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Gordon K, Leonardi C, Lebwohl M, Cameron G, Erickson J, Braun D, Banerjee S, Augendre-Ferrante B. Efficacité et tolérance de l’ixekizumab, anticorps monoclonal anti-interleukine-17A, dans le traitement du psoriasis en plaques chronique. Étude de phase II, en ouvert pendant un minimum de 52semaines. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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52
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Stockfleth E, Peris K, Guillen C, Cerio R, Basset‐Seguin N, Foley P, Sanches J, Culshaw A, Erntoft S, Lebwohl M. Physician perceptions and experience of current treatment in actinic keratosis. J Eur Acad Dermatol Venereol 2014; 29:298-306. [DOI: 10.1111/jdv.12530] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
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Reich K, Lebwohl M, Griffiths C, Szapary P. Tolérance cardiovasculaire évaluée dans le cadre du programme de développement clinique portant sur le traitement du psoriasis par l’ustekinumab : rapport final portant sur un suivi de cinq ans. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papp KA, Griffiths CEM, Gordon K, Lebwohl M, Szapary PO, Wasfi Y, Chan D, Hsu MC, Ho V, Ghislain PD, Strober B, Reich K. Long-term safety of ustekinumab in patients with moderate-to-severe psoriasis: final results from 5 years of follow-up. Br J Dermatol 2013; 168:844-54. [PMID: 23301632 DOI: 10.1111/bjd.12214] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term safety evaluations of biologics are needed to inform patient management decisions. OBJECTIVES To evaluate the safety of ustekinumab in patients with moderate-to-severe psoriasis treated for up to 5 years. METHODS Safety data were pooled from four studies of ustekinumab for psoriasis. Rates of adverse events (AEs), serious AEs (SAEs) and AEs of interest [infections, nonmelanoma skin cancers (NMSCs), other malignancies and major adverse cardiovascular events (MACE)] per 100 patient-years (PY) of follow-up were analysed by ustekinumab dose (45 or 90 mg) and by year of follow-up (years 1-5) to evaluate the dose response and impact of cumulative exposure. Observed rates of overall mortality and other malignancies were compared with those expected in the general U.S. population. RESULTS Analyses included 3117 patients (8998 PY) who received one or more doses of ustekinumab, with 1482 patients treated for ≥4 years (including 838 patients ≥5 years). At year 5, event rates (45 mg, 90 mg, respectively) for overall AEs (242·6, 225·3), SAEs (7·0, 7·2), serious infections (0·98, 1·19), NMSCs (0·64, 0·44), other malignancies (0·59, 0·61) and MACE (0·56, 0·36) were comparable between dose groups. Year-to-year variability was observed, but no increasing trend was evident. Rates of overall mortality and other malignancies were comparable with those expected in the general U.S. population. CONCLUSIONS No dose-related or cumulative toxicity was observed with increasing duration of ustekinumab exposure for up to 5 years. Rates of AEs reported in ustekinumab psoriasis trials are generally comparable with those reported for other biologics approved for the treatment of moderate-to-severe psoriasis.
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Papp K, Griffiths C, Gordon K, Lebwohl M, Szapary PO, Wasfi Y, Chan D, Shen YK, Ho V, Ghislain PD, Strober B, Reich K. SAT0287 Long-Term Safety Of Ustekinumab: 5 Years of Follow-Up from the Psoriasis Clinical Development Program Including Patients with Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reich K, Langley R, Lebwohl M, Szapary P, Yeilding N, Hsu MC, Griffiths C, Quiniou JB. Mise à jour des données de tolérance cardiovasculaire poolées des études de phase 2 et 3 de l’ustekinumab dans le psoriasis jusqu’à 4 ans de suivi. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.10.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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van de Kerkhof P, Kragballe K, Segaert S, Lebwohl M. Factors impacting the combination of topical corticosteroid therapies for psoriasis: perspectives from the international psoriasis council. J Eur Acad Dermatol Venereol 2011; 25:1130-9. [DOI: 10.1111/j.1468-3083.2011.04113.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reich K, Langley R, Lebwohl M, Szapary P, Guzzo C, Yeilding N, Li S, Hsu MC, Griffiths C. Cardiovascular safety of ustekinumab in patients with moderate to severe psoriasis: results of integrated analyses of data from phase II and III clinical studies. Br J Dermatol 2011; 164:862-72. [DOI: 10.1111/j.1365-2133.2011.10257.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barker J, Horn EJ, Lebwohl M, Warren RB, Nast A, Rosenberg W, Smith C. Assessment and management of methotrexate hepatotoxicity in psoriasis patients: report from a consensus conference to evaluate current practice and identify key questions toward optimizing methotrexate use in the clinic. J Eur Acad Dermatol Venereol 2010; 25:758-64. [PMID: 21198946 DOI: 10.1111/j.1468-3083.2010.03932.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Experts in psoriasis, hepatology, pharmacokinetics and pharmacogenetics convened to discuss the safety and monitoring of methotrexate with respect to hepatotoxicity when used in the treatment of psoriasis. Methotrexate is an efficacious and cost-effective treatment for psoriasis, but is associated with significant safety issues, particularly relating to hepatotoxicity. Current British, Dutch, German, EU and US guidelines for baseline evaluations, monitoring and prevention of hepatotoxicity in patients with psoriasis receiving methotrexate were evaluated. Liver safety monitoring is currently reliant upon multiple methods, including biopsy, serological tests for biomarkers such as type III procollagen amino terminal propeptide (PIIINP), and liver function tests based on liver enzymes. Monitoring of patients receiving long-term therapy is expected to be improved by the utilization of serum biomarkers currently in development such as the Enhanced Liver Fibrosis (ELF) panel and other non-invasive tests of hepatic architecture, such as fibroelastography, microbubbles and magnetic resonance imaging. Appropriate studies to determine optimal dosing to maximize efficacy and minimize toxicity, potentially utilizing pharmacogenetic principles, are clearly needed. Key questions for future research are identified including needs for optimal screening and monitoring, identification of appropriate biomarkers, assessment of relationships between dosing and safety, utility of liver biopsy, optimal dosing regimens (including route of administration), methods to measure methotrexate levels in blood, and use of methotrexate as a standardized active comparator in trials of experimental drugs used to treat psoriasis.
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Lebwohl M, Papp K, Han C, Schenkel B, Yeilding N, Wang Y, Krueger GG. Ustekinumab improves health-related quality of life in patients with moderate-to-severe psoriasis: results from the PHOENIX 1 trial. Br J Dermatol 2009; 162:137-46. [PMID: 19903183 DOI: 10.1111/j.1365-2133.2009.09491.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background PHOENIX 1 was a phase III, randomized, double-blind, placebo-controlled study that demonstrated the long-term efficacy and safety of ustekinumab in patients with moderate-to-severe psoriasis. Objectives To assess the effect of ustekinumab maintenance therapy on health-related quality of life (HRQoL) in PHOENIX 1 patients. Patients and methods Patients (n = 766) were randomized to receive ustekinumab 45 mg (n = 255) or 90 mg (n = 256) at weeks 0 and 4 and every 12 weeks thereafter, or placebo (n = 255) at weeks 0 and 4 with crossover to ustekinumab at week 12. Ustekinumab-randomized patients achieving at least 75% improvement in Psoriasis Area and Severity Index (PASI) 75 at weeks 28 and 40 were re-randomized at week 40 to continue ustekinumab or be withdrawn until loss of therapeutic effect. HRQoL was assessed using the SF-36 and Dermatology Life Quality Index (DLQI). Results At baseline, more than 97% had a DLQI > 1 and the average DLQI was > 10, indicating a significant impact on patients' HRQoL. Significantly greater proportions of patients receiving ustekinumab 45 and 90 mg achieved a normalized DLQI score (< or = 1) compared with placebo (53.2%, 52.4% and 6.0%, respectively, both P < 0.001) at week 12 and achieved a clinically meaningful improvement (increase of at least five points) in SF-36 physical (23.1%, 33.7% and 15.6%) and mental (25.5%, 31.3% and 14.8%) component summary scores. At week 12, changes in individual DLQI and SF-36 domains were significantly better in each ustekinumab group vs. placebo (P < 0.001). The magnitude of improvement across SF-36 scales was greatest for the bodily pain and social functioning domains. Improvements in HRQoL were sustained with maintenance ustekinumab therapy through at least 1 year. Regression analysis showed that, after adjustment for improvement in PASI or Physician's Global Assessment (PGA), ustekinumab-treated patients demonstrated significant improvements in DLQI. Conclusions Ustekinumab improves HRQoL in patients with moderate-to-severe psoriasis. Patient-reported outcomes measured a treatment effect beyond that indicated by clinical measures.
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Spuls PI, Hadi S, Rivera L, Lebwohl M. Retrospective analysis of the treatment of psoriasis of the palms and soles. J DERMATOL TREAT 2009; 14 Suppl 2:21-5. [PMID: 14578095 DOI: 10.1080/jdt.14.s2.21.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this retrospective analysis, the effect of currently used treatments in 26 patients with psoriasis of the palms and soles were analyzed. In general, patients are treated initially with topical medications including superpotent topical corticosteroids in combination with calcipotriene ointment or tazarotene gel or both. If satisfactory improvement is not achieved in 4-8 weeks, systemic retinoids are added, formerly etretinate and currently acitretin, except in women of childbearing potential. If the latter regimen is not effective within two months, soak PUVA is added to the regimen of oral retinoids and topical medications. If improvement is inadequate, or if the treatment regimen is not tolerated, methotrexate or cyclosporine have been added in the past. The availability of the excimer laser has recently modified our approach so that this therapy is used in combination with acitretin before soak PUVA. With the availability of biologic agents, methotrexate is avoided because of its hepatotoxicity and bone marrow toxicity and cyclosporine is avoided because of its nephrotoxicity. If oral acitretin plus topical therapy is not adequate to control the disease and the excimer laser is not an option because of its limited availability, alefacept, etanercept and infliximab are added when possible. Other biologic agents are likely to be added to this list in the future.
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Maryles S, Rozenblit M, Lebwohl M. Transition from methotrexate and cyclosporine to other therapies including retinoids, ultraviolet light and biologic agents in the management of patients with psoriasis. J DERMATOL TREAT 2009. [DOI: 10.1080/jdt.14.s2.7.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lebwohl M, Tannis C, Carrasco D. Acitretin suppression of squamous cell carcinoma: Case report and literature review. J DERMATOL TREAT 2009; 14 Suppl 2:3-6. [PMID: 14578092 DOI: 10.1080/jdt.14.s2.3.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Retinoids have been used for the treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmentosum, and in patients with recurrent skin cancers as a result of immunosuppression for renal transplantation. We report a 40-year-old male who began to develop multiple squamous cell carcinomas of the skin after treatment with PUVA for severe psoriasis. The numbers of squamous cell carcinomas increased when acitretin was discontinued and decreased when he was taking the drug at a dose of 25 mg daily. Acitretin should be considered as a maintenance therapy for psoriasis patients developing squamous cell carcinomas as a result of PUVA therapy.
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Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrowband UVB and acitretin. J DERMATOL TREAT 2009; 14 Suppl 2:17-20. [PMID: 14578094 DOI: 10.1080/jdt.14.s2.17.20] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In this retrospective analysis the effect of narrowband ultraviolet B treatment in combination with acitretin is reviewed in 40 patients with plaque psoriasis. Narrowband UVB is highly effective for plaque psoriasis, but requires multiple phototherapy treatments, making patient compliance problematic. Oral acitretin is moderately effective as monotherapy, but when combined with ultraviolet B or PUVA, its use has reduced the number of treatments required for clearing, and has resulted in clearing of patients otherwise refractory to these phototherapeutic modalities. There is only sparse data on the combination of acitretin with narrowband UVB. We therefore analyzed data on 40 patients treated with this combination. RESULTS The majority of patients treated had psoriasis that was refractory to treatment with broadband ultraviolet B, monotherapy with narrowband UVB, monotherapy with acitretin, or the combination of acitretin and broadband UVB. In this difficult-to-treat group of patients, the combination of low dose acitretin (25 mg po daily) and narrowband UVB three times per week resulted in greater than 75% improvement in 29 (72.5%) patients. Only 5 (12.5%) patients had less than 50% improvement. The combination was well tolerated and associated with typical retinoid and narrowband UVB side effects including elevation of serum lipids, burn and cheilitis. CONCLUSION The combination of acitretin with narrowband UVB results in faster improvement even in more difficult-to-treat patients. In combination the treatments appear to have synergistic effects.
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Horn EJ, Domm S, Katz HI, Lebwohl M, Mrowietz U, Kragballe K. Topical corticosteroids in psoriasis: strategies for improving safety. J Eur Acad Dermatol Venereol 2009; 24:119-24. [PMID: 20175860 DOI: 10.1111/j.1468-3083.2009.03358.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Corticosteroids are a mainstay of topical therapy for psoriasis. While efficacious and relatively safe when used carefully, the potential for side effects, notably skin atrophy and adrenal suppression, have been associated with excesses in potency, prolonged or widespread use. The International Psoriasis Council Working Group on Topical Therapy has reviewed the efficacy and safety of topical corticosteroids and recommends strategies for safe, long-term use of these agents.
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van de Kerkhof P, Griffiths CEM, Christophers E, Lebwohl M, Krueger GG. Alefacept in the treatment of psoriasis in patients for whom conventional therapies are inadequate. Dermatology 2006; 211:256-63. [PMID: 16205071 DOI: 10.1159/000087020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 12/20/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many patients with moderate to severe chronic plaque psoriasis fail to respond to or are not appropriate candidates for conventional systemic therapies and/or phototherapy. OBJECTIVES To assess the efficacy, quality of life and safety of alefacept among the proportion of patients who participated in the phase III studies and who were not suitable candidates for conventional systemic psoriasis therapies or phototherapy. METHODS The patient's historical responses at the baseline visit during the phase III studies of alefacept were used to identify a subpopulation in whom the use of methotrexate, ciclosporin, retinoids, ultraviolet B or psoralen plus ultraviolet A was ineffective or inappropriate. Endpoints included Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and adverse events. RESULTS Most patients (69%) who were treated with alefacept in the phase III programme were not candidates for > or =1 of the above-mentioned therapies, and 41 and 21% were not candidates for > or =2 and > or =3, respectively. A reduction in PASI of > or =75% was achieved by 27, 23 and 26% of alefacept-treated patients who were not candidates for > or =1, > or =2 and > or =3 conventional systemic psoriasis therapies or phototherapy, respectively (all p < or = 0.001 vs. placebo). The corresponding results for PASI 50 were 53, 52 and 50% (all p < or = 0.001 vs. placebo). At 2 weeks after the last dose of alefacept, mean DLQI overall scores were reduced by -4.2, -3.9 and -5.2, respectively (all p < or = 0.001 vs. placebo). The incidence of adverse events was similar in the alefacept and placebo groups. CONCLUSIONS The efficacy, quality of life effects and safety of alefacept in patients who were not candidates for conventional systemic psoriasis therapies or phototherapy were similar to those reported previously for the overall alefacept-treated population in the phase III studies.
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Abstract
Even before the recent development of biological agents, a long list of effective treatments has been available for patients with psoriasis. Topical therapies such as corticosteroids, vitamin D analogues, and retinoids are used for localised disease. Phototherapy including broadband ultraviolet B (UVB), narrowband UVB, PUVA, and climatotherapy are effective for more extensive disease. Systemic therapies such as methotrexate, retinoids, and ciclosporin are effective for patients with refractory or extensive cutaneous disease.
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Abstract
Actinic keratoses are a common problem in the population, and one of the most common conditions treated by dermatologists. Risk factors for the development of actinic keratosis are those associated with increased sun exposure and increased susceptibility to sun exposure such as low latitude, working outdoors, light skin, and history of sunburn. The role of the immune system is clear from the frequency of actinic keratoses in transplant patients. There is strong evidence that actinic keratoses can progress to squamous cell carcinoma, underscoring the need to identify and treat patients at risk.
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Wong VK, Lebwohl M. The use of alefacept in the treatment of psoriasis. SKIN THERAPY LETTER 2003; 8:1-2, 7. [PMID: 14610613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Alefacept (AMEVIVE or LFA#TIP, Biogen) is the newest effective systemic therapy for chronic plaque psoriasis and was approved by the US FDA in January 2003. Clinical studies have shown that alefacept, given via weekly IM or IV injections for 12 weeks, was well tolerated, with no reported serious adverse events. Most significantly, it was found that alefacept provides a long-lasting remittive effect. These findings support the use of alefacept as a viable treatment of psoriasis, without the toxicities associated with some of the current systemic treatments available.
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Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrowband UVB and acitretin. J DERMATOL TREAT 2003. [DOI: 10.1080/738528794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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73
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Lebwohl M, Tannis C, Carrasco D. Acitretin suppression of squamous cell carcinoma: Case report and literature review. J DERMATOL TREAT 2003. [DOI: 10.1080/738528792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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74
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Lebwohl M, Menter A, Koo J, Feldman S. Case studies in severe psoriasis: A clinical strategy. J DERMATOL TREAT 2003. [DOI: 10.1080/738528791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maryles S, Rozenblit M, Lebwohl M. Transition from methotrexate and cyclosporine to other therapies including retinoids, ultraviolet light and biologic agents in the management of patients with psoriasis. J DERMATOL TREAT 2003; 14 Suppl 2:7-16. [PMID: 14578093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Patients with psoriasis typically face longterm therapy for their chronic disease. Often, the therapeutic agents that physicians use to treat them may become less effective or may cause safety or toxicity issues. The clinician must then decide the next therapy for his/her patient and assess benefit/risk of the next therapeutic agent or combination. In moving the patient from one therapy to the next, specific characteristics of the transition must be assessed, and how to stop the existing therapy, and introduce the new agent(s). The decision making process must take into account the longterm risks to the patient. This article focuses on the transition for patients with psoriasis being managed with methotrexate and cyclosporine to retinoids, phototherapy, and newer agents.
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