Do loading doses of biologics improve psoriasis outcomes?
Loading doses of biologic therapy for psoriasis improve short term clinical outcomes but not overall success rates during maintenance therapy, a review has found.
The main benefit of loading doses was in speed to improvement rather than long term outcomes, according to data analysed from four clinical trials and one retrospective observational study of patients taking adalimumab, etanercept, or secukinumab.
The findings, presented at the American Academy of Dermatology 2022 meeting showed that a loading dose regimen of adalimumab yielded the greatest change in PASI at week four but after then clinical response fell between the non-loading dose regimens. Three clinical trials that compared etanercept loading dose regimens found they yielded better outcomes at week twelve but by week twenty-four yielded similar efficacy to non-loading dose regimens. A loading dose regimen of secukinumab produced a stronger clinical response at week twelve but no statistically significant difference between regimens subsequently, a restrospective observational study found.
The results showed benefits of loading disease “which may have substantial value for patients, but this initial difference in clinical outcomes wanes over time,” the US authors concluded.
More research is needed to evaluate the effects of loading doses beyond speed to clinical response, including effects on neutrlalising antibodies and impact on efficacy during the maintenance period when some patients subsequently lose response, they suggested.
Melanoma screening program shows promise
A primary care screening program for melanoma could improve detection rates but at the risk of some overdiagnosis, a five-year observational study from the US has found
A population-based screening study involving almost 560,000 primary care patients found that melanoma screening was associated with increased detection of thin melanoma (in situ and thickness ≤1 mm) equivalent to an additional 18 thin melanomas detected per 100 000 person-years.
There were also 4.7 fewer thick melanomas (>1 mm) per 100,000 in the screened vs unscreened group, with notable reductions in interval melanomas in patients 65 years and older (HR, 0.6; P = .15 for lesions >2 mm; and HR, 0.3; P = .05 for lesions >4 mm).
While the results were not statistically significant, an accompanying editorial said the data suggest a better prognosis for patients who received screening.
“Taken together, we believe these real-world results reflect the promise of screening programs to detect melanoma at an earlier stage and improve patient outcomes,” it concluded.
The findings are published in JAMA Dermatology
Anifrolumab approved by TGA for lupus
Anifrolumab (Saphnelo, AstraZeneca) has been TGA-approved as add-on treatment of adult patients with moderate to severe, active systemic lupus erythematosus (SLE).
The drug binds to subunit 1 of the type I interferon receptor to inhibit type I IFN signalling thereby blocking the biological activity of type I IFNs. A post-hoc analysis of pooled data from phase III clinical trials showed anifrolumab was consistently associated with improvements in both skin rash and arthritis, compared to placebo, in patients with moderate to severe SLE.
Treatment with the human immunoglobulin G1 kappa monoclonal antibody (IgG1κ) should be initiated and supervised by a physician experienced in the treatment of lupus, the TGA said.
It said the benefit-risk profile of anifrolumab was considered favourable for the therapeutic use approved. Its safety and efficacy has not been evaluated in patients with severe active lupus nephritis or severe active central nervous system lupus.
The recommended dose of anifrolumab is 300 mg, administered as an IV infusion over a 30 minute period, every 4 weeks.