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Lessons from Psoriasis-What Can
We Apply to Alopecia Areata?
Mark Lebwohl, MD
ProfessorAnd Chairman
Kimberly and Eric J. Waldman
Department of Dermatology
Icahn School of Medicine at Mount Sinai
IL-17A
IL-17F
IL-17R
IL-12
Antimicrobial
peptides
IL-1β
IL-6
TNF-α
S100
CXCL8
CXCL9
CXCL10
CXCL11
CCL20
Activation
Natural
killer T
cell
Keratinocyt
e
Myeloid
dendritic cell
Plasmacytoid
dendritic cell
Macrophage
IL-1β
IL-6
TNF-αTNF-α
INF-γ
INF-γ
Th1
cell
Th17
cell
TNF-α
INF-γ
Keratinocyt
e
TNF-
α
Adaptive
immunity
Innate
immunity
Innate
immunity
IL-20
Adapted from: Nestle F, et al, NEJM 2009; 501.
Pathogenesis of Psoriasis
Th22
cell
IL-22
IL-20
IL-23
Abnormal cell proliferation in psoriasis.
Weinstein GD, Frost P.
J Invest
Dermatol. 1968;50(3):254-9.
Autoradiographic analysis of turnover times of
normal and psoriatic epidermis.
Weinstein GD, Van Scott EJ.
J Invest Dermatol. 1965;45:257-62.
normal
psoriasis
Immunologic mechanisms in psoriasis.
Gottlieb AB.
J Am Acad Dermatol.1988;18:1376-80.
Lymphocyte trafficking in psoriasis: a new
perspective emphasizing the dermal dendrocyte with
active dermal recruitment
mediated via endothelial cells followed by intra-
epidermal T-cell activation.
Nickoloff BJ, Griffiths CE.
J Invest Dermatol. 1990;95:35S-37S.
Resistant severe psoriasis controlled with systemic
cyclosporine therapy.
Picascia DD, Garden JM, Freinkel RK,
Roenigk HH Jr.
Transplant Proc. 1988;20(3Suppl 4):58-62.
Cyclosporine A in the treatment of psoriasis: a clinical
and mechanistic perspective.
Griffiths CE, Voorhees JJ.
J Invest Dermatol.1990;95(5 Suppl):53S-55S.
An international, randomized, double-
blind, placebo-controlled phase 3 trial of
intramuscular alefacept in patients with
chronic plaque psoriasis.
Lebwohl M, Christophers E, Langley R,
Ortonne JP, Roberts J, Griffiths CE;
Alefacept Clinical Study Group.
Arch Dermatol. 2003;139:719-27.
Efalizumab Study Group. A novel
targeted T-cell modulator, efalizumab,
for plaque psoriasis.
Lebwohl M, Tyring SK, Hamilton TK, Toth D,
Glazer S, Tawfik NH, Walicke P,
Dummer W, Wang X, Garovoy MR, Pariser D;
N Engl J Med. 2003 Nov
20;349(21):2004-13.
Efficacy and safety of infliximab monotherapy for
plaque-type psoriasis: a randomized trial.
Chaudhari U, et al.
Lancet 2002
June 9;357(9271):1842-1847.
Efficacy and safety of ustekinumab, a human
interleukin-12/23 monoclonal antibody, in patients with
psoriasis: 52-week results from a randomised, double-
blind, placebo-controlled trial (PHOENIX 2).
Papp KA,et al. Lancet. 2008;371(9625):1675-84.
Efficacy and safety of ustekinumab, a human interleukin-
12/23 monocl onal antibody, in patients with psoriasis:
76-week results from a randomised, double-blind,
placebo-controlled trial (PHOENIX 1).
Leonardi CL,et al. Lancet. 2008;371(9625):1665-74
Adapted from Nestle FO, et al. N Engl J Med. 2009;361:496-509.
Ixekizumab, Secukinumab, Bimekizumab
IL-17A
IIL-17F
IL-23
IL-12
Antimicrobial
peptides
IL-1β
IL-6
TNF-α
S100
CXCL8
CXCL9
CXCL10
CXCL11
CCL20
Activation
Natural
killer
T cell
Keratinocyte
Myeloid
dendritic
cell
Plasmacytoid
dendritic cell
Macrophage
IL-1β
IL-6
TNF-αTNF-α
INF-γ
INF-α
Th1 cell
Th17 cell
TNF-α
INF-γ
Keratinocyte
TNF-α
Adaptive
immunity
Innate immunityInnate immunity
IL-20
Th22
cell
IL-22
IL-20
Secukinumab
Ixekizumab
Key Cells and Mediators in Psoriasis
IL-17A
IL-17F
IL-17R
IL-12
Antimicrobial peptides
IL-1β
IL-6
TNF-α
S100
CXCL8
CXCL9
CXCL10
CXCL11
CCL20
Activation
Natural
killer T cell
Keratinocyte
Myeloid
dendritic cell
Plasmacytoid
dendritic cell
Macrophage
IL-1β
IL-6
TNF-αTNF-α
INF-γ
INF-γ
Th1 cell
Th17 cell
TNF-α
INF-γ
Keratinocyte
TNF-α
Adaptive immunity
Innate immunityInnate immunity
IL-20
Adapted from: Nestle F, et al, NEJM 2009; 501.
Mechanism of Brodalumab
Th22 cell
IL-22
IL-20
IL-23
IL-17A
IL-17F
IL-17R
IL-12
Antimicrobial peptides
IL-1β
IL-6
TNF-α
S100
CXCL8
CXCL9
CXCL10
CXCL11
CCL20
Activation
Natural
killer T cell
Keratinocyte
Myeloid
dendritic cell
Plasmacytoid
dendritic cell
Macrophage
IL-1β
IL-6
TNF-αTNF-α
INF-γ
INF-γ
Th1 cell
Th17 cell
TNF-α
INF-γ
Keratinocyte
TNF-α
Adaptive immunity
Innate immunityInnate immunity
IL-20
Adapted from: Nestle F, et al, NEJM 2009; 501.
Mechanism of Guselkumab, Risankizumab, Mirikizumab
Th22 cell
IL-22
IL-20
IL-23
Secukinumab in plaque psoriasis--results
of two phase 3 trials.
Langley RG, Elewski BE, Lebwohl M, Reich K,
Griffiths CE, Papp K, Puig L, Nakagawa H, Spelman
L, Sigurgeirsson B, Rivas E, Tsai TF, Wasel N,
Tyring S, Salko T, Hampele I, Notter M, Karpov A,
Helou S, Papavassilis C; ERASURE Study
Group; FIXTURE Study Group.
N Engl J Med. 2014 Jul 24;371(4):326-38.
Comparison of ixekizumab with etanercept or
placebo in moderate-to-severe psoriasis
(UNCOVER-2 and UNCOVER-3): results
from two phase 3 randomised trials.
Griffiths CE, Reich K, Lebwohl M, van de Kerkhof
P, Paul C, Menter A, Cameron
GS, Erickson J, Zhang L, Secrest RJ, Ball S, Braun
DK, Osuntokun OO, Heffernan
MP, Nickoloff BJ, Papp K; UNCOVER-2 and
UNCOVER-3 investigators.
Lancet. 2015;386(9993):541-51.
Phase 3 Studies Evaluating Brodalumab
Compared to Ustekinumab In Psoriasis
MLebwohl, BStrober, AMenter, KGordon, JWeglowska,
LPuig, KPapp, LSpelman, DToth, FKerdel, AArmstrong, G
Stingl, AKimball, HBachelez, JWu, JCrowley, RLangley,
TBlicharski,CPaul, JLacour,STyring,LKircik,SChimenti,
KCallis Duffin, JBagel, JKoo, GAras, JLi, W Song, C
Milmont, YShi, N Erondu, PKlekotka, BKotzin, A Nirula
NEJM in press
Risankizumab versus Ustekinumab for
Moderate-to-Severe Plaque Psoriasis.
Papp KA, Blauvelt A, Bukhalo M, Gooderham M, Krueger JG, Lacour
JP, Menter A, Philipp S, Sofen H, Tyring S, Berner BR, Visvanathan S,
Pamulapati C, Bennett N, Flack M, Scholl P, Padula SJ.
N Engl J Med. 2017;376:1551-1560.
Confidential
TSLP
Gittler JK…and Guttman-Yassky E. J Allergy Clin Immunol Sep 2012
• Gottlieb, A
• Krueger, G
• Menter, A
• Papp, K
• Gelfand, J
• Gisondi, P
• Krueger, J
• Reich, K
• Kimball, A
• Smith, CH
• Feldman, S
• Gordon, K
• Griffiths, CEM
• Kirby, B
• Saurat, JH
• Neimann, A
• Sterry, W
• Pathirana, D
• Sampogna, F
• Van de Kerkhof, PCM
• Leonardi, C
• Raychaudhuri, SP
• Kragballe, K.
• Prodanovich, S
Lessons from Psoriasis: What Can We Apply to Alopecia Areata?

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Lessons from Psoriasis: What Can We Apply to Alopecia Areata?

  • 1. Lessons from Psoriasis-What Can We Apply to Alopecia Areata? Mark Lebwohl, MD ProfessorAnd Chairman Kimberly and Eric J. Waldman Department of Dermatology Icahn School of Medicine at Mount Sinai
  • 2. IL-17A IL-17F IL-17R IL-12 Antimicrobial peptides IL-1β IL-6 TNF-α S100 CXCL8 CXCL9 CXCL10 CXCL11 CCL20 Activation Natural killer T cell Keratinocyt e Myeloid dendritic cell Plasmacytoid dendritic cell Macrophage IL-1β IL-6 TNF-αTNF-α INF-γ INF-γ Th1 cell Th17 cell TNF-α INF-γ Keratinocyt e TNF- α Adaptive immunity Innate immunity Innate immunity IL-20 Adapted from: Nestle F, et al, NEJM 2009; 501. Pathogenesis of Psoriasis Th22 cell IL-22 IL-20 IL-23
  • 3. Abnormal cell proliferation in psoriasis. Weinstein GD, Frost P. J Invest Dermatol. 1968;50(3):254-9. Autoradiographic analysis of turnover times of normal and psoriatic epidermis. Weinstein GD, Van Scott EJ. J Invest Dermatol. 1965;45:257-62.
  • 5. Immunologic mechanisms in psoriasis. Gottlieb AB. J Am Acad Dermatol.1988;18:1376-80. Lymphocyte trafficking in psoriasis: a new perspective emphasizing the dermal dendrocyte with active dermal recruitment mediated via endothelial cells followed by intra- epidermal T-cell activation. Nickoloff BJ, Griffiths CE. J Invest Dermatol. 1990;95:35S-37S.
  • 6. Resistant severe psoriasis controlled with systemic cyclosporine therapy. Picascia DD, Garden JM, Freinkel RK, Roenigk HH Jr. Transplant Proc. 1988;20(3Suppl 4):58-62. Cyclosporine A in the treatment of psoriasis: a clinical and mechanistic perspective. Griffiths CE, Voorhees JJ. J Invest Dermatol.1990;95(5 Suppl):53S-55S.
  • 7. An international, randomized, double- blind, placebo-controlled phase 3 trial of intramuscular alefacept in patients with chronic plaque psoriasis. Lebwohl M, Christophers E, Langley R, Ortonne JP, Roberts J, Griffiths CE; Alefacept Clinical Study Group. Arch Dermatol. 2003;139:719-27.
  • 8. Efalizumab Study Group. A novel targeted T-cell modulator, efalizumab, for plaque psoriasis. Lebwohl M, Tyring SK, Hamilton TK, Toth D, Glazer S, Tawfik NH, Walicke P, Dummer W, Wang X, Garovoy MR, Pariser D; N Engl J Med. 2003 Nov 20;349(21):2004-13.
  • 9. Efficacy and safety of infliximab monotherapy for plaque-type psoriasis: a randomized trial. Chaudhari U, et al. Lancet 2002 June 9;357(9271):1842-1847.
  • 10. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double- blind, placebo-controlled trial (PHOENIX 2). Papp KA,et al. Lancet. 2008;371(9625):1675-84. Efficacy and safety of ustekinumab, a human interleukin- 12/23 monocl onal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Leonardi CL,et al. Lancet. 2008;371(9625):1665-74
  • 11. Adapted from Nestle FO, et al. N Engl J Med. 2009;361:496-509. Ixekizumab, Secukinumab, Bimekizumab IL-17A IIL-17F IL-23 IL-12 Antimicrobial peptides IL-1β IL-6 TNF-α S100 CXCL8 CXCL9 CXCL10 CXCL11 CCL20 Activation Natural killer T cell Keratinocyte Myeloid dendritic cell Plasmacytoid dendritic cell Macrophage IL-1β IL-6 TNF-αTNF-α INF-γ INF-α Th1 cell Th17 cell TNF-α INF-γ Keratinocyte TNF-α Adaptive immunity Innate immunityInnate immunity IL-20 Th22 cell IL-22 IL-20 Secukinumab Ixekizumab Key Cells and Mediators in Psoriasis
  • 12. IL-17A IL-17F IL-17R IL-12 Antimicrobial peptides IL-1β IL-6 TNF-α S100 CXCL8 CXCL9 CXCL10 CXCL11 CCL20 Activation Natural killer T cell Keratinocyte Myeloid dendritic cell Plasmacytoid dendritic cell Macrophage IL-1β IL-6 TNF-αTNF-α INF-γ INF-γ Th1 cell Th17 cell TNF-α INF-γ Keratinocyte TNF-α Adaptive immunity Innate immunityInnate immunity IL-20 Adapted from: Nestle F, et al, NEJM 2009; 501. Mechanism of Brodalumab Th22 cell IL-22 IL-20 IL-23
  • 13. IL-17A IL-17F IL-17R IL-12 Antimicrobial peptides IL-1β IL-6 TNF-α S100 CXCL8 CXCL9 CXCL10 CXCL11 CCL20 Activation Natural killer T cell Keratinocyte Myeloid dendritic cell Plasmacytoid dendritic cell Macrophage IL-1β IL-6 TNF-αTNF-α INF-γ INF-γ Th1 cell Th17 cell TNF-α INF-γ Keratinocyte TNF-α Adaptive immunity Innate immunityInnate immunity IL-20 Adapted from: Nestle F, et al, NEJM 2009; 501. Mechanism of Guselkumab, Risankizumab, Mirikizumab Th22 cell IL-22 IL-20 IL-23
  • 14. Secukinumab in plaque psoriasis--results of two phase 3 trials. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CE, Papp K, Puig L, Nakagawa H, Spelman L, Sigurgeirsson B, Rivas E, Tsai TF, Wasel N, Tyring S, Salko T, Hampele I, Notter M, Karpov A, Helou S, Papavassilis C; ERASURE Study Group; FIXTURE Study Group. N Engl J Med. 2014 Jul 24;371(4):326-38.
  • 15. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Griffiths CE, Reich K, Lebwohl M, van de Kerkhof P, Paul C, Menter A, Cameron GS, Erickson J, Zhang L, Secrest RJ, Ball S, Braun DK, Osuntokun OO, Heffernan MP, Nickoloff BJ, Papp K; UNCOVER-2 and UNCOVER-3 investigators. Lancet. 2015;386(9993):541-51.
  • 16. Phase 3 Studies Evaluating Brodalumab Compared to Ustekinumab In Psoriasis MLebwohl, BStrober, AMenter, KGordon, JWeglowska, LPuig, KPapp, LSpelman, DToth, FKerdel, AArmstrong, G Stingl, AKimball, HBachelez, JWu, JCrowley, RLangley, TBlicharski,CPaul, JLacour,STyring,LKircik,SChimenti, KCallis Duffin, JBagel, JKoo, GAras, JLi, W Song, C Milmont, YShi, N Erondu, PKlekotka, BKotzin, A Nirula NEJM in press
  • 17. Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis. Papp KA, Blauvelt A, Bukhalo M, Gooderham M, Krueger JG, Lacour JP, Menter A, Philipp S, Sofen H, Tyring S, Berner BR, Visvanathan S, Pamulapati C, Bennett N, Flack M, Scholl P, Padula SJ. N Engl J Med. 2017;376:1551-1560.
  • 18. Confidential TSLP Gittler JK…and Guttman-Yassky E. J Allergy Clin Immunol Sep 2012
  • 19. • Gottlieb, A • Krueger, G • Menter, A • Papp, K • Gelfand, J • Gisondi, P • Krueger, J • Reich, K • Kimball, A • Smith, CH • Feldman, S • Gordon, K • Griffiths, CEM • Kirby, B • Saurat, JH • Neimann, A • Sterry, W • Pathirana, D • Sampogna, F • Van de Kerkhof, PCM • Leonardi, C • Raychaudhuri, SP • Kragballe, K. • Prodanovich, S