Reynolds DJ, Mountain S, Bartle V, Remfry E, Barnes MR, Reynolds NJ, Thompson A

AI MULTIPLY.  Targeting everyday decision makers in research: early career researcher and patient and public involvement and engagement collaboration in an AI-in-healthcare project. 

Patient and Public Involvement and Engagement (PPIE) is critical in the development and application of Artificial Intelligence (AI) in healthcare research to ensure that outcomes align with patients’ and the public’s needs. However, current PPIE practices often limit involvement to reactive tasks such as reviewing documents and providing plain English summaries. Whilst important, this approach can sideline PPIE from influencing key research decisions. Consequently, PPIE interactions often fail to adequately reach and influence everyday decision makers. On AI and big data research projects, these decisions are often made by Early Career Researchers (ECRs) who play a vital role in the day-to-day research process. After realising these limitations, and to address them, the NIHR-funded AI MULTIPLY consortium introduced twice-monthly “ECRs meet PPIE” sessions.

Alexander H, Malek R, Prieto-Merino D, Gribaleva E, Baden M, Beattie P, Brown S, Burton T, Cameron S, Coker B, Cork MJ, Hearn R, Ingram JR, Irvine AD, Johnston GA, Lambert A, Lunt M, Man I, Newell L, Ogg G, Patel P, Wan M, Warren RB, Woolf R, Yiu ZZN, Reynolds N, Ardern-Jones MR, Flohr C. 

A prospective observational cohort study comparing the treatment effectiveness and safety of ciclosporin, dupilumab and methotrexate in adult and paediatric patients with atopic dermatitis: results from the UK-Irish A-STAR register.

The main conventional systemic treatments for atopic dermatitis (AD) are methotrexate (MTX) and ciclosporin (CyA). Dupilumab was the first novel systemic agent to enter routine clinical practice. There are no head-to-head randomized controlled trials or real-world studies comparing these agents directly. Network meta-analyses provide indirect comparative efficacy and safety data and have shown strong evidence for dupilumab and CyA.

This research shows real-world comparison of CyA, dupilumab and MTX in AD suggests that dupilumab is consistently more effective than MTX and that CyA is most effective in very severe disease within 1 year of follow-up.

Al-Janabi A, Alabas OA, Yiu ZZ, Foulkes AC, Eyre S, Khan AH, Reynolds NJ, Smith CH, Griffiths CE, Warren RB, BADBIR Study Group.

Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis

Biologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown.

Incidence rates of paradoxical eczema, paradoxical eczema risk by biologic class, and the association of demographic and clinical variables with risk of paradoxical eczema were assessed using propensity score-weighted Cox proportional hazards regression models.

Hussain AB, Singleton G, Ball S, Weatherhead SC, Reynolds NJ, Hampton PJ.

Adopting a personalised approach to blood monitoring in psoriasis patients prescribed biologic therapy – a retrospective single centre review of real-world data.

With increasing evidence supporting earlier treatment intervention in patients with psoriasis and the growing number of available biosimilars it is likely that our prescribing of biologic therapies will continue to rise.¹ Studies published from the British Association of Dermatologists Biologics and Immunomodulators Register group have demonstrated long-term safety of biologic therapies in psoriasis.² Nevertheless, 6-monthly blood monitoring is performed for patients with psoriasis prescribed biologic therapies in most UK centres. This is largely guided by the British Association of Dermatologists 2020 guidelines for biologic therapy for psoriasis³ that recommends monitoring full blood count, creatinine and electrolytes and liver function tests at initially 3–4 months after starting therapy, then 6 monthly, or as clinically indicated. Six-monthly blood monitoring has significant healthcare cost implications, creates a burden on patient time and has a substantial environmental impact. However, patients with psoriasis requiring biologic therapies have a considerable burden of multiple long-term conditions that must be carefully considered when determining an individual’s blood monitoring frequency.

Motedayen Aval L, Yiu ZZN, Alabas OA, Griffiths CEM, Reynolds NJ, Hampton PJ, Smith CH, Warren RB; BADBIR Study Group.

Drug survival of IL-23 and IL-17 inhibitors versus other biologics for psoriasis: A British Association of Dermatologists Biologics and Immunomodulators Register cohort study.

Interleukin (IL)-23p19 and IL-17 inhibitors have demonstrated high efficacy for psoriasis in randomized controlled trials, though real-world data, particularly for risankizumab (IL-23p19 inhibitor) and brodalumab (IL-17 receptor (IL-17R) inhibitor), is limited.

Guselkumab and risankizumab have the most favourable drug survival for effectiveness, with comparable safety to ustekinumab, and more favourable than other BADBIR biologics. Longer drug survival may reduce treatment burden by minimizing treatment switches, clinic visits and disease flares, supporting IL-23p19 inhibitors as a practical long-term option for psoriasis.