CKD (ARI, 1.80; < .0001), ESRD (ARI, 0.38; < .0001), and dialysis (ARI, 0.28; < .0001). The increased risk persisted at 5 years (ARI, 2.02, 3.28, 0.58, 0.42, respectively; all P < .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all P < .0001). < .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all < .0001). Patients with psoriasis who received biologics showed a higher risk for CKD at 10 years despite renoprotective therapy ( P < .0001) than those without psoriasis. IN PRACTICE: 'Psoriasis may trigger a T-helper-17-driven inflammatory response, leading to the production of cytokines such as IL-17, IL-12/23, and TNF,' which induce renal inflammation, and this process is 'not targeted by ACEis, ARBs, or SGLT2is,' which may explain the persistently elevated CKD risk in patients with both T2DM and psoriasis, according to the study authors. They added that the findings support earlier evidence that 'biologics do not ameliorate the deterioration of renal function' in those with existing renal issues and a prospective study is needed to confirm these associations. SOURCE: The study was led by Tarun Sontam, Texas A&M School of Medicine, Dallas, Texas, and was published online on May 7 in the Journal of the American Academy of Dermatology . LIMITATIONS: The study did not account for psoriasis severity or duration and adherence to renoprotective therapy. The authors noted that uncontrolled factors might influence the findings. DISCLOSURES: The authors reported having no conflicts of interest. The study had no funding source.
