Efficacy and safety of tofacitinib for chronic plaque psoriasis and psoriatic arthritis: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To summarize and analyze the results of published randomized controlled trials of tofacitinib for the treatment of chronic plaque psoriasis and psoriatic arthritis(PsA) and discuss its efficacy and safety. PATIENTS AND METHODS: An exhaustive systematic search encompassing PubMed, Cochrane, Embase, and Web of Science databases was conducted up to July 2023. Studies eligible for inclusion were analyzed, organized using Review Manager version 5.4.1 (Cochrane Collaboration, Oxford, UK) and STATA 15.0 version (Stata Corp, College Station, TX, USA) software. RESULTS: A total of six articles, covering 1393 patients (844 treated with tofacitinib and 549 with placebo), were included. The foundational characteristics of tofacitinib and placebo group showed similarity, except for age and Dermatology Life Quality Index (DLQI) score, especially in the context of chronic plaque psoriasis. It is noteworthy that we discovered tofacitinib exhibited a significant impact on Psoriasis Area and Severity Index 75 (PASI75) response, Physician's Global Assessment (PGA) response, and adverse events (AEs) in cases of chronic plaque psoriasis. Similarly, tofacitinib demonstrated substantial influence on American College of Rheumatology 20/50 (ACR20/50) response, PASI75 response, as well as alterations in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score, Health Assessment Questionnaire-Disability Index (HAQ-DI) Score, Dactylitis Severity Score (DSS), and Leeds Enthesitis Index (LEI) Score in the context of psoriatic arthritis (PsA). Nevertheless, there was no statistically significant impact of tofacitinib on serious adverse events (SAEs) in chronic plaque psoriasis, as well as on both adverse events (AEs) and SAEs in psoriatic arthritis (PsA). CONCLUSIONS: A comprehensive analysis revealed that tofacitinib has a positive effect on addressing skin and joint symptoms, as well as improving the quality of life for patients with chronic plaque psoriasis and psoriatic arthritis (PsA). However, the safety of the drug's long-term usage even requires further validation. Key Points • In 6 analyses involving a total of 1393 patients, tofacitinib exhibits positive effect on the treatment of both chronic plaque psoriasis and psoriatic arthritis (PsA). • Although dose-based subgroup analyses have demonstrated effectiveness. Some studies indicate that the 5-mg dose (twice daily) may not show an effect due to the failure of non-inferiority trials comparing tofacitinib with placebo. Therefore, caution is required when interpreting its effectiveness. On the other hand, the 10-mg dose (BID) has been associated with an increase in adverse events and serious adverse events, and is recommended to be used with caution in patients with cardiovascular or uveitis risk factors. • Tofacitinib has efficacy in comorbid psychiatric disorders (depression, anxiety, or Alzheimer's disease) and inflammatory bowel disease (ulcerative colitis), but patients with comorbid renal insufficiency, hepatic dysfunction, osteoporosis, cardiovascular disease, or uveitis may need to be moderated or avoided with tofacitinib.

Efficacy and safety of vitamin D supplementation on psoriasis: A systematic review and meta-analysis.

OBJECTIVES: Our aim was to analyze the results of published randomized controlled trials (RCTs) on vitamin D supplementation for psoriasis in order to explore its effectiveness and safety. PATIENTS AND METHODS: As of July 7 2023, we conducted a systematic literature search in PubMed, Cochrane, Embase, and Web of Science Core Collection databases. The study outcomes included change values in Psoriasis Area and Severity Index (PASI) (at 3 months, 6 months, and end of follow-up)/Dermatology Life Quality Index (DLQI)/Psoriasis disability index (PDI)/C-reactive protein (CRP), and adverse events. RESULTS: 333 patients from 4 studies were evaluated. Pooled analyses showed no significant effect of DLQI/PDI/CRP change value (P > 0.05) or PASI change value (3 months, end of follow-up; P > 0.05). Sensitivity analyses and statistical tests did not support the results of the PASI change values (6 months, P = 0.05). However, the results of subgroup analyses should not be ignored(supplementation with vitamin D2 or Asia would be more effective; P = 0.03). There were no serious adverse effects, and only a few individuals experienced nausea. CONCLUSIONS: The efficacy and safety of vitamin D supplementation in the treatment of psoriasis remains unremarkable. The search for a new prognostic index that combines clinical and laboratory factors is needed to compensate for the shortcomings of existing measures and provide stronger evidence of validity.

Modeling and Control of COVID-19 Transmission from a Perspective of Polymerization Reaction Dynamics.

Due to the serious economic losses and deaths caused by COVID-19, the modeling and control of such a pandemic has become a hot research topic. This paper finds an analogy between a polymerization reaction and COVID-19 transmission dynamics, which will provide a novel perspective to optimal control measures. Susceptible individuals, exposed people, infected cases, recovered population, and the dead can be assumed to be specific molecules in the polymerization system. In this paper, a hypothetical polymerization reactor is constructed to describe the transmission of an epidemic, and its kinetic parameters are regressed by the least-squares method. The intensity of social distancing u is considered to the mixing degree of the reaction system, and contact tracing and isolation ρ can be regarded as an external circulation in the main reactor to reduce the concentration of active species. Through these analogies, this model can predict the peak infection, deaths, and end time of the epidemic under different control measures to support the decision-making process. Without any measures (u = 1.0 and ρ = 0), more than 90% of the population would be infected. It takes several years to complete herd immunity by nonpharmacological intervention when the proportion of deaths is limited to less than 5%. However, vaccination can reduce the time to tens to hundreds of days, which is related to the maximum number of vaccines per day.

Bioinformatic analysis of key pathways and genes involved in pediatric atopic dermatitis.

The initiation of atopic dermatitis (AD) typically happens very early in life, but most of our understanding of AD is derived from studies on AD patients in adult. The aim of the present study was to identify gene signature speficic to pediatric AD comapred with adult AD. The gene expression profiles of four datasets (GSE32924, GSE36842, GSE58558, and GSE107361) were downloaded from the GEO database. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were performed, and protein-protein interaction (PPI) network was constructed by Cytoscape software. Total 654 differentially expressed genes (DEGs) (394 up-regulated and 260 down-regulated) were identified in pediatric AD samples with adult AD samples as control. The up-regulated DEGs were significantly enriched in the migration and chemotaxis of granulocyte and neutrophil, while down-regulated DEGs were significantly enriched in biological adhesion. KEGG pathway analysis showed that up-regulated DEGs participated in chemokine signaling pathway while down-regulated DEGs participated in adherens junction, focal adhesion, and regulation of actin cytoskeleton. The top 10 hub genes GAPDH, EGFR, ACTB, ESR1, CDK1, CXCL8, CD44, KRAS, PTGS2, and SMC3 were involved in chemokine signaling pathway, cytokine-cytokine receptor interaction, interleukin-17 signaling pathway, and regulation of actin cytoskeleton. In conclusion, we identified DEGs and hub genes involved in pediatric AD, which might be used as therapeutic targets and diagnostic biomarkers for pediatric AD.

[A randomized, placebo controlled study on Fangfeng Tongsheng granule in treatment of sub-acute eczema].

The clinical study was conducted to further evaluation the effectiveness and safety of Fangfeng Tongsheng granule in the treatment of sub-acute eczema (superficial cold and interior heat syndrome, exterior and interior sthenic syndrome). In the block randomized, multi-centered study, totally 108 patients were enrolled and assigned to two groups: 72 patients in the test group and 36 patients in the placebo control group. Those in the test group took Fangfeng Tongsheng granule with the dose of 3 g, twice a day, while those in the control group were give simulated agent granules with the same dose. The therapeutic course lasted for 14 days. Their efficacies in TCM syndrome, dermal symptoms and adverse events were observed. According to the test results, except for the one exit case, all of the remaining 108 cases, including 71 in the test group, and 36 in the control group, completed the clinical trial. As for the efficacy of TCM syndrome, after the medication for 2 weeks, the cure rate was 33.81% (24/71) in the test group and 0% (0/36) in the control group (P < 0.01), with a statistical difference between the two groups. Regarding the TCM score, after the medication for 2 weeks, the test group decreased by (12.82 +/- 7.96), while the control group decreased by (3.67 +/- 4.12), indicating a statistical difference between the two groups. As for the efficacy of dermal symptoms, after the medication for 2 weeks, the cure rate was 25.35% (18/71) in the test group and 0% (0/36) in the control group, with a statistical difference between the two groups. Regarding the dermal symptom score, after the medication for 2 weeks., the test group decreased by (10.04 +/- 7.17), while the control group decreased by (2.33 +/- 3.57), indicating a statistical difference between the two groups. There was no significant adverse event caused by Fangfeng Tongsheng granule. In conclusion, Fangfeng Tongsheng granule was effective and safe in treating subcute eczema (superficial cold and interior heat syndrome, exterior and interior sthenic syndrome).