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Evolving Treatment of Severe Alopecia
The classification of severe alopecia areata (AA) and its treatment are evolving. Dr Ali Jabbari, from the University of Iowa, discusses factors that characterize severe AA and traces the expanded treatment options provided by the advent of Janus kinase (JAK) inhibitors.
Dr Jabbari reports on a modified AA severity scale, published in the Journal of American Academy of Dermatology, in which the presence of certain factors upgrade the level of severity. Factors include eyebrow/eyelash involvement and psychosocial comorbidities such as depression, anxiety, and social phobias. Traditional treatments for severe AA have relied largely on corticosteroids. Dr Jabbari explains how this treatment can be helpful for patients with limited disease, but may be burdensome for those with severe disease, in terms of injection pain and side effects of long-term use. Another option for patients with severe AA is the use of systemic immunosuppressants, but these are not as effective as newer treatments.
Dr Jabbari looks at two FDA-approved options for JAK inhibitors: baricitinib for patients aged 18 years or older and ritlecitinib for patients aged 12 years or older. He notes some of the potential side effects of these medications but concludes that JAK inhibitors are a safe option for treating patients with severe AA.
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Ali Jabbari, MD, PhD, Chair, DEO, Roger I. Ceilley Associate Professor, Department of Dermatology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
Ali Jabbari, MD, PhD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Pfizer; Inc.; Cage Bio
Received research grant from: National Institutes of Health; Department of Veterans Affairs; Pfizer; Inc
Scientific Advisory Board for: BiologicsMD
The classification of severe alopecia areata (AA) and its treatment are evolving. Dr Ali Jabbari, from the University of Iowa, discusses factors that characterize severe AA and traces the expanded treatment options provided by the advent of Janus kinase (JAK) inhibitors.
Dr Jabbari reports on a modified AA severity scale, published in the Journal of American Academy of Dermatology, in which the presence of certain factors upgrade the level of severity. Factors include eyebrow/eyelash involvement and psychosocial comorbidities such as depression, anxiety, and social phobias. Traditional treatments for severe AA have relied largely on corticosteroids. Dr Jabbari explains how this treatment can be helpful for patients with limited disease, but may be burdensome for those with severe disease, in terms of injection pain and side effects of long-term use. Another option for patients with severe AA is the use of systemic immunosuppressants, but these are not as effective as newer treatments.
Dr Jabbari looks at two FDA-approved options for JAK inhibitors: baricitinib for patients aged 18 years or older and ritlecitinib for patients aged 12 years or older. He notes some of the potential side effects of these medications but concludes that JAK inhibitors are a safe option for treating patients with severe AA.
--
Ali Jabbari, MD, PhD, Chair, DEO, Roger I. Ceilley Associate Professor, Department of Dermatology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
Ali Jabbari, MD, PhD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Pfizer; Inc.; Cage Bio
Received research grant from: National Institutes of Health; Department of Veterans Affairs; Pfizer; Inc
Scientific Advisory Board for: BiologicsMD
The classification of severe alopecia areata (AA) and its treatment are evolving. Dr Ali Jabbari, from the University of Iowa, discusses factors that characterize severe AA and traces the expanded treatment options provided by the advent of Janus kinase (JAK) inhibitors.
Dr Jabbari reports on a modified AA severity scale, published in the Journal of American Academy of Dermatology, in which the presence of certain factors upgrade the level of severity. Factors include eyebrow/eyelash involvement and psychosocial comorbidities such as depression, anxiety, and social phobias. Traditional treatments for severe AA have relied largely on corticosteroids. Dr Jabbari explains how this treatment can be helpful for patients with limited disease, but may be burdensome for those with severe disease, in terms of injection pain and side effects of long-term use. Another option for patients with severe AA is the use of systemic immunosuppressants, but these are not as effective as newer treatments.
Dr Jabbari looks at two FDA-approved options for JAK inhibitors: baricitinib for patients aged 18 years or older and ritlecitinib for patients aged 12 years or older. He notes some of the potential side effects of these medications but concludes that JAK inhibitors are a safe option for treating patients with severe AA.
--
Ali Jabbari, MD, PhD, Chair, DEO, Roger I. Ceilley Associate Professor, Department of Dermatology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
Ali Jabbari, MD, PhD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Pfizer; Inc.; Cage Bio
Received research grant from: National Institutes of Health; Department of Veterans Affairs; Pfizer; Inc
Scientific Advisory Board for: BiologicsMD
Anti-CD20 Therapy for Relapsing Multiple Sclerosis
Data have shown that CD20-expressing B cells are crucial to the pathogenesis of multiple sclerosis (MS). First approved by the US Food and Drug Administration for MS in 2017, anti-CD20 monoclonal antibody therapies including ocrelizumab, ofatumumab, and ublituximab have proven effective at controlling the symptoms of relapsing-remitting MS (RRMS).
In this ReCAP, Dr Fred D. Lublin, of the Mount Sinai School of Medicine, discusses recent data on anti-CD20 agents for RRMS, including results presented at the 2024 meeting of the Consortium of Multiple Sclerosis Centers (CMSC).
He discusses a protocol examining the effect on RRMS of extending dosage intervals or stopping anti-CD20 therapy after 1 or 2 years of treatment based on results suggesting that the B cells that return post depletion are predominantly regulatory rather than pathogenic.
Next, Dr Lublin discusses a paper presented at CMSC on risks for serious infections in individuals taking ocrelizumab or ofatumumab. Major predictors were found to be progressive disease, prior use of a disease-modifying therapy, and longer duration of therapy.
Finally, he considers recent studies comparing rituximab, an anti-CD20 therapy not approved for MS in the United States but commonly used off-label internationally, with more recent therapies such as ocrelizumab. Data currently indicate that an increased risk for infections are associated with rituximab vs ocrelizumab, but further research is under way.
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Fred D. Lublin, MD, Director, The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY
Fred D. Lublin, MD, has disclosed the following relevant financial relationships:
Sources of Funding for Research: Novartis; Biogen; Sanofi; NMSS; NIH; Brainstorm Cell Therapeutics
Consulting Agreements/Advisory Boards/DSMB: Biogen; EMD Serono; Novartis; Actelion/Janssen; Sanofi/Genzyme; Roche/Genentech; Horizon Therapeutics/Amgen; Bristol Myers Squibb; Mapi Pharma; Brainstorm Cell Therapeutics; Mylan/Viatris; Immunic; Avotres; Neurogene; LabCorp; Entelexo Biotherapeutics; Neuralight; SetPoint Medical; Hexal/Sandoz; Baim Institute; Sudo Biosciences; Lapix Therapeutics; Biohaven Pharmaceuticals; Abata Therapeutics; Cognito Therapeutics; ImmPACT Bio
Speaker: Sanofi
Stock Options: Avotres; Neuralight; Lapix Therapeutics; Entelexo
I may discuss unapproved agents that are in the MS developmental pipeline without any recommendation on their use.
Data have shown that CD20-expressing B cells are crucial to the pathogenesis of multiple sclerosis (MS). First approved by the US Food and Drug Administration for MS in 2017, anti-CD20 monoclonal antibody therapies including ocrelizumab, ofatumumab, and ublituximab have proven effective at controlling the symptoms of relapsing-remitting MS (RRMS).
In this ReCAP, Dr Fred D. Lublin, of the Mount Sinai School of Medicine, discusses recent data on anti-CD20 agents for RRMS, including results presented at the 2024 meeting of the Consortium of Multiple Sclerosis Centers (CMSC).
He discusses a protocol examining the effect on RRMS of extending dosage intervals or stopping anti-CD20 therapy after 1 or 2 years of treatment based on results suggesting that the B cells that return post depletion are predominantly regulatory rather than pathogenic.
Next, Dr Lublin discusses a paper presented at CMSC on risks for serious infections in individuals taking ocrelizumab or ofatumumab. Major predictors were found to be progressive disease, prior use of a disease-modifying therapy, and longer duration of therapy.
Finally, he considers recent studies comparing rituximab, an anti-CD20 therapy not approved for MS in the United States but commonly used off-label internationally, with more recent therapies such as ocrelizumab. Data currently indicate that an increased risk for infections are associated with rituximab vs ocrelizumab, but further research is under way.
--
Fred D. Lublin, MD, Director, The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY
Fred D. Lublin, MD, has disclosed the following relevant financial relationships:
Sources of Funding for Research: Novartis; Biogen; Sanofi; NMSS; NIH; Brainstorm Cell Therapeutics
Consulting Agreements/Advisory Boards/DSMB: Biogen; EMD Serono; Novartis; Actelion/Janssen; Sanofi/Genzyme; Roche/Genentech; Horizon Therapeutics/Amgen; Bristol Myers Squibb; Mapi Pharma; Brainstorm Cell Therapeutics; Mylan/Viatris; Immunic; Avotres; Neurogene; LabCorp; Entelexo Biotherapeutics; Neuralight; SetPoint Medical; Hexal/Sandoz; Baim Institute; Sudo Biosciences; Lapix Therapeutics; Biohaven Pharmaceuticals; Abata Therapeutics; Cognito Therapeutics; ImmPACT Bio
Speaker: Sanofi
Stock Options: Avotres; Neuralight; Lapix Therapeutics; Entelexo
I may discuss unapproved agents that are in the MS developmental pipeline without any recommendation on their use.
Data have shown that CD20-expressing B cells are crucial to the pathogenesis of multiple sclerosis (MS). First approved by the US Food and Drug Administration for MS in 2017, anti-CD20 monoclonal antibody therapies including ocrelizumab, ofatumumab, and ublituximab have proven effective at controlling the symptoms of relapsing-remitting MS (RRMS).
In this ReCAP, Dr Fred D. Lublin, of the Mount Sinai School of Medicine, discusses recent data on anti-CD20 agents for RRMS, including results presented at the 2024 meeting of the Consortium of Multiple Sclerosis Centers (CMSC).
He discusses a protocol examining the effect on RRMS of extending dosage intervals or stopping anti-CD20 therapy after 1 or 2 years of treatment based on results suggesting that the B cells that return post depletion are predominantly regulatory rather than pathogenic.
Next, Dr Lublin discusses a paper presented at CMSC on risks for serious infections in individuals taking ocrelizumab or ofatumumab. Major predictors were found to be progressive disease, prior use of a disease-modifying therapy, and longer duration of therapy.
Finally, he considers recent studies comparing rituximab, an anti-CD20 therapy not approved for MS in the United States but commonly used off-label internationally, with more recent therapies such as ocrelizumab. Data currently indicate that an increased risk for infections are associated with rituximab vs ocrelizumab, but further research is under way.
--
Fred D. Lublin, MD, Director, The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY
Fred D. Lublin, MD, has disclosed the following relevant financial relationships:
Sources of Funding for Research: Novartis; Biogen; Sanofi; NMSS; NIH; Brainstorm Cell Therapeutics
Consulting Agreements/Advisory Boards/DSMB: Biogen; EMD Serono; Novartis; Actelion/Janssen; Sanofi/Genzyme; Roche/Genentech; Horizon Therapeutics/Amgen; Bristol Myers Squibb; Mapi Pharma; Brainstorm Cell Therapeutics; Mylan/Viatris; Immunic; Avotres; Neurogene; LabCorp; Entelexo Biotherapeutics; Neuralight; SetPoint Medical; Hexal/Sandoz; Baim Institute; Sudo Biosciences; Lapix Therapeutics; Biohaven Pharmaceuticals; Abata Therapeutics; Cognito Therapeutics; ImmPACT Bio
Speaker: Sanofi
Stock Options: Avotres; Neuralight; Lapix Therapeutics; Entelexo
I may discuss unapproved agents that are in the MS developmental pipeline without any recommendation on their use.
Evolving Treatment of Nonradiographic Axial Spondyloarthritis
Nonradiographic axial spondyloarthritis (nr-axSpA) shares many characteristics with radiographic disease and responds to the same treatments, yet it has fewer FDA-approved options.
As Dr Marina Magrey, from Case Western Reserve University School of Medicine, in Cleveland, Ohio, explains, the TNF inhibitor certolizumab has been approved on the basis of results from the C-axSpAnd study.
Similarly, the IL-17 inhibitors secukinumab and ixekizumab are also options, and the results of the COAST-X and PREVENT studies show them to be safe and efficacious.
In closing, Dr Magrey outlines the SELECT-AXIS 2 study showing benefit from the JAK inhibitor upadacitinib for nr-axSpA, with no additional safety signals.
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Professor of Rheumatology, Case Western Reserve University School of Medicine; Chief, Division of Rheumatology, University Hospitals, Cleveland, Ohio
Marina N. Magrey, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Novartis; AbbVie; UCB Pharma; Pfizer; Eli Lilly; Janssen; Bristol Myers Squibb
Received research grant from: AbbVie; Bristol Myers Squibb; Amgen
Nonradiographic axial spondyloarthritis (nr-axSpA) shares many characteristics with radiographic disease and responds to the same treatments, yet it has fewer FDA-approved options.
As Dr Marina Magrey, from Case Western Reserve University School of Medicine, in Cleveland, Ohio, explains, the TNF inhibitor certolizumab has been approved on the basis of results from the C-axSpAnd study.
Similarly, the IL-17 inhibitors secukinumab and ixekizumab are also options, and the results of the COAST-X and PREVENT studies show them to be safe and efficacious.
In closing, Dr Magrey outlines the SELECT-AXIS 2 study showing benefit from the JAK inhibitor upadacitinib for nr-axSpA, with no additional safety signals.
--
Professor of Rheumatology, Case Western Reserve University School of Medicine; Chief, Division of Rheumatology, University Hospitals, Cleveland, Ohio
Marina N. Magrey, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Novartis; AbbVie; UCB Pharma; Pfizer; Eli Lilly; Janssen; Bristol Myers Squibb
Received research grant from: AbbVie; Bristol Myers Squibb; Amgen
Nonradiographic axial spondyloarthritis (nr-axSpA) shares many characteristics with radiographic disease and responds to the same treatments, yet it has fewer FDA-approved options.
As Dr Marina Magrey, from Case Western Reserve University School of Medicine, in Cleveland, Ohio, explains, the TNF inhibitor certolizumab has been approved on the basis of results from the C-axSpAnd study.
Similarly, the IL-17 inhibitors secukinumab and ixekizumab are also options, and the results of the COAST-X and PREVENT studies show them to be safe and efficacious.
In closing, Dr Magrey outlines the SELECT-AXIS 2 study showing benefit from the JAK inhibitor upadacitinib for nr-axSpA, with no additional safety signals.
--
Professor of Rheumatology, Case Western Reserve University School of Medicine; Chief, Division of Rheumatology, University Hospitals, Cleveland, Ohio
Marina N. Magrey, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Novartis; AbbVie; UCB Pharma; Pfizer; Eli Lilly; Janssen; Bristol Myers Squibb
Received research grant from: AbbVie; Bristol Myers Squibb; Amgen
Targeting JAK Inhibitors in Severe Alopecia Areata
Alopecia areata (AA) is an autoimmune disease that affects 2% of the population. Janus kinase (JAK) signaling has been shown to improve outcomes for many patients with severe AA, as outlined by Dr Brittany Craiglow, associate professor adjunct, Yale School of Medicine, New Haven, Connecticut.
Dr Craiglow reports that in AA, hair loss can be caused by key cytokines, including interleukin 15 and interferon gamma. These cytokines use the JAK-STAT pathway to transmit their signal. JAK inhibitors, which interfere with that pathway, are showing to be an effective treatment that can lead to hair growth.
Two JAK inhibitors have received US Food and Drug Administration approval for treatment of severe AA. Oral JAK1/2 inhibitor baricitinib has been approved for patients aged 18 years or older. The oral JAK3 inhibitor ritlecitinib has been approved for patients aged 12 years or older.
Dr Craiglow looks at clinical trials involving these JAK inhibitors. The results show that patients are more likely to respond to treatment earlier in the disease process. The study also found that patients with less severe hair loss (50%-94%) respond better than did those with severe hair loss.
Finally, Dr Craiglow explores the topic of JAK inhibitor selection. She notes that different medications will hit different JAK proteins, the failure of one JAK inhibitor does not always predict failure of another. Dr Craiglow points to current efficacy of these targeted therapies and expresses optimism about the future of personalized medicine in treating patients with severe AA.
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Brittany Craiglow, MD, Associate Professor Adjunct, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
Brittany Craiglow, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AbbVie; BiologicsMD; Dermavant; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme; Sun Pharmaceuticals
Serve(d) as a speaker or a member of a speaker’s bureau for: AbbVie; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme
Alopecia areata (AA) is an autoimmune disease that affects 2% of the population. Janus kinase (JAK) signaling has been shown to improve outcomes for many patients with severe AA, as outlined by Dr Brittany Craiglow, associate professor adjunct, Yale School of Medicine, New Haven, Connecticut.
Dr Craiglow reports that in AA, hair loss can be caused by key cytokines, including interleukin 15 and interferon gamma. These cytokines use the JAK-STAT pathway to transmit their signal. JAK inhibitors, which interfere with that pathway, are showing to be an effective treatment that can lead to hair growth.
Two JAK inhibitors have received US Food and Drug Administration approval for treatment of severe AA. Oral JAK1/2 inhibitor baricitinib has been approved for patients aged 18 years or older. The oral JAK3 inhibitor ritlecitinib has been approved for patients aged 12 years or older.
Dr Craiglow looks at clinical trials involving these JAK inhibitors. The results show that patients are more likely to respond to treatment earlier in the disease process. The study also found that patients with less severe hair loss (50%-94%) respond better than did those with severe hair loss.
Finally, Dr Craiglow explores the topic of JAK inhibitor selection. She notes that different medications will hit different JAK proteins, the failure of one JAK inhibitor does not always predict failure of another. Dr Craiglow points to current efficacy of these targeted therapies and expresses optimism about the future of personalized medicine in treating patients with severe AA.
--
Brittany Craiglow, MD, Associate Professor Adjunct, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
Brittany Craiglow, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AbbVie; BiologicsMD; Dermavant; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme; Sun Pharmaceuticals
Serve(d) as a speaker or a member of a speaker’s bureau for: AbbVie; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme
Alopecia areata (AA) is an autoimmune disease that affects 2% of the population. Janus kinase (JAK) signaling has been shown to improve outcomes for many patients with severe AA, as outlined by Dr Brittany Craiglow, associate professor adjunct, Yale School of Medicine, New Haven, Connecticut.
Dr Craiglow reports that in AA, hair loss can be caused by key cytokines, including interleukin 15 and interferon gamma. These cytokines use the JAK-STAT pathway to transmit their signal. JAK inhibitors, which interfere with that pathway, are showing to be an effective treatment that can lead to hair growth.
Two JAK inhibitors have received US Food and Drug Administration approval for treatment of severe AA. Oral JAK1/2 inhibitor baricitinib has been approved for patients aged 18 years or older. The oral JAK3 inhibitor ritlecitinib has been approved for patients aged 12 years or older.
Dr Craiglow looks at clinical trials involving these JAK inhibitors. The results show that patients are more likely to respond to treatment earlier in the disease process. The study also found that patients with less severe hair loss (50%-94%) respond better than did those with severe hair loss.
Finally, Dr Craiglow explores the topic of JAK inhibitor selection. She notes that different medications will hit different JAK proteins, the failure of one JAK inhibitor does not always predict failure of another. Dr Craiglow points to current efficacy of these targeted therapies and expresses optimism about the future of personalized medicine in treating patients with severe AA.
--
Brittany Craiglow, MD, Associate Professor Adjunct, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
Brittany Craiglow, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AbbVie; BiologicsMD; Dermavant; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme; Sun Pharmaceuticals
Serve(d) as a speaker or a member of a speaker’s bureau for: AbbVie; Incyte; Eli Lilly; Pfizer; Regeneron; Sanofi-Genzyme
Inflammatory Bowel Disease Highlights From Digestive Disease Week 2024
Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.
Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.
The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.
Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.
Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.
The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.
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Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California
Andres J. Yarur, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion
Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.
Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.
The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.
Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.
Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.
The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.
--
Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California
Andres J. Yarur, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion
Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.
Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.
The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.
Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.
Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.
The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.
--
Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California
Andres J. Yarur, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion
CGRP-Targeted Therapies for Chronic Migraine Management
Migraine attacks are classified as chronic or episodic. Chronic migraines occur at least 15 days a month, and often prove functionally debilitating. In 2018, therapies that target the calcitonin gene-related peptide (CGRP) were first introduced to help manage migraine attacks.
Dr Stephanie Nahas from Thomas Jefferson University in Philadelphia, Pennsylvania, discusses optimal approaches for incorporating these therapies, which include small molecule agents called gepants, and monoclonal antibodies. In both cases, these therapies prevent CGRP from binding to its receptor, which helps to reduce migraine symptomatology, both acutely and over time
According to Dr Nahas, the choice of therapy for an individual patient depends primarily on patient preferences. Most gepants are administered orally, and monoclonal antibodies are injected.
Dr Nahas recommends that these therapies should be considered when a previous treatment proves insufficient to reduce disease burden to the degree that allows improved functioning and quality of life for the patient.
--
Stephanie J. Nahas-Geiger, MD, MSEd, Associate Professor, Department of Neurology, Division of Headache Medicine, Thomas Jefferson University; Assistant Director, Headache Medicine Fellowship Program, Jefferson Headache Center, Philadelphia, Pennsylvania
Stephanie J. Nahas-Geiger, MD, MSEd, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: AbbVie; Eli Lilly; Lundbeck; Pfizer; Theranica; Tonix (no relationships are active)
Migraine attacks are classified as chronic or episodic. Chronic migraines occur at least 15 days a month, and often prove functionally debilitating. In 2018, therapies that target the calcitonin gene-related peptide (CGRP) were first introduced to help manage migraine attacks.
Dr Stephanie Nahas from Thomas Jefferson University in Philadelphia, Pennsylvania, discusses optimal approaches for incorporating these therapies, which include small molecule agents called gepants, and monoclonal antibodies. In both cases, these therapies prevent CGRP from binding to its receptor, which helps to reduce migraine symptomatology, both acutely and over time
According to Dr Nahas, the choice of therapy for an individual patient depends primarily on patient preferences. Most gepants are administered orally, and monoclonal antibodies are injected.
Dr Nahas recommends that these therapies should be considered when a previous treatment proves insufficient to reduce disease burden to the degree that allows improved functioning and quality of life for the patient.
--
Stephanie J. Nahas-Geiger, MD, MSEd, Associate Professor, Department of Neurology, Division of Headache Medicine, Thomas Jefferson University; Assistant Director, Headache Medicine Fellowship Program, Jefferson Headache Center, Philadelphia, Pennsylvania
Stephanie J. Nahas-Geiger, MD, MSEd, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: AbbVie; Eli Lilly; Lundbeck; Pfizer; Theranica; Tonix (no relationships are active)
Migraine attacks are classified as chronic or episodic. Chronic migraines occur at least 15 days a month, and often prove functionally debilitating. In 2018, therapies that target the calcitonin gene-related peptide (CGRP) were first introduced to help manage migraine attacks.
Dr Stephanie Nahas from Thomas Jefferson University in Philadelphia, Pennsylvania, discusses optimal approaches for incorporating these therapies, which include small molecule agents called gepants, and monoclonal antibodies. In both cases, these therapies prevent CGRP from binding to its receptor, which helps to reduce migraine symptomatology, both acutely and over time
According to Dr Nahas, the choice of therapy for an individual patient depends primarily on patient preferences. Most gepants are administered orally, and monoclonal antibodies are injected.
Dr Nahas recommends that these therapies should be considered when a previous treatment proves insufficient to reduce disease burden to the degree that allows improved functioning and quality of life for the patient.
--
Stephanie J. Nahas-Geiger, MD, MSEd, Associate Professor, Department of Neurology, Division of Headache Medicine, Thomas Jefferson University; Assistant Director, Headache Medicine Fellowship Program, Jefferson Headache Center, Philadelphia, Pennsylvania
Stephanie J. Nahas-Geiger, MD, MSEd, has disclosed the following relevant financial relationships:
Serve(d) as a consultant for: AbbVie; Eli Lilly; Lundbeck; Pfizer; Theranica; Tonix (no relationships are active)
Optimal Preventive Therapy for Episodic Migraine
Episodic migraine occurs fewer than 15 days per month but can become chronic if poorly controlled. It is estimated that preventive therapy is indicated in over one third of patients with episodic migraine. Dr Barbara Nye from Wake Forest University in Winston-Salem, North Carolina, discusses optimal approaches for managing episodic migraine. According to Dr Nye, several factors, including patient preference, clinical evidence, and insurance coverage, will help inform which treatments can be offered.
She mentions that currently approved treatments include nonspecific therapeutics such as antiseizure, antidepressant, and blood pressure medications. Newer therapies known as gepants and injectable monoclonal antibodies are also available to manage and prevent episodic migraine.
Dr Nye concludes that the appropriate therapeutic goal is a reduction in headache frequency, reduction in headache severity, and improved response to medications, as well as decreasing the level of disability that patients are experiencing.
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Barbara L. Nye, MD, Associate Professor of Neurology, Wake Forest University; Director, Headache Fellowship, Department of Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
Barbara L. Nye, MD, has disclosed no relevant financial relationships.
Episodic migraine occurs fewer than 15 days per month but can become chronic if poorly controlled. It is estimated that preventive therapy is indicated in over one third of patients with episodic migraine. Dr Barbara Nye from Wake Forest University in Winston-Salem, North Carolina, discusses optimal approaches for managing episodic migraine. According to Dr Nye, several factors, including patient preference, clinical evidence, and insurance coverage, will help inform which treatments can be offered.
She mentions that currently approved treatments include nonspecific therapeutics such as antiseizure, antidepressant, and blood pressure medications. Newer therapies known as gepants and injectable monoclonal antibodies are also available to manage and prevent episodic migraine.
Dr Nye concludes that the appropriate therapeutic goal is a reduction in headache frequency, reduction in headache severity, and improved response to medications, as well as decreasing the level of disability that patients are experiencing.
--
Barbara L. Nye, MD, Associate Professor of Neurology, Wake Forest University; Director, Headache Fellowship, Department of Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
Barbara L. Nye, MD, has disclosed no relevant financial relationships.
Episodic migraine occurs fewer than 15 days per month but can become chronic if poorly controlled. It is estimated that preventive therapy is indicated in over one third of patients with episodic migraine. Dr Barbara Nye from Wake Forest University in Winston-Salem, North Carolina, discusses optimal approaches for managing episodic migraine. According to Dr Nye, several factors, including patient preference, clinical evidence, and insurance coverage, will help inform which treatments can be offered.
She mentions that currently approved treatments include nonspecific therapeutics such as antiseizure, antidepressant, and blood pressure medications. Newer therapies known as gepants and injectable monoclonal antibodies are also available to manage and prevent episodic migraine.
Dr Nye concludes that the appropriate therapeutic goal is a reduction in headache frequency, reduction in headache severity, and improved response to medications, as well as decreasing the level of disability that patients are experiencing.
--
Barbara L. Nye, MD, Associate Professor of Neurology, Wake Forest University; Director, Headache Fellowship, Department of Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
Barbara L. Nye, MD, has disclosed no relevant financial relationships.
Acute Treatment of Migraine in Clinical Practice
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
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Acute Treatment of Migraine in Clinical Practice
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
Migraine can be divided into two broad categories: episodic, in which attacks occur between two and four times a month; and chronic, in which individuals suffer from headaches for at least half the month and experience at least eight attacks.
Acute treatment is fundamental to reducing the immediate disability of migraine attack in both types, and several effective migraine-specific therapies have been approved.
Dr Jessica Ailani, director of the Headache Center at Medstar Georgetown University Hospital, Washington, DC, discusses the benefits, potential side effects, and optimal use of migraine-specific therapies available for acute migraine, including how they can be used to build an effective treatment plan for an individual patient.
These include triptans (5-HT1B/1D receptor agonists), ergotamines (dihydroergotamine), neuromodulation devices, ditans (5-HT1F agonists), and gepants (CGRP antagonists).
--
Jessica Ailani, MD, Professor of Clinical Neurology, Director, Headache Center, Medstar Georgetown University Hospital, Washington, DC
Jessica Ailani, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Aeon; electroCore; Dr. Reddy; Eli-Lilly; GlaxoSmithKline (2023); Lundbeck; Linpharma; Ipsen; Merz; Miravo; Pfizer; Neurolief; Gore; Satsuma; Scilex; Theranica; Tonix
Received research grant from: Parema; Ipsen; Lundbeck
Treating Active Psoriatic Arthritis When the First-Line Biologic Fails
Over the past two decades, the therapeutic landscape for psoriatic arthritis (PsA) has been transformed by the introduction of more than a dozen targeted therapies.
For most patients with active PsA, a tumor necrosis factor (TNF) inhibitor is recommended as the first-line biologic therapy. But some patients do not achieve an adequate response to TNF inhibitors or are intolerant to these therapies.
Choosing the right treatment after failure of the first biologic requires that clinicians consider several factors. Dr Atul Deodhar, of Oregon Health & Science University, discusses guidelines from the American College of Rheumatology/National Psoriasis Foundation and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) for appropriate treatment strategies.
He also discusses factors critical to the optimal choice of the next therapy, such as the domains of disease activity, patient comorbidities, and whether the biologic's failure was primary or secondary.
Aside from choosing a new biologic, Dr Deodhar notes that there are other options to intensify the effect of the initial biologic. He says the clinician and patient may consider increasing the dose and frequency of the initial biologic medication or moving to a combination therapy by adding another drug, such as methotrexate.
--
Atul A. Deodhar, MD, Professor of Medicine, Division of Arthritis and Rheumatic Diseases, School of Medicine, Oregon Health & Science University; Medical Director, Rheumatology Clinics, OHSU Hospital, Portland, Oregon
Atul A. Deodhar, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant, for: Bristol Myers Squibb; Eli Lilly; Janssen; MoonLake; Novartis; Pfizer; UCB
Serve(d) as a speaker for: Eli Lilly; Novartis; Pfizer; UCB
Received research grant from: AbbVie; Bristol Myers Squibb; Celgene; Janssen; MoonLake; Novartis; Pfizer; UCB
Received income in an amount equal to or greater than $250 from: Bristol Myers Squibb; Eli Lilly; Janssen; Novartis; Pfizer; Samsung Bioepis; UCB
Over the past two decades, the therapeutic landscape for psoriatic arthritis (PsA) has been transformed by the introduction of more than a dozen targeted therapies.
For most patients with active PsA, a tumor necrosis factor (TNF) inhibitor is recommended as the first-line biologic therapy. But some patients do not achieve an adequate response to TNF inhibitors or are intolerant to these therapies.
Choosing the right treatment after failure of the first biologic requires that clinicians consider several factors. Dr Atul Deodhar, of Oregon Health & Science University, discusses guidelines from the American College of Rheumatology/National Psoriasis Foundation and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) for appropriate treatment strategies.
He also discusses factors critical to the optimal choice of the next therapy, such as the domains of disease activity, patient comorbidities, and whether the biologic's failure was primary or secondary.
Aside from choosing a new biologic, Dr Deodhar notes that there are other options to intensify the effect of the initial biologic. He says the clinician and patient may consider increasing the dose and frequency of the initial biologic medication or moving to a combination therapy by adding another drug, such as methotrexate.
--
Atul A. Deodhar, MD, Professor of Medicine, Division of Arthritis and Rheumatic Diseases, School of Medicine, Oregon Health & Science University; Medical Director, Rheumatology Clinics, OHSU Hospital, Portland, Oregon
Atul A. Deodhar, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant, for: Bristol Myers Squibb; Eli Lilly; Janssen; MoonLake; Novartis; Pfizer; UCB
Serve(d) as a speaker for: Eli Lilly; Novartis; Pfizer; UCB
Received research grant from: AbbVie; Bristol Myers Squibb; Celgene; Janssen; MoonLake; Novartis; Pfizer; UCB
Received income in an amount equal to or greater than $250 from: Bristol Myers Squibb; Eli Lilly; Janssen; Novartis; Pfizer; Samsung Bioepis; UCB
Over the past two decades, the therapeutic landscape for psoriatic arthritis (PsA) has been transformed by the introduction of more than a dozen targeted therapies.
For most patients with active PsA, a tumor necrosis factor (TNF) inhibitor is recommended as the first-line biologic therapy. But some patients do not achieve an adequate response to TNF inhibitors or are intolerant to these therapies.
Choosing the right treatment after failure of the first biologic requires that clinicians consider several factors. Dr Atul Deodhar, of Oregon Health & Science University, discusses guidelines from the American College of Rheumatology/National Psoriasis Foundation and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) for appropriate treatment strategies.
He also discusses factors critical to the optimal choice of the next therapy, such as the domains of disease activity, patient comorbidities, and whether the biologic's failure was primary or secondary.
Aside from choosing a new biologic, Dr Deodhar notes that there are other options to intensify the effect of the initial biologic. He says the clinician and patient may consider increasing the dose and frequency of the initial biologic medication or moving to a combination therapy by adding another drug, such as methotrexate.
--
Atul A. Deodhar, MD, Professor of Medicine, Division of Arthritis and Rheumatic Diseases, School of Medicine, Oregon Health & Science University; Medical Director, Rheumatology Clinics, OHSU Hospital, Portland, Oregon
Atul A. Deodhar, MD, has disclosed the following relevant financial relationships:
Serve(d) as a consultant, for: Bristol Myers Squibb; Eli Lilly; Janssen; MoonLake; Novartis; Pfizer; UCB
Serve(d) as a speaker for: Eli Lilly; Novartis; Pfizer; UCB
Received research grant from: AbbVie; Bristol Myers Squibb; Celgene; Janssen; MoonLake; Novartis; Pfizer; UCB
Received income in an amount equal to or greater than $250 from: Bristol Myers Squibb; Eli Lilly; Janssen; Novartis; Pfizer; Samsung Bioepis; UCB