2023-12-27 15:14:49
Transcript of the video by PD Dr. Martin Hartmann, Heidelberg
Beautiful good day,
This is Martin Hartmann from the dermatology clinic at Heidelberg University.
Today we’re talking regarding the top topics in dermatology and infectiology in 2023.
DoxyPEP Study
The DoxyPEP study was presented at the beginning of the year [1]. Rates of bacterial sexually transmitted infections (STIs) had been observed to increase in patients who had taken pre-exposure prophylaxis (PrEP) for HIV. They were randomly assigned to receive doxycycline 200 mg or standard therapy within 72 hours of unprotected sex. Doxycycline reduced rates of chlamydia, gonorrhea and syphilis.
Lenacapavir
Lenacapavir is an HIV capsid inhibitor approved for the combination treatment of HIV infection in patients with multiple drug resistance. In the assessment by the Federal Joint Committee (G-BA), no additional benefit was seen, so the company Gilead withdrew the product from the German market for economic reasons [2].
This is all the sadder because lenacapavir is currently being tested subcutaneously as PrEP twice a year and is now also left out of the German studies.
Spesolimab
Spesolimab is an interleukin-36 antibody for the treatment of generalized pustular psoriasis, a severe disease. However, it costs around €25,000 per year. The G-BA saw no additional benefit here either, so the company Boehringer Ingelheim withdrew the preparation from the market [3]. Although only 300 patients are expected per year, the emergency medication is unfortunately no longer available for these patients.
Deucravatinib
At the beginning of the year, deucravacitinib, an oral TYK2 inhibitor, was approved for the treatment of psoriasis. It demonstrated clear superiority compared to apremilast in the pivotal studies [4] and it is approximately as effective as adalimumab.
Ruxolitinib-Creme
Ruxolitinib caused a stir last year. In 2023 it was approved for the topical treatment of non-segmental vitiligo in patients aged 12 and over. The problem here is also the price, a tube of 100 g costs around €1,000. It is approved for treatment of the hands and face. Here, too, 100 grams is not enough forever. When therapy is stopped, the effect is expected to diminish.
There are a few other preparations for local treatment of the hands for hand eczema and also for psoriasis, some of which have been approved. The industry is observing how ruxolitinib cream can establish itself on the market.
Cabotegravir zur PrEP
Cabotegravir, which has been approved in combination with rilpivirine for the treatment of HIV infection since 2020, has had its approval expanded; it can now be used in combination with safer sex practices for pre-exposure prophylaxis (PrEP). It must be injected deep intragluteally; following 2 initial injections 1 month apart, the injection interval in the maintenance phase is 2 months.
Because this makes PrEP significantly more expensive, it remains to be seen to what extent the health insurance companies will cover the costs.
Ritlecitinib
Ritlecitinib irreversibly and selectively inhibits Janus kinase (JAK) 3 and tyrosine kinase. It has been on the market for the treatment of alopecia areata since November 2023. Baracitinib is currently approved. The problem with both preparations is that alopecia is considered a lifestyle disease and the patients therefore have to bear the costs themselves, which is almost €20,000 per year [5]. So all you have to do is apply to the health insurance company.
Lebrikizumab
Lebrikizumab is a new interleukin-13 inhibitor for the treatment of atopic dermatitis, which is roughly comparable to tralokinumab, but is slightly more effective. In the previous pivotal studies, lebrikizumab showed a higher rate of conjunctivitis among the side effects [6]. It remains to be seen to what extent this preparation will become established next year among the 4 previously approved preparations.
Efinaconazol
Efinaconazole is an azole antifungal that has long been approved in the United States and Japan. Almirall has submitted an application for approval in the EU. It is twice as effective as ciclopirox for local therapy of onychomycosis [7]. We will then have another preparation available with which we can effectively treat onychomycosis.
Dengue vaccine
A new vaccine is available once morest the dengue virus, tested in children and adults. There is a new statement from STIKO on this dengue vaccine [8]. It recommends vaccination once morest dengue for people aged 4 years and over who have a history of a dengue virus infection confirmed by laboratory diagnosis and who are traveling to a dengue-endemic area. For dengue-naïve individuals who have not experienced a dengue infection in the past, data is currently very limited.
People who have a history of a dengue virus infection confirmed by laboratory diagnosis and who carry out targeted activities with the virus outside of endemic areas should receive a complete series of vaccinations as an occupationally indicated vaccination
We have a new vaccine and it remains to be seen how it will prevail in the following years.
That was the year in review of 2023. Thanks for listening.
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