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Røpke M, Bulai Livideanu C, Kaldate R, Snel A, Paul C. Changes in interleukin-17A, macrophage-derived chemokine and adiponectin following treatment of psoriasis with calcipotriol plus betamethasone dipropionate aerosol foam: results from the PSO-ABLE study. Br J Dermatol 2017; 178:e33-e34. [PMID: 28722136 DOI: 10.1111/bjd.15814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Røpke
- LEO Pharma A/S, Ballerup, Denmark
| | - C Bulai Livideanu
- Paul Sabatier University and Larrey University Hospital, Toulouse, France
| | - R Kaldate
- Myriad Genetics, Salt Lake City, UT, U.S.A
| | - A Snel
- LEO Pharma A/S, Ballerup, Denmark
| | - C Paul
- Paul Sabatier University and Larrey University Hospital, Toulouse, France
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152
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DFD-01 Reduces Transepidermal Water Loss and Improves Skin Hydration and Flexibility. Dermatol Ther (Heidelb) 2017; 7:507-514. [PMID: 29134613 PMCID: PMC5698208 DOI: 10.1007/s13555-017-0209-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction In plaque psoriasis, the benefit of topical steroids is well established. The vehicle formulation of topical steroids may also provide benefit in addition to the effects of the steroid itself. DFD-01 (betamethasone dipropionate spray, 0.05%) is a formulation composed of a topical steroid in an emollient-like vehicle that enhances penetration to the target site of inflammation in the skin. The aim of this study was to assess the effect of DFD-01 and its vehicle on skin hydration and barrier function in compromised skin and to evaluate its effect on flexibility in healthy skin. Methods Eighteen healthy white volunteers were enrolled in each of two studies. In Study 1, dry shaving of volar forearms created a compromised skin barrier, through which transepidermal water loss (TEWL) was measured using an evaporimeter. Capacitance, a measure of epidermal hydration, was also measured at baseline and at 1, 2 and 4 h after application of DFD-01 or its vehicle formulation. In Study 2, intact skin flexibility was tested with a cutometer before and at 1, 2 and 4 h after application of DFD-01 or vehicle. Results In Study 1, both DFD-01 and its vehicle were effective at reducing TEWL through the compromised stratum corneum. Capacitance measurements confirmed this finding; razor-chafed skin treated with either DFD-01 or vehicle exhibited levels of skin hydration similar to unshaved control skin. Study 2 found softening and greater flexibility of normal skin treated with either DFD-01 or vehicle compared with nontreated control skin samples. Conclusions These tests suggest that the DFD-01 formulation and its vehicle are each effective at retaining moisture within a damaged skin barrier and for softening and increasing the flexibility of intact skin. Funding Dr. Reddy’s Laboratories.
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153
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Chen P, Li C, Xue R, Chen H, Tian X, Zeng K, Zhang X, Liang J. Efficacy and safety of acitretin monotherapy in children with pustular psoriasis: results from 15 cases and a literature review. J DERMATOL TREAT 2017; 29:353-363. [PMID: 29098909 DOI: 10.1080/09546634.2017.1395798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Changxing Li
- Department of Dermatology, Dongguan Sixth People’s Hospital, Dongguan, P.R. China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Huiheng Chen
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Xin Tian
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
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154
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Zhou L, Du GS, Pan LC, Zheng YG, Liu ZJ, Shi HD, Yang SZ, Shi XJ, Xuan M, Feng LK, Zhu ZD. Sirolimus treatment for cirrhosis or hepatocellular carcinoma patients accompanied by psoriasis after liver transplantation: A single center experience. Oncol Lett 2017; 14:7817-7824. [PMID: 29344227 PMCID: PMC5755223 DOI: 10.3892/ol.2017.7217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022] Open
Abstract
There is currently no consensus on the most suitable therapeutic approach for psoriasis (PS) co-existing with posthepatic cirrhosis (PCs) and hepatocellular carcinoma (HCC) following liver transplantation (LT). The present study provides an analysis of the therapeutic experience of such patients. Five LT recipients (two with PC and three with HCC) with accompanying PS were included. The induction program consisted of methylprednisolone plus basiliximab treatment. The initial postoperative treatment scheme consisted of tacrolimus (FK506) plus mycophenolate mofetil (MMF) and hormone; the latter was withdrawn 1 week after LT. The patients with PC had been using FK506 with or without a postoperative MMF program; the patients with HCC and recurrence of PS had been switched to a sirolimus (SRL)-based replacement therapy. Furthermore, all patients received anti-hepatitis B virus (HBV) therapy. The patients were followed up after 8.3±1.5 years. There was a positive correlation between HBV-DNA copy numbers, and psoriatic area and severity index (PASI) scores (r=0.97; P=0.006). The PASI scores were decreased significantly at 6 months following surgery compared with pre-transplantation (P<0.05). The patients who had received the FK506-based treatment experienced PS recurrence two years post-transplantation. The PASI scores increased significantly (P<0.05) and then declined gradually, maintaining a stable level (P<0.05) by 1 year after switching to the SRL-based treatment. The patients who had received the SRL-based treatment exhibited no recurrence of PS. The results of the present study suggest that SRL therapy provides a promising novel treatment method for patients with PS following LT that may be superior to tacrolimus treatment. When co-existing HBV is present pre-transplantation, regular injection of human hepatitis B immunoglobulin should be used to prevent the HBV from relapsing or aggravating the PS.
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Affiliation(s)
- Lin Zhou
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.,Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Guo-Sheng Du
- Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Li-Chao Pan
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yong-Gen Zheng
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.,Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Zhi-Jia Liu
- Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Hai-Da Shi
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Shao-Zhen Yang
- Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Xian-Jie Shi
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Meng Xuan
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Li-Kui Feng
- Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
| | - Zhi-Dong Zhu
- Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China
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155
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Affiliation(s)
- D M Thappa
- Department of Dermatology and STD, JIPMER, Puducherry, India
| | - M Malathi
- Department of Dermatology and STD, JIPMER, Puducherry, India
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156
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Patel NU, Felix K, Reimer D, Feldman SR. Calcipotriene/betamethasone dipropionate for the treatment of psoriasis vulgaris: an evidence-based review. Clin Cosmet Investig Dermatol 2017; 10:385-391. [PMID: 29033598 PMCID: PMC5628677 DOI: 10.2147/ccid.s131727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While topical medications remain the cornerstone of the psoriasis treatment paradigm, they also come with the risk of multiple side effects. An alternative topical treatment option, calcipotriene or calcipotriol, is a vitamin D derivative that is thought to work by inhibiting keratinocyte proliferation and enhancing keratinocyte differentiation. Multiple studies have demonstrated its efficacy and safety in improving psoriasis when used in combination with topical corticosteroids. Given the effectiveness and side effect profile seen with this combination of topical steroid and calcipotriene, the US Food and Drug Administration approved a calcipotriene/betamethasone dipropionate product for use in psoriasis patients over the age of 12 in 2006. Our paper seeks to review clinical trial evidence of this combination medication and its use in the treatment of psoriasis vulgaris. While assessment of available evidence indicates that the topical medication is both safe and effective for the treatment of psoriasis vulgaris, addressing limitations of what is known, such as tolerability, adherence, and patient preference, of this combination drug in future high-impact studies is needed.
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Affiliation(s)
- Nupur U Patel
- Center for Dermatology Research, Department of Dermatology
| | - Kayla Felix
- Center for Dermatology Research, Department of Dermatology
| | | | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology.,Department of Pathology.,Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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157
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Chiricozzi A, Pimpinelli N, Ricceri F, Bagnoni G, Bartoli L, Bellini M, Brandini L, Caproni M, Castelli A, Fimiani M, Marsili F, Mazzatenta C, Niccoli MC, Panduri S, Pellegrino M, Sirna R, Volpi W, Romanelli M, Prignano F. Treatment of psoriasis with topical agents: Recommendations from a Tuscany Consensus. Dermatol Ther 2017; 30. [PMID: 28940579 DOI: 10.1111/dth.12549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/06/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
Psoriasis is a chronic and relapsing inflammatory skin disease, clinically characterized by erythematous and scaly plaques. Treatment approach is mainly driven by disease severity, though several factors should be considered in order to identify the optimal therapeutic choice. Mild psoriasis may be treated with a wide array of topical agents including corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound. Because guidelines may not provide practical indications regarding the therapeutic approach, the use of topical agents in psoriasis is more individually tailored. In order to homogenize the standard of care, at least in a local setting, we collected the real-life-based recommendations for the use of topical therapies from an expert panel, the Tuscany Consensus Group on Psoriasis, representing all leading centers for psoriasis established in Tuscany. With this document, this consensus group sought to define principles guiding the selection of therapeutic agents with straightforward recommendations derived from a real-life setting.
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Affiliation(s)
- Andrea Chiricozzi
- Dermatology Department, University of Pisa. Via Roma 67, 56126 Pisa, Italy
| | - Nicola Pimpinelli
- Department of Surgery and Translational Medicine, Section of Dermatology and Venereology, University of Florence School of Medicine, Florence, Italy
| | - Federica Ricceri
- Department of Surgery and Translational Medicine, Section of Dermatology and Venereology, University of Florence School of Medicine, Florence, Italy
| | | | - Laura Bartoli
- Dermatology Unit, San Jacopo Hospital, ASL 3, Pistoia, Italy
| | - Mauro Bellini
- Dermatology Unit, Carrara Hospital, USL nordovest, Carrara, Italy
| | - Luca Brandini
- Dermatology Unit, San Giuseppe Hospital, ASL 11, Empoli, Italy
| | - Marzia Caproni
- Dermatologic Rare Diseases and Skin Immunopathology Unit, University of Florence, Florence, Italy.,U.O. Dermatology I, University of Florence, Florence, Italy
| | | | - Michele Fimiani
- Departmernt of Dermatology, Division of Medical, Surgical and Neurosciences, University of Siena, Siena Italy
| | - Franco Marsili
- Dermatology Unit, Versilia Hospital, ASL 12, Lido di Camaiore, Lucca, Italy
| | | | | | - Salvatore Panduri
- Dermatology Department, University of Pisa. Via Roma 67, 56126 Pisa, Italy
| | - Michele Pellegrino
- Departmernt of Dermatology, Division of Medical, Surgical and Neurosciences, University of Siena, Siena Italy
| | - Riccardo Sirna
- Dermatology Unit, Misericordia Hospital, ASL 9, Grosseto, Italy
| | - Walter Volpi
- U.O. Dermatology I, University of Florence, Florence, Italy
| | - Marco Romanelli
- Dermatology Department, University of Pisa. Via Roma 67, 56126 Pisa, Italy
| | - Francesca Prignano
- Department of Surgery and Translational Medicine, Section of Dermatology and Venereology, University of Florence School of Medicine, Florence, Italy
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158
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Asche CV, Kim M, Feldman SR, Zografos P, Lu M. Budget impact model in moderate-to-severe psoriasis vulgaris assessing effects of calcipotriene and betamethasone dipropionate foam on per-patient standard of care costs. J Med Econ 2017; 20:1000-1006. [PMID: 28581873 DOI: 10.1080/13696998.2017.1339279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To develop a budget impact model (BIM) for estimating the financial impact of formulary adoption and uptake of calcipotriene and betamethasone dipropionate (C/BD) foam (0.005%/0.064%) on the costs of biologics for treating moderate-to-severe psoriasis vulgaris in a hypothetical US healthcare plan with 1 million members. METHODS This BIM incorporated epidemiologic data, market uptake assumptions, and drug utilization costs, simulating the treatment mix for patients who are candidates for biologics before (Scenario #1) and after (Scenario #2) the introduction of C/BD foam. Predicted outcomes were expressed in terms of the annual cost of treatment (COT) and the COT per member per month (PMPM). RESULTS At year 1, C/BD foam had the lowest per-patient cost ($9,913) necessary to achieve a Psoriasis Area and Severity Index (PASI)-75 response compared with etanercept ($73,773), adalimumab ($92,871), infliximab ($34,048), ustekinumab ($83,975), secukinumab ($113,858), apremilast ($47,960), and ixekizumab ($62,707). Following addition of C/BD foam to the formulary, the annual COT for moderate-to-severe psoriasis would decrease by $36,112,572 (17.91%, from $201,621,219 to $165,508,647). The COT PMPM is expected to decrease by $3.00 (17.86%, from $16.80 to $13.80). LIMITATIONS Drug costs were based on Medi-Span reference pricing (January 21, 2016); differences in treatment costs for drug administration, laboratory monitoring, or adverse events were not accounted for. Potentially confounding were the definition of "moderate-to-severe" and the heterogeneous efficacy data. The per-patient cost for PASI-75 response at year 1 was estimated from short-term efficacy data for C/BD foam and apremilast only. CONCLUSIONS The introduction of C/BD foam is expected to decrease the annual COT for moderate-to-severe psoriasis treatable with biologics by $36,112,572 for a hypothetical US healthcare plan with 1 million plan members, and to lower the COT PMPM by $3.00.
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Affiliation(s)
- Carl V Asche
- a University of Illinois College of Medicine at Peoria , Peoria , IL , USA
- b University of Illinois at Chicago College of Pharmacy , Chicago , IL , USA
| | - Minchul Kim
- a University of Illinois College of Medicine at Peoria , Peoria , IL , USA
| | - Steven R Feldman
- c Wake Forest University School of Medicine , Winston-Salem , NC , USA
| | | | - Minyi Lu
- d LEO Pharma, Inc. , Madison , NJ , USA
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159
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Segaert S, Shear NH, Chiricozzi A, Thaçi D, Carrascosa JM, Young H, Descamps V. Optimizing Anti-Inflammatory and Immunomodulatory Effects of Corticosteroid and Vitamin D Analogue Fixed-Dose Combination Therapy. Dermatol Ther (Heidelb) 2017; 7:265-279. [PMID: 28785924 PMCID: PMC5574747 DOI: 10.1007/s13555-017-0196-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 12/02/2022] Open
Abstract
Abstract Fixed-dose combination topical therapy with corticosteroid and vitamin D analog provides effective treatment and possible long-term management of psoriasis. The anti-inflammatory and immunomodulatory effects of corticosteroids and vitamin D analogs in treating psoriasis are well investigated; their complementary effects lead to the disruption of the inflammatory feedback loop underlying psoriasis pathogenesis. Recent preclinical data showed that combination therapy is more effective than monotherapies of the active ingredients in preventing activation of resting pro-inflammatory cells, inducing immunomodulation, reducing inflammatory responses by regulating T cell production, and normalizing keratinocytes. The increased understanding of the mechanism of action of fixed-dose combination therapy from preclinical studies is supported by several clinical studies. As the efficacy of topical therapy is correlated with the skin penetration of the active ingredients, new drug delivery systems have been developed. The fixed-dose combination Cal/BD aerosol foam creates a modified supersaturated formulation when applied to the skin, which is maintained for at least 26 h in the laboratory setting. Clinical studies have demonstrated superior efficacy of fixed-dose combination calcipotriol (Cal) 50 µg/g and betamethasone dipropionate (BD) 0.5 mg/g aerosol foam compared with monotherapies of the active ingredients. Furthermore, Cal/BD aerosol foam has shown significantly improved efficacy compared with more traditional formulations, such as Cal/BD ointment and gel, in other studies. Calcipotriol also mitigates risks associated with betamethasone dipropionate and vice versa, resulting in the favorable safety profile observed with fixed-dose combination treatment. Recent data also suggest that fixed-dose combination treatment could provide long-term management of psoriasis, although further clinical investigations are needed. Overall, these data support the value of fixed-dose combination therapy of corticosteroid and vitamin D analog and highlight the added potential of innovative drug delivery for the treatment of psoriasis. Funding LEO Pharma.
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Affiliation(s)
- Siegfried Segaert
- Dermatology Department, University Hospital Leuven, Leuven, Belgium.
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Center and University of Toronto, Toronto, Canada
| | | | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Jose-Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma of Barcelona, Badalona, Spain
| | - Helen Young
- Division of Musculoskeletal and Dermatological Sciences, The Dermatology Research Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Vincent Descamps
- Department of Dermatology, Bichat-Claude Bernard Hospital, Paris 7 Denis Diderot University, Paris, France
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160
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Helwa I, Choudhary V, Chen X, Kaddour-Djebbar I, Bollag WB. Anti-Psoriatic Drug Monomethylfumarate Increases Nuclear Factor Erythroid 2-Related Factor 2 Levels and Induces Aquaporin-3 mRNA and Protein Expression. J Pharmacol Exp Ther 2017; 362:243-253. [PMID: 28515158 PMCID: PMC5502379 DOI: 10.1124/jpet.116.239715] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/10/2017] [Indexed: 12/22/2022] Open
Abstract
Oxidative stress contributes to inflammatory skin diseases, including psoriasis. Monomethylfumarate (MMF) is an antipsoriatic agent with a poorly understood mechanism of action. In other cell types MMF increases the expression of nuclear factor erythroid-derived 2-like 2 (Nrf2), a transcription factor that regulates cellular antioxidant responses, to reduce oxidative stress like that observed in inflammatory disorders such as multiple sclerosis. We tested the hypothesis that MMF enhances Nrf2 activity in keratinocytes, thereby improving their capacity to counteract environmental stresses. We used Western analysis, immunofluorescence, and real-time quantitative reverse-transcription polymerase chain reaction to examine the effect of MMF on the expression of Nrf2 and its targets. We also measured intracellular reactive oxygen species (ROS) levels following MMF treatment. Our data show that MMF increased total and nuclear Nrf2 levels in primary mouse keratinocytes and enhanced mRNA expression of several Nrf2-downstream effectors, including heme oxygenase-1 and peroxiredoxin-6. Moreover, MMF treatment attenuated the generation of ROS following hydrogen peroxide treatment. On the other hand, the expression and membranous localization of aquaporin-3 (AQP3), a glycerol channel implicated in keratinocyte differentiation, was stimulated by MMF, which also enhanced keratinocyte glycerol uptake. The Nrf2 activator sulforaphane also increased AQP3 levels, suggesting that AQP3 expression may be regulated by Nrf2. We show for the first time that MMF stimulates Nrf2 and AQP3 expression and function/activity in keratinocytes. This effect may account, in part, for the previously observed ability of MMF to inhibit proliferation and inflammatory mediator production and promote differentiation in keratinocytes and to treat psoriasis.
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Affiliation(s)
- Inas Helwa
- Charlie Norwood VA Medical Center (V.C., X.C., I.K.-D., W.B.B.), Augusta, Georgia; Department of Oral Biology (I.H., W.B.B.), Department of Physiology (V.C., X.C., I.K.-D., W.B.B.), and Department of Medicine (Dermatology) (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Vivek Choudhary
- Charlie Norwood VA Medical Center (V.C., X.C., I.K.-D., W.B.B.), Augusta, Georgia; Department of Oral Biology (I.H., W.B.B.), Department of Physiology (V.C., X.C., I.K.-D., W.B.B.), and Department of Medicine (Dermatology) (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Xunsheng Chen
- Charlie Norwood VA Medical Center (V.C., X.C., I.K.-D., W.B.B.), Augusta, Georgia; Department of Oral Biology (I.H., W.B.B.), Department of Physiology (V.C., X.C., I.K.-D., W.B.B.), and Department of Medicine (Dermatology) (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Ismail Kaddour-Djebbar
- Charlie Norwood VA Medical Center (V.C., X.C., I.K.-D., W.B.B.), Augusta, Georgia; Department of Oral Biology (I.H., W.B.B.), Department of Physiology (V.C., X.C., I.K.-D., W.B.B.), and Department of Medicine (Dermatology) (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Wendy B Bollag
- Charlie Norwood VA Medical Center (V.C., X.C., I.K.-D., W.B.B.), Augusta, Georgia; Department of Oral Biology (I.H., W.B.B.), Department of Physiology (V.C., X.C., I.K.-D., W.B.B.), and Department of Medicine (Dermatology) (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia
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161
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Development and Validation of a Novel Questionnaire for Adherence with Topical Treatments in Psoriasis (QATOP). Am J Clin Dermatol 2017; 18:571-581. [PMID: 28321796 DOI: 10.1007/s40257-017-0272-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Self-report measures are the most used methodologies for the evaluation of adherence to psoriasis topical treatment, although currently there is no standard questionnaire for this purpose. OBJECTIVE The present study aimed at developing a novel questionnaire (Questionnaire for Adherence to TOPical treatment [QATOP]) for the assessment of adherence to topical treatment in psoriasis. METHODS A questionnaire containing nine items organized into two parts (part 1: current patient treatment; part 2: adherence to treatment, amount used, and treatment-associated variables) was developed, supported by a systematic literature review, qualitative patient focus interviews, and expert-group input. Its content validity was determined by a pilot study of six patients. Adherence to topical treatment was then assessed in 35 patients with psoriasis, after 45 days of treatment, using the QATOP and a medication log. Associations between different items of the QATOP and the log were investigated. RESULTS Adherence results were 63.5 ± 29.2% for the log and 60.9 ± 24.4% for the QATOP, and were strongly correlated (R = 0.819, p < 0.001). Distinct posologic regimens were reported by patients, which, in some cases, were not the usual doses. Patients also reported using doses of medicine on each application that were markedly lower than required. CONCLUSION The QATOP is a valid and reliable self-report measure of adherence to topical treatment in patients with psoriasis. The use of this standard questionnaire could improve the methodological quality of adherence studies. Improvement of the clarity of posologic instructions is clearly urgently needed.
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Chua-Aguilera CJ, Möller B, Yawalkar N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clin Rev Allergy Immunol 2017; 53:371-393. [DOI: 10.1007/s12016-017-8632-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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163
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Demirkan S, Gündüz Ö, Devrim T. Sorafenib-asssociated hand-foot syndrome treated with topical calcipotriol. JAAD Case Rep 2017; 3:354-357. [PMID: 28761920 PMCID: PMC5522952 DOI: 10.1016/j.jdcr.2017.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Serkan Demirkan
- Department of Dermatology and Venerology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Özgür Gündüz
- Department of Dermatology and Venerology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Tuba Devrim
- Department of Pathology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
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Tanimoto A, Shinozaki Y, Yamamoto Y, Katsuda Y, Taniai-Riya E, Toyoda K, Kakimoto K, Kimoto Y, Amano W, Konishi N, Hayashi M. A novel JAK inhibitor JTE-052 reduces skin inflammation and ameliorates chronic dermatitis in rodent models: Comparison with conventional therapeutic agents. Exp Dermatol 2017; 27:22-29. [DOI: 10.1111/exd.13370] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Atsuo Tanimoto
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Yuichi Shinozaki
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Yasuo Yamamoto
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Yoshiaki Katsuda
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Eriko Taniai-Riya
- Toxicology Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Hadano Kanagawa Japan
| | - Kaoru Toyoda
- Toxicology Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Hadano Kanagawa Japan
| | - Kochi Kakimoto
- Toxicology Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Hadano Kanagawa Japan
| | - Yukari Kimoto
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Wataru Amano
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Noriko Konishi
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
| | - Mikio Hayashi
- Biological/Pharmacological Research Laboratories; Central Pharmaceutical Research Institute; Japan Tobacco Inc.; Takatsuki Osaka Japan
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Boisgard AS, Lamrayah M, Dzikowski M, Salmon D, Kirilov P, Primard C, Pirot F, Fromy B, Verrier B. Innovative drug vehicle for local treatment of inflammatory skin diseases: Ex vivo and in vivo screening of five topical formulations containing poly(lactic acid) (PLA) nanoparticles. Eur J Pharm Biopharm 2017; 116:51-60. [DOI: 10.1016/j.ejpb.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Custom-made micro applicators for high-dose-rate brachytherapy treatment of chronic psoriasis. J Contemp Brachytherapy 2017; 9:263-269. [PMID: 28725251 PMCID: PMC5509984 DOI: 10.5114/jcb.2017.68304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose In this study, we present the treatment of the psoriatic nail beds of patients refractory to standard therapies using high-dose-rate (HDR) brachytherapy. The custom-made micro applicators (CMMA) were designed and constructed for radiation dose delivery to small curvy targets with complicated topology. The role of the HDR brachytherapy treatment was to stimulate the T cells for an increased immune response. Material and methods The patient diagnosed with psoriatic nail beds refractory to standard therapies received monthly subunguinal injections that caused significant pain and discomfort in both hands. The clinical target was defined as the length from the fingertip to the distal interphalangeal joint. For the accurate and reproducible setup in the multi-fractional treatment delivery, the CMMAs were designed. Five needles were embedded into the dense plastic mesh and covered with 5 mm bolus material for each micro applicator. Five CMMAs were designed, resulting in the usage of 25 catheters in total. Results The prescription dose was planned to the depth of the anterior surface of the distal phalanx, allowing for the sparing of the surrounding tissue. The total number of the active dwell positions was 145 with step size of 5 mm. The total treatment time was 115 seconds with a 7.36 Ci activity of the 192Ir source. The treatment resulted in good pain control. The patient did not require further injections to the nail bed. After this initial treatment, additional two patients with similar symptoms received HDR brachytherapy. The treatment outcome was favorable in all cases. Conclusions The first HDR brachytherapy treatment of psoriasis of the nail bed is presented. The initial experience revealed that brachytherapy treatment was well-tolerated and resulted in adequate control of the disease. A larger cohort of patients will be required for additional conclusions related to the long-term clinical benefits.
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Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam in Patients with Moderate-to-Severe Psoriasis: Sub-Group Analysis of the PSO-ABLE Study. Am J Clin Dermatol 2017; 18:405-411. [PMID: 28236223 PMCID: PMC5422452 DOI: 10.1007/s40257-017-0258-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fixed-combination calcipotriol 50 μg/g plus betamethasone 0.5 mg/g (Cal/BD) aerosol foam is a new topical treatment for psoriasis. Although moderate-to-severe psoriasis is typically treated with systemic/biologic therapies, a topical treatment that is efficacious in these patients may be a significant cost-saving alternative to systemic therapy. OBJECTIVE The objective of this study was to assess the response to Cal/BD foam and gel in patients with moderate-to-severe psoriasis enrolled in the phase III, 12-week PSO-ABLE study. METHODS Patients eligible for this analysis had moderate-to-severe psoriasis, defined by the 'Rule of Tens': body surface area ≥10% or Psoriasis Area and Severity Index (PASI) [excluding head; modified PASI (mPASI)] >10 or Dermatology Life-Quality Index >10. Endpoints included: proportion of patients achieving mPASI75 or mPASI90; change in body surface area; proportion of patients clear/almost clear with a ≥2 grade improvement (i.e., treatment success); change in Dermatology Life-Quality Index. RESULTS Seventy-seven Cal/BD foam patients and 82 gel patients had moderate-to-severe psoriasis. A greater proportion achieved mPASI75 and mPASI90 with Cal/BD foam than gel at weeks 4, 8, and 12 (57.1 vs. 35.4%; p = 0.006 and 15.6 vs. 12.2% at week 12, respectively); overall reduction in mPASI from baseline to week 12 was 64% with the foam vs. 51% with the gel. Overall reduction in body surface area at week 12 was 50% with the foam and 39% with the gel. Treatment success rates were higher with the Cal/BD foam than the gel at weeks 1, 2, 4, 8 (p = 0.0089), and 12, and a greater proportion of foam patients achieved a Dermatology Life-Quality Index score of 0/1 at weeks 4 (p = 0.004), 8, and 12 (p = 0.001). CONCLUSION Cal/BD foam can be considered as a treatment option in some patients with moderate-to-severe psoriasis who are potential candidates for systemic therapy. CLINICALTRIALS. GOV IDENTIFIER NCT02132936.
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Martinez-Santana V, Rodriguez-Murphy E, Smithson A, Miserachs-Aranda N, Del Río-Gil R, Torre-Lloverás I. Efficacy and safety of direct-acting antiviral agents when combined with secukinumab. Eur J Hosp Pharm 2017; 25:53-56. [PMID: 31156986 DOI: 10.1136/ejhpharm-2017-001212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/23/2023] Open
Abstract
Background The interference in the immune response induced by biological disease-modifying antirheumatic drugs (bDMARDs) increases the risk of reactivation of infections. Treatment of patients with chronic hepatitis C virus (HCV) infection and psoriasis is complex. The efficacy and safety of the new direct-acting antiviral agents (DAA) when combined with bDMARDs remain unknown. Case report We present a case of a 44-year-old Caucasian man affected with psoriasis and HCV infection. Throughout the course of the psoriatic disease, this patient received several lines of treatment, including secukinumab, a new type of bDMARD. At the time of commencing secukinumab, new DAA agents (ledipasvir/sofosbuvir) were also initiated. At week 12 post-treatment, hepatitis C viral load was undetectable and the patient remained in remission of psoriasis. Conclusion This case report suggests that secukinumab is a therapeutic option in patients with psoriasis, particularly in those cases with HCV infection where treatment with DAA agents is warranted.
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Affiliation(s)
| | | | - Alex Smithson
- Infectious Diseases Unit, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - Nuria Miserachs-Aranda
- Pharmacy, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - Ruben Del Río-Gil
- Dermatology, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
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Iversen L, Lange M, Bissonette R, Carvalho A, van de Kerkhof P, Kirby B, Kleyn C, Lynde C, van der Walt J, Wu J. Topical treatment of psoriasis: questionnaire results on topical therapy accessibility and influence of body surface area on usage. J Eur Acad Dermatol Venereol 2017; 31:1188-1195. [DOI: 10.1111/jdv.14250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
Affiliation(s)
- L. Iversen
- Department of Dermatology; Aarhus University Hospital; Aarhus C Denmark
| | - M.M. Lange
- Department of Dermatology; Aarhus University Hospital; Aarhus C Denmark
| | | | - A.V.E. Carvalho
- Santa Casa de Misericórdia de Porto Alegre Hospital; Porto Alegre Brazil
| | | | - B. Kirby
- St. Vincents Hospital; Dublin Ireland
| | - C.E. Kleyn
- The Dermatology Centre; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester UK
| | - C.W. Lynde
- Department of Medicine; University of Toronto; Toronto ON Canada
| | | | - J.J. Wu
- Department of Dermatology; Kaiser Permanente Los Angeles Medical Center; Los Angeles CA USA
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Efficacy and Safety of Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam Compared with Betamethasone 17-Valerate-Medicated Plaster for the Treatment of Psoriasis. Clin Drug Investig 2017; 37:355-361. [PMID: 27995521 PMCID: PMC5346111 DOI: 10.1007/s40261-016-0489-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Fixed combination calcipotriol as hydrate (Cal) 50 µg/g plus betamethasone as dipropionate (BD) 0.5 mg/g aerosol foam is an alcohol-free treatment for psoriasis. Betamethasone 17-valerate 2.25 mg (BV)-medicated plasters are recommended for treating psoriasis plaques localized in difficult-to-treat (DTT; elbow, knee, anterior face of the tibia) areas. Objective The aim of this study was to compare the efficacy of Cal/BD foam with BV-medicated plaster in patients with plaque psoriasis. Methods In this phase IIa, randomized, single-center, investigator-blinded, 4-week study, both Cal/BD foam and BV-medicated plaster were applied once daily to six test sites (three for each treatment). The primary efficacy endpoint was absolute change in total clinical score (TCS; sum of erythema, scaling, and infiltration); secondary endpoints were changes from baseline in each individual clinical score, ultrasonographic changes (total skin and echo-poor band thickness), and safety; and post hoc analysis was change from baseline in TCS on DTT areas. Results Thirty-five patients were included. Least-squares mean change in TCS from baseline was significantly greater for Cal/BD foam (−5.8) than BV-medicated plaster (−3.7; difference −2.2; 95% confidence interval −2.6 to −1.8; p < 0.001); greater changes for Cal/BD foam were observed from day 8 for each clinical sign. Absolute total skin and echo-poor band thickness change was significantly greater for Cal/BD foam than for BV-medicated plaster (both p < 0.001). Post hoc analyses showed that Cal/BD foam was significantly more effective than BV-medicated plaster on DTT areas after 4 weeks (p < 0.001), and both treatments were well tolerated. Conclusion Cal/BD foam demonstrated superior efficacy versus BV-medicated plasters, including on DTT areas, in patients with plaque psoriasis. Clinical trial registration number: NCT02518048.
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Armstrong AW, Koning JW, Rowse S, Tan H, Mamolo C, Kaur M. Initiation, Switching, and Cessation of Psoriasis Treatments Among Patients with Moderate to Severe Psoriasis in the United States. Clin Drug Investig 2017; 37:493-501. [DOI: 10.1007/s40261-017-0508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paul C, Bang B, Lebwohl M. Fixed combination calcipotriol plus betamethasone dipropionate aerosol foam in the treatment of psoriasis vulgaris: rationale for development and clinical profile. Expert Opin Pharmacother 2017; 18:115-121. [PMID: 27936972 DOI: 10.1080/14656566.2016.1269749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Psoriasis is a chronic, immune-mediated inflammatory disorder with a significant negative impact on quality of life. Most patients with mild-to-moderate psoriasis manage their disease with topical therapies; the most commonly used formulations contain corticosteroids and/or vitamin D3 analogues. However, adherence to topical treatment remains a significant issue as the daily treatment regimen can be cumbersome and time consuming and many patients do not obtain complete/almost complete clearance. Areas covered: Published pre-clinical and clinical data evaluating calcipotriol 50 µg/g (Cal) and betamethasone 0.5 mg/g as dipropionate (BD) aerosol foam in patients with psoriasis. Expert opinion: Cal/BD aerosol foam, a once-daily, alcohol-free, paraffin-based vehicle with emollient properties, was developed to increase the therapeutic options available to patients. Cal/BD aerosol foam is rapidly effective for treating psoriasis and the greater efficacy compared with the ointment and gel formulations is consistent and clinically relevant. This enhanced efficacy is due to improved skin penetration of the active ingredients following the formation of a stable supersaturated solution on the skin. Studies have shown increasing patient satisfaction with Cal/BD aerosol foam. It is hoped that this optimized formulation of Cal/BD will improve adherence and help to address the unmet medical needs of patients with mild-to-moderate psoriasis.
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Affiliation(s)
- Carle Paul
- a Professor and Chairman of the Department of Dermatology , Paul Sabatier University and Larrey Hospital , Toulouse , France
| | - Bo Bang
- b Medical Lead, Skin inflammation Projects , LEO Pharma A/S , Ballerup , Denmark
| | - Mark Lebwohl
- c Professor and System Chair of the Department of Dermatology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Malatestinic W, Nordstrom B, Wu JJ, Goldblum O, Solotkin K, Lin CY, Kistler K, Fraeman K, Johnston J, Hawley LCDRL, Sicignano N, Araujo A. Characteristics and Medication Use of Psoriasis Patients Who May or May Not Qualify for Randomized Controlled Trials. J Manag Care Spec Pharm 2017; 23:370-381. [PMID: 28230450 PMCID: PMC10398198 DOI: 10.18553/jmcp.2017.16367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical trials impose exclusion criteria that may limit the generalizability of results. OBJECTIVES To (a) determine the percentage of real-world patients who would qualify for psoriasis randomized controlled trials; (b) ascertain differences between moderate-to-severe psoriasis patients who would be eligible, ineligible, or potentially eligible for clinical trials; and (c) compare their biologic treatment patterns. METHODS Moderate-to-severe psoriasis patients were identified from the U.S. Department of Defense health care database from January 1, 2008, to October 31, 2013. Eligibility classification for psoriasis trials was based on common trial exclusion criteria involving medical conditions and recent treatment history. Patient characteristics and treatment patterns of 4 biologics (adalimumab, etanercept, infliximab, and ustekinumab) were compared between groups. Adherence was measured by medication possession ratio and persistence as continuous time on drug with ≤ 90-day gap between supply times. RESULTS Among 16,284 qualifying psoriasis patients, 4,677 (28.7%) were medically ineligible, and 8,466 (52.0%) had ineligibility-related treatments that could be stopped prior to trial entry; the latter patients were considered potentially eligible for psoriasis trials. Common reasons for medical ineligibility included malignancies and hematologic disorders; treatment ineligibilities included use of topical corticosteroids and phototherapy. Medically ineligible patients were older and had more comorbidities, while potentially eligible patients were younger and healthier than trial-eligible patients. Most treatment patterns were similar across groups, except that, compared with the trial-eligible group, medically ineligible patients had greater adherence to infliximab and potentially trial-eligible patients had greater adherence and persistence to adalimumab. CONCLUSIONS This large real-world study found that patients who may be ineligible for psoriasis trials differ in important respects (e.g., comorbidities, prior treatments) from their trial-eligible counterparts. Regardless of their differences at baseline, adherence, persistence, and switching of biologic medications are largely similar, with few differences noted among groups. DISCLOSURES Financial support for this study was provided by Lilly USA. Wu has received research funding from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Coherus Biosciences, Dermira, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, Sandoz, and Sun Pharmaceutical Industries, and he is a consultant for AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Pfizer, Regeneron, and Sun Pharmaceutical Industries. Malatestinic, Goldblum, Solotkin, Lin, Johnston, and Araujo are employees and/or stock owners of Lilly. Nordstrom, Kistler, and Fraeman are employees of Evidera, which received funding from Lilly to conduct this study. LCDR Hawley is a military service member. This work was prepared as part of her official duties. Title 17 U.S.C. 105 provides that "copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. 101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of that person's official duties. Research data were derived from an approved Naval Medical Center, Portsmouth, Virginia, institutional review board protocol. The views expressed in this work are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government. Study concept and design were contributed by Malatestinic and Araujo, along with the other authors. Nordstrom, Kistler, Fraeman, and Sicignano collected the data, and data interpretation was performed by Wu, Lin, and Hawley, along with Malatestinic, Nordstrom, Solotkin, and Araujo. The manuscript was written by Johnston, Malatestinic, Kistler, Wu, and Araujo, along with Nordstrom, Goldblum, Solotkin, Hawley, and Sicignano, and revised by Goldblum, Solotkin, Malatestinic, and Araujo, along with Nordstrom, Wu, Fraeman, Johnston, Hawley, and Sicignano.
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Young M, Aldredge L, Parker P. Psoriasis for the primary care practitioner. J Am Assoc Nurse Pract 2017; 29:157-178. [PMID: 28233460 DOI: 10.1002/2327-6924.12443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance.
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Affiliation(s)
- Melodie Young
- Modern Dermatology, Baylor-Health Texas Affiliate, Dallas, Texas
| | - Lakshi Aldredge
- Dermatology Service, Operative Care Division, VA Portland Health Care System, Portland, Oregon
| | - Patti Parker
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
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van der Meijden WI, Boffa MJ, Ter Harmsel WA, Kirtschig G, Lewis FM, Moyal-Barracco M, Tiplica GS, Sherrard J. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2017; 31:925-941. [PMID: 28164373 DOI: 10.1111/jdv.14096] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Abstract
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - W A Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- University Hospital of Tübingen, Tübingen, Germany
| | - F M Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London and Frimley Health NHS Trust, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Churchill Hospital, Oxford, UK
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Abstract
BACKGROUND Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. OBJECTIVE Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. METHODS Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. RESULTS To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. CONCLUSIONS More controlled studies are needed for an evidence-based approach to scalp psoriasis.
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Common Dermatoses. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_122] [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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Yamauchi P. DFD-01: a novel topical formulation of betamethasone dipropionate for the treatment of extensive psoriasis. Expert Rev Clin Immunol 2016; 13:85-91. [PMID: 27967262 DOI: 10.1080/1744666x.2017.1270756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Betamethasone dipropionate has been used for the topical treatment of psoriasis in multiple formulations. DFD-01 (Sernivo™, Promius Pharma LLC) is a new midpotent lotion formulation of betamethasone dipropionate 0.05% that has recently been approved for the treatment of mild to moderate psoriasis for up to 4 weeks. Areas covered: This review will critically appraise available clinical information on DFD-01. Phase 3 efficacy and safety results will be reviewed on head-to-head comparison of DFD-01 with a superpotent augmented betamethasone dipropionate 0.05% lotion. It is suggested that the formulation of DFD-01 has enabled this midpotent topical steroid to demonstrate equivalent efficacy to a superpotent steroid. Expert commentary: DFD-01's unique advantage is that this product has the efficacy of a higher potency steroid but with the safety profile of a mid-potency steroid based on VCA assays. This formulation also has aesthetic appeal, which may benefit compliance.
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Affiliation(s)
- Paul Yamauchi
- a Dermatology Institute and Skin Care Center , Santa Monica , CA , USA.,b Division of Dermatology , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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González-Parra E, Daudén E, Carrascosa J, Olveira A, Botella R, Bonanad C, Rivera R. Kidney Disease and Psoriasis. A New Comorbidity? ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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González-Parra E, Daudén E, Carrascosa J, Olveira A, Botella R, Bonanad C, Rivera R. Enfermedad renal y psoriasis. ¿Una nueva comorbilidad? ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:823-829. [DOI: 10.1016/j.ad.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/19/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022] Open
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Armstrong AW, Koning JW, Rowse S, Tan H, Mamolo C, Kaur M. Under-Treatment of Patients with Moderate to Severe Psoriasis in the United States: Analysis of Medication Usage with Health Plan Data. Dermatol Ther (Heidelb) 2016; 7:97-109. [PMID: 27905011 PMCID: PMC5336424 DOI: 10.1007/s13555-016-0153-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory disorder with significant morbidity and mortality, but a persistent gap appears to exist for the adequate treatment of patients with moderate to severe disease. As the extent of under-treatment is unknown, we attempted to determine overall treatment patterns and estimate under-treatment using a large database. Methods Data from the US National Health and Wellness Survey was used to estimate the proportion of patients with mild, moderate or severe psoriasis. The proportion with moderate to severe disease was estimated by excluding those with mild disease, and projecting this to the total insured US population, weighted by age and gender. Using US health plan claims data, patient totals by treatment type were determined between October 1, 2007 and September 30, 2012. Patients had to be continuously enrolled in a health plan and be ≥18 years at the end of the analysis window. Psoriasis was confirmed if patients had at least one claim of any type of psoriasis except psoriatic arthropathy (ICD-9 code 696.1). A monthly treatment history, classified by biologic, traditional oral systemic, phototherapy and topical therapy, was recorded for each patient. Results There were an estimated 1.7 million insured US patients with moderate to severe psoriasis. Of these, 1 million (59%) were not treated for their condition in the preceding year. Among 695,488 patients who were treated for psoriasis in the preceding year, 346,201 were currently receiving treatment and 349,287 had lapsed treatment. Of the patients lapsed and currently treated in this period, the numbers who received each treatment type were 156,409 (biologic), 222,657 (traditional oral systemic), 22,911 (phototherapy), and 293,511 (topical). A limitation of the study was that only insurance claims were analyzed. Conclusion Moderate to severe psoriasis remains persistently untreated or under-treated. We suggest that potential barriers preventing access to care be explored. Funding This study was sponsored by Pfizer Inc.
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Queille-Roussel C, Bang B, Clonier F, Lacour JP. Enhanced vasoconstrictor potency of the fixed combination calcipotriol plus betamethasone dipropionate in an innovative aerosol foam formulation vs. other corticosteroid psoriasis treatments. J Eur Acad Dermatol Venereol 2016; 30:1951-1956. [PMID: 27306589 PMCID: PMC5108427 DOI: 10.1111/jdv.13714] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/11/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND An aerosol foam formulation of fixed combination calcipotriol 50 μg/g (Cal) and betamethasone 0.5 mg/g (as dipropionate; BD) has been developed for psoriasis vulgaris treatment. OBJECTIVE To compare Cal/BD aerosol foam pharmacodynamic activity with Cal/BD ointment and with other topical corticosteroids of different potencies by assessing vasoconstrictor potential. METHODS A Phase I, single-centre, investigator-blinded, vehicle-controlled, intra-individual comparison vasoconstriction study. Healthy volunteers received a single application on selected sites of: Cal/BD aerosol foam, clobetasol propionate 0.5 mg/g cream (CP; very potent), Cal/BD ointment (potent), fluocinolone acetonide 0.25 mg/g ointment (FA; moderately potent), BD aerosol foam and aerosol foam vehicle. A seventh untreated site acted as a negative control. Skin blanching was assessed by visual (primary response criterion) and colorimetric a* and L* measurements (secondary criteria), and was analysed over time (6-32 h post-application). RESULTS Thirty-five healthy volunteers were included. All active treatments led to significantly greater skin blanching than control. By visual assessment, skin blanching with Cal/BD aerosol foam was significantly less compared with CP cream [mean AUC0-32 2560 vs. 3831; mean difference = -1272; 95% confidence interval (CI): -1598, -945; P < 0.001], similar to BD aerosol foam (mean AUC0-32 2560 vs. 2595; mean difference = -35; 95% CI: -362, 292; P = 0.83) and significantly greater than Cal/BD ointment (mean AUC0-32 2560 vs. 2008; mean difference = 552; 95% CI: 225, 878; P = 0.001) and FA ointment (mean AUC0-32 2560 vs. 1981; mean difference = 578; 95% CI: 251, 905; P < 0.001). Colorimetric assessments a* and L* also indicated significantly reduced skin blanching with Cal/BD aerosol foam compared with CP cream. No adverse events (AEs) were reported. CONCLUSION Cal/BD aerosol foam can be considered a more potent formulation than Cal/BD ointment and the moderately potent FA ointment, but less potent than the very potent corticosteroid, CP cream.
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Affiliation(s)
- C Queille-Roussel
- Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice, France.
| | - B Bang
- LEO Pharma A/S, Ballerup, Denmark
| | | | - J-P Lacour
- Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice, France
- Service de Dermatologie, University Hospital of Nice, Nice, France
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Abstract
Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL), which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Shikha Chugh
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Shivani Bansal
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
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Stein Gold L, Villumsen J, Rosen M. Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam is Effective, Independent of Body Mass Index and the Extent and Severity of Psoriasis. Dermatol Ther (Heidelb) 2016; 6:667-673. [PMID: 27714595 PMCID: PMC5120636 DOI: 10.1007/s13555-016-0147-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Good treatment adherence is important in the effective management of psoriasis and is related to both the frequency of applications and the amount of product used versus the recommended dose. The efficacy and safety of fixed combination calcipotriol 50 µg/g (Cal) and betamethasone 0.5 mg/g as dipropionate (BD) in the treatment of psoriasis is well established; an aerosol foam formulation has been developed to enhance adherence. This subanalysis from the Phase III PSO-FAST study evaluates the amount of Cal/BD foam used during treatment and the association between the extent and severity of baseline disease. Methods Patients (≥18 years) with mild-to-severe body psoriasis were randomized 3:1 to once-daily Cal/BD foam or vehicle. The amount of Cal/BD foam and vehicle used over the 4-week study period was evaluated according to three baseline disease assessments: extent of body surface area (BSA) affected by psoriasis, physician’s global assessment of disease severity (PGA) and modified psoriasis area and severity index (mPASI). Treatment success and mPASI75 rates were assessed according to body mass index (BMI) and body weight. Results 323 patients were randomized to Cal/BD foam and 103 to vehicle. At week 4, the mean total amount of Cal/BD foam used was 120.8 g (n = 293), which was similar to the amount of vehicle used (128.9 g; n = 98). The total amount of Cal/BD foam used at week 4 was greater with increasing BSA and increasing severity of baseline PGA and mPASI. Throughout the study, 93.1% of patients in the Cal/BD foam group and 99.0% of patients in the vehicle group missed ≤10% of treatment applications. Treatment success and mPASI75 rates were generally similar when stratified according to BMI and body weight. Conclusions This subanalysis demonstrates that Cal/BD aerosol foam is used appropriately and is effective for the treatment of psoriasis, independent of BMI and the extent or severity of disease. Clinical trials number NCT01866163. Funding LEO Pharma A/S.
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186
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Papp KA, Bissonnette R, Gooderham M, Feldman SR, Iversen L, Soung J, Draelos Z, Mamolo C, Purohit V, Wang C, Ports WC. Treatment of plaque psoriasis with an ointment formulation of the Janus kinase inhibitor, tofacitinib: a Phase 2b randomized clinical trial. BMC DERMATOLOGY 2016; 16:15. [PMID: 27716172 PMCID: PMC5048458 DOI: 10.1186/s12895-016-0051-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/09/2016] [Indexed: 12/30/2022]
Abstract
Background Most psoriasis patients have mild to moderate disease, commonly treated topically. Current topical agents have limited efficacy and undesirable side effects associated with long-term use. Tofacitinib is a small molecule Janus kinase inhibitor investigated for the topical treatment of psoriasis. Methods This was a 12-week, randomized, double-blind, parallel-group, vehicle-controlled Phase 2b study of tofacitinib ointment (2 % and 1 %) applied once (QD) or twice (BID) daily in adults with mild to moderate plaque psoriasis. Primary endpoint: proportion of patients with Calculated Physician’s Global Assessment (PGA-C) clear or almost clear and ≥2 grade improvement from baseline at Weeks 8 and 12. Secondary endpoints: proportion of patients with PGA-C clear or almost clear; proportion achieving Psoriasis Area and Severity Index 75 (PASI75) response; percent change from baseline in PASI and body surface area; change from baseline in Itch Severity Item (ISI). Adverse events (AEs) were monitored and clinical laboratory parameters measured. Results Overall, 435 patients were randomized and 430 patients received treatment. The proportion of patients with PGA-C clear or almost clear and ≥2 grade improvement from baseline at Week 8 was 18.6 % for 2 % tofacitinib QD (80 % confidence interval [CI] for difference from vehicle: 3.8, 18.2 %) and 22.5 % for 2 % tofacitinib BID (80 % CI: 3.1, 18.5 %); this was significantly higher vs vehicle for both dosage regimens. No significant difference vs vehicle was seen at Week 12. Significantly more patients achieved PGA-C clear or almost clear with 2 % tofacitinib QD and BID and 1 % tofacitinib QD (not BID) at Week 8, and with 2 % tofacitinib BID at Week 12. Pruritus was significantly reduced vs vehicle with 2 % and 1 % tofacitinib BID (starting Day 2), and 2 % tofacitinib QD (starting Day 3). Overall, 44.2 % of patients experienced AEs, 8.1 % experienced application site AEs, and 2.3 % experienced serious AEs. The highest incidence of AEs (including application site AEs) was in the vehicle QD group. Conclusions In adults with mild to moderate plaque psoriasis, 2 % tofacitinib ointment QD and BID showed greater efficacy than vehicle at Week 8, but not Week 12, with an acceptable safety and local tolerability profile. Trial registration NCT01831466 registered March 28, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12895-016-0051-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim A Papp
- K Papp Clinical Research and Probity Medical Research Inc, Waterloo, ON, Canada
| | | | - Melinda Gooderham
- SKiN Centre for Dermatology and Probity Medical Research Inc, Peterborough, and Queens University, Kingston, ON, Canada
| | | | | | | | - Zoe Draelos
- Dermatology Consulting Services, High Point, NC, USA
| | - Carla Mamolo
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - Vivek Purohit
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - Cunshan Wang
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - William C Ports
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA.
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Paul C, Stein Gold L, Cambazard F, Kalb RE, Lowson D, Bang B, Griffiths CEM. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol 2016; 31:119-126. [PMID: 27531752 PMCID: PMC6207928 DOI: 10.1111/jdv.13859] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Background Fixed combination calcipotriol 50 μg/g (Cal) plus betamethasone 0.5 mg/g (BD) foam has been developed as a new treatment option for patients with psoriasis. Methods The randomized, parallel‐group, investigator‐blinded Phase III, 12‐week PSO‐ABLE study compared the efficacy and safety of Cal/BD foam with Cal/BD gel. Patients aged ≥18 years with mild‐to‐severe psoriasis were randomized 4:4:1:1 to once‐daily Cal/BD foam, Cal/BD gel, foam vehicle or gel vehicle (NCT02132936). The primary efficacy endpoint was the proportion of patients who were clear/almost clear with a ≥ 2 grade improvement according to the physician's global assessment of disease severity (i.e. treatment success) at week 4 for Cal/BD foam vs. week 8 for Cal/BD gel. Secondary efficacy endpoints included: proportion of patients achieving at least a 75% reduction in modified psoriasis area and severity index (mPASI75), and time to treatment success (TTTS). Safety was monitored throughout. Results A total of 463 patients were randomized: Cal/BD foam (n = 185), Cal/BD gel (n = 188), foam vehicle (n = 47), gel vehicle (n = 43); overall completion rate was 90%. Cal/BD foam achieved higher treatment success rates (38% vs. 22%; P < 0.001) and mPASI75 (52% vs. 35%; P < 0.001) by week 4 than Cal/BD gel by week 8. Median TTTS with Cal/BD foam was 6 weeks; this could not be determined for Cal/BD gel as 50% treatment success was not achieved (P < 0.001). Adverse drug reactions were reported in 14 (7.6%) Cal/BD aerosol foam patients and 7 (3.7%) Cal/BD gel patients; all were single events except for itch with Cal/BD aerosol foam (n = 5; 2.7%) and worsening psoriasis with Cal/BD gel (n = 3; 1.6%). Conclusion Cal/BD aerosol foam showed significantly greater efficacy after 4 weeks, than 8 weeks of treatment with Cal/BD gel, with similar tolerability.
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Affiliation(s)
- C Paul
- Paul Sabatier University and Larrey Hospital, Toulouse, France
| | | | - F Cambazard
- Jean Monnet University, Saint-Etienne, France
| | - R E Kalb
- State University of New York, Buffalo, NY, USA
| | - D Lowson
- LEO Pharma A/S, Ballerup, Denmark
| | - B Bang
- LEO Pharma A/S, Ballerup, Denmark
| | - C E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester, UK
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188
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Comparative efficacy and incremental cost per responder of methotrexate versus apremilast for methotrexate-naïve patients with psoriasis. J Am Acad Dermatol 2016; 75:740-746. [PMID: 27476973 DOI: 10.1016/j.jaad.2016.05.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND To our knowledge, no clinical trials directly compare apremilast with methotrexate (the standard of care for initial systemic treatment of psoriasis). OBJECTIVE We sought to compare apremilast's relative efficacy with that of methotrexate for moderate to severe psoriasis. METHODS An anchor-based indirect comparison was conducted for 75% improvement in Psoriasis Area and Severity Index score from baseline to week 16 (PASI 75) rates for systemic-naïve patients from Efficacy and Safety Trial Evaluating the Effects of apreMilast in psoriasis (ESTEEM) 1 and 2 (apremilast vs placebo) and Comparative study of HumirA vs. Methotrexate vs Placebo In psOriasis patieNts (CHAMPION) (adalimumab vs methotrexate vs placebo) trials. The difference-in-difference in PASI 75 response rates was calculated as the difference between the ESTEEM apremilast and placebo rates and the CHAMPION methotrexate versus placebo rates. Number needed to treat and incremental drug cost per responder were also estimated. RESULTS No statistically significant difference was found between apremilast and methotrexate in PASI 75 (risk difference 13.1%; 95% confidence interval -1.8% to 28.0%; P = .09). Number needed to treat with apremilast versus methotrexate to gain 1 additional PASI 75 responder was 7.6. Annual incremental drug cost of this responder was estimated at $187,888.33. LIMITATIONS Few trials compare systemic-naïve patients. Only direct medication costs were considered. CONCLUSIONS There was no statistical evidence of greater efficacy for apremilast versus methotrexate. The $187,888 incremental cost per PASI 75 may exceed what payers are willing to pay.
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189
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Lee JH, Youn JI, Kim TY, Choi JH, Park CJ, Choe YB, Song HJ, Kim NI, Kim KJ, Lee JH, Yoo HJ. A multicenter, randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly, the combination of etanercept 25 mg twice weekly and acitretin, and acitretin alone in patients with moderate to severe psoriasis. BMC DERMATOLOGY 2016; 16:11. [PMID: 27455955 PMCID: PMC4960797 DOI: 10.1186/s12895-016-0048-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 07/08/2016] [Indexed: 11/17/2022]
Abstract
Background Etanercept, a soluble tumor necrosis factor receptor, and acitretin have been shown to be effective in treating psoriasis. Acitretin is widely used in Korea. However, the combination of etanercept plus acitretin has not been evaluated among Korean patients with psoriasis. The objective of this study was to investigate the efficacy and safety of combination therapy with etanercept and acitretin in patients with moderate to severe plaque psoriasis. Methods Sixty patients with psoriasis were randomized to receive etanercept 50 mg twice weekly (BIW) for 12 weeks followed by etanercept 25 mg BIW for 12 weeks (ETN-ETN); etanercept 25 mg BIW plus acitretin 10 mg twice daily (BID) for 24 weeks (ETN-ACT); or acitretin 10 mg BID for 24 weeks (ACT). The primary efficacy measurement was the proportion of patients achieving 75 % improvement in Psoriasis Area and Severity Index (PASI 75) at week 24. Secondary end points included 50 % improvement in PASI (PASI 50) at week 24 and clear/almost-clear by Physician Global Assessment (PGA) at each visit through week 24. Results The proportions of patients achieving PASI 75, PASI 50, and PGA clear/almost-clear at week 24 in the ETN-ETN (52.4, 71.4, and 52.4 %, respectively) and ETN-ACT groups (57.9, 84.2, and 52.6 %, respectively) were higher than in the ACT group (22.2, 44.4, and 16.7 %, respectively). The incidence of adverse events was similar across all arms. This was an open-label study with a small number of patients. Conclusion In Korean patients with moderate to severe plaque psoriasis, etanercept alone or in combination with acitretin was more effective than acitretin. All treatments were well tolerated throughout the study. Trial registration This study was registered on July 7, 2009 at ClinicalTrials.gov, NCT00936065.
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Affiliation(s)
- Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea.
| | - Jai-Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Tae-Yoon Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee-Ho Choi
- Department of Dermatology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Jong Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Hae-Jun Song
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
| | - Nack-In Kim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kwang-Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Seoul, Korea
| | - Jeung-Hoon Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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Efficacy of an innovative aerosol foam formulation of fixed combination calcipotriol plus betamethasone dipropionate in patients with psoriasis vulgaris. Clin Drug Investig 2016; 35:239-45. [PMID: 25708531 PMCID: PMC4368848 DOI: 10.1007/s40261-015-0269-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Objective The antipsoriatic effect of an innovative aerosol foam formulation of fixed combination calcipotriol 50 μg/g (as hydrate; Cal) and betamethasone 0.5 mg/g (as dipropionate; BD) was explored in order to compare the effect with that of the first-line treatment Cal/BD ointment. Methods This was a Phase IIa, single-centre, investigator-blinded, exploratory study, with intra-individual comparison using a modified psoriasis plaque test. Patients were treated once daily (6 days/week) for 4 weeks with Cal/BD foam, Cal/BD ointment, BD foam and Cal/BD foam vehicle, randomized to four plaque test sites (5 cm2 each). The primary efficacy endpoint was change in total clinical score (TCS; sum of erythema, scaling and lesional thickness). Secondary endpoints included ultrasonographic changes in total skin thickness and echo-poor band thickness, and adverse events. Results Twenty-four patients, median age 52.5 years (range 21–75), completed this study. At week 4, test sites treated with Cal/BD foam had a significantly greater decrease in mean (±SD) TCS (−6.00 ± 1.27) versus those treated with Cal/BD ointment (−5.25 ± 1.78; difference −0.75; 95 % CI −1.46 to −0.04; p = 0.038), BD foam (−4.96 ± 1.85; difference −1.04; 95 % CI −1.75 to −0.33; p = 0.005) or foam vehicle (−1.88 ± 1.12; difference −4.13; 95 % CI −4.83 to −3.42; p < 0.001). Total skin thickness and echo-poor band thickness of Cal/BD foam-treated sites were reduced to a greater extent than those treated with comparators. Eleven patients reported 17 adverse events, the most frequent being headache (five patients). There were no lesional/perilesional adverse events or adverse drug-related events. Conclusions Cal/BD foam demonstrated a significant improvement in antipsoriatic effect over Cal/BD ointment, BD foam and foam vehicle alone.
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Rerknimitr P, Nitinawarat J, Weschawalit S, Wititsuwannakul J, Wongtrakul P, Jutiviboonsuk A, Dhorranintra B, Asawanonda P. The Efficacy of Gynura pseudochina DC. var. hispida Thv. Ointment in Treating Chronic Plaque Psoriasis: A Randomized Controlled Trial. J Altern Complement Med 2016; 22:669-75. [PMID: 27391857 DOI: 10.1089/acm.2016.0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A recent study showed that Gynura pseudochina DC. var. hispida Thv. leaf extract (GP) can reduce the activation of the nuclear factor κB (NF-κB) pathway and suppress the release of interleukin (IL)-1β, IL-6, and tumor necrosis factor -α, which play an important role in the pathogenesis of psoriasis. METHODS Twenty-five patients with mild to moderate plaque psoriasis completed a 4-week trial. Twice daily, they applied the GP ointment on psoriatic lesions on one side of the body, and they applied 0.1% triamcinolone (TA) cream on the other side. The Targeted Area Score (TAS), Psoriasis Severity Index (PSI) scores, and Physician's Global Assessment (PGA) scores were assessed at baseline and at weeks 1, 2, 3, and 4. Pre- and post-treatment skin samples were taken. Phosphorylation of NF-κB p65, Ki-67, and epidermal thickness were analyzed through immunohistochemistry. RESULTS The TAS for erythema, scaling, and induration and PSI scores decreased on both treated sides. A statistically significant difference was observed beginning at the first week of treatment. The GP ointment significantly decreased scaling scores. However, no significant differences were observed between the TAS for erythema and induration or the PSI and PGA scores. Immunohistochemical staining revealed diminution of phosphorylated NF-κB p65, Ki-67, and epidermal thickness in the lesions treated with the GP ointment. The ointment was well tolerated, with minimal side effects. No laboratory abnormalities were detected. CONCLUSIONS The GP ointment demonstrated efficacy similar to that of 0.1% TA cream for mild to moderate chronic plaque psoriasis. In addition, its short-term side effects were minimal.
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Affiliation(s)
- Pawinee Rerknimitr
- 1 Dermatology Unit, Department of Medicine, King Chulalongkorn Memorial Hospital , Thai Red Cross Society, Bangkok, Thailand .,2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University , Bangkok, Thailand
| | - Jantakan Nitinawarat
- 2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University , Bangkok, Thailand
| | - Sinee Weschawalit
- 2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University , Bangkok, Thailand
| | - Jade Wititsuwannakul
- 2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University , Bangkok, Thailand
| | - Paveena Wongtrakul
- 3 Division of Pharmaceutical Technology, Faculty of Pharmaceutical Science, Huachiew Chalermprakiet University , Samutprakarn, Thailand
| | - Aranya Jutiviboonsuk
- 4 Division of Pharmacognosy, Faculty of Pharmaceutical Science, Huachiew Chalermprakiet University , Samutprakarn, Thailand
| | - Boonjeur Dhorranintra
- 5 Department of Pharmacology, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Pravit Asawanonda
- 2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University , Bangkok, Thailand
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Sala M, Elaissari A, Fessi H. Advances in psoriasis physiopathology and treatments: Up to date of mechanistic insights and perspectives of novel therapies based on innovative skin drug delivery systems (ISDDS). J Control Release 2016; 239:182-202. [PMID: 27381248 DOI: 10.1016/j.jconrel.2016.07.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
Psoriasis is a chronic inflammatory disease affecting mainly the skin but which can be complicated by psoriatic arthritis (PsA).This autoimmune skin disorder concerns 2-5% of the world population. To date, the physiopathology of psoriasis is not still completely elucidated but many researches are ongoing which have led for example to the discovery of the Th17/Th22 pathway. The conventional therapeutic approaches (local or systemic route) appeal to various classes of drugs with complex mechanisms of action and non-negligible side effects. Although there is no therapy capable to cure psoriasis, the current goal is to relieve symptoms as longer as possible with a good benefit/risk ratio. That is one of the principal limits of conventional antipsoriatic drugs. New formulations based on nanoencapsulation are a promising opportunity to answer to this limit by offering an optimization of the conventional antipsoriatic drug use (higher activity, lower side effects and frequency of application, etc.). Herein, we tried to put in perspective the mechanistic insights (histological and immunological views) proposed into scientific literature these last years in order to have a better comprehension of psoriasis physiopathology resulting in skin lesions and PsA. The therapeutic armamentarium and the different strategies in the management of psoriasis are discussed in greater details. To finish, the field of encapsulation in nanoparticles is broached in order to put forward recent advances in innovative skin drug delivery systems (ISDDSs) of antipsoriatic active agents for a better efficacy, safety and compliance.
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Affiliation(s)
- M Sala
- University Claude Bernard Lyon 1, Laboratoire d'Automatique et de Génie des Procédés, CNRS, UMR 5007, LAGEP-CPE-308G, 43 bd. du 11 Nov.1918, F-69622 Villeurbanne, France; Pharmacie centrale, Hospices Civils de Lyon, 57, Rue Francisque Darcieux, 69563 Saint Genis Laval, France
| | - A Elaissari
- University Claude Bernard Lyon 1, Laboratoire d'Automatique et de Génie des Procédés, CNRS, UMR 5007, LAGEP-CPE-308G, 43 bd. du 11 Nov.1918, F-69622 Villeurbanne, France
| | - H Fessi
- University Claude Bernard Lyon 1, Laboratoire d'Automatique et de Génie des Procédés, CNRS, UMR 5007, LAGEP-CPE-308G, 43 bd. du 11 Nov.1918, F-69622 Villeurbanne, France.
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Abstract
Psoriasis is a chronic condition that affects more than 7 million Americans. This article explores the pathogenesis and physical signs of psoriasis. Over the past 2 decades enhanced understanding of the immunologic basis of psoriasis has led to the development of new systemic agents that have revolutionized the management of this disease, and these modalities, along with traditional therapies, are described.
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Affiliation(s)
- Stephen M Schleicher
- DermDOX Center for Dermatology, 20 North Laurel Street, Hazleton, PA 18201, USA; St. Luke's Health Systems, 801 Ostrum Street, Bethlehem, PA 18015, USA; The Commonwealth Medical College, Scranton, PA 18605, USA; University of Pennsylvania Medical College, Philadelphia, PA 19104, USA.
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194
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Cutaneous Adverse Events in the Randomized, Double-Blind, Active-Comparator DECIDE Study of Daclizumab High-Yield Process Versus Intramuscular Interferon Beta-1a in Relapsing-Remitting Multiple Sclerosis. Adv Ther 2016; 33:1231-45. [PMID: 27251051 PMCID: PMC4939160 DOI: 10.1007/s12325-016-0353-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Indexed: 01/21/2023]
Abstract
Introduction Cutaneous adverse events (AEs) have been observed in clinical studies of daclizumab high-yield process (HYP) in relapsing-remitting multiple sclerosis (RRMS). Here, we report cutaneous AEs observed in the randomized, double-blind, active-comparator DECIDE study (ClinicalTrials.gov identifier, NCT01064401). Methods DECIDE was a randomized, double-blind, active-controlled phase 3 study of daclizumab HYP 150 mg subcutaneous every 4 weeks versus interferon (IFN) beta-1a 30 mcg intramuscular (IM) once weekly in RRMS. Treatment-emergent AEs were classified and recorded by investigators. Investigators also assessed the severity of each AE, and whether it met the criteria for a serious AE. Cutaneous AEs were defined as AEs coded to the Medical Dictionary for Regulatory Activities System Organ Class of skin and subcutaneous tissue disorders. The incidence, severity, onset, resolution, and management of AEs were analyzed by treatment group. Results Cutaneous AEs were reported in 37% of daclizumab HYP-treated patients and 19% of IFN beta-1a-treated patients. The most common investigator-reported cutaneous AEs with daclizumab HYP were rash (7%) and eczema (4%). Most patients with cutaneous AEs remained on treatment (daclizumab HYP, 81%; IM IFN beta-1a, 90%) and had events that were mild or moderate (94% and 98%) and subsequently resolved (78% and 82%). Most patients with cutaneous AEs did not require treatment with corticosteroids or were treated with topical corticosteroids (daclizumab HYP, 73%; IM IFN beta-1a, 81%). Serious cutaneous AEs were reported in 14 (2%) daclizumab HYP patients and one (<1%) IM IFN beta-1a patient. Conclusion There was an increased risk of cutaneous AEs with daclizumab HYP. While physicians should be aware of the potential for serious cutaneous AEs, the typical cutaneous AEs were mild-to-moderate in severity, manageable, and resolved over time. Funding Biogen and AbbVie Biotherapeutics Inc. Trial registration ClinicalTrials.gov identifier, NCT01064401. Electronic supplementary material The online version of this article (doi:10.1007/s12325-016-0353-2) contains supplementary material, which is available to authorized users.
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195
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Supersaturation of Calcipotriene and Betamethasone Dipropionate in a Novel Aerosol Foam Formulation for Topical Treatment of Psoriasis Provides Enhanced Bioavailability of the Active Ingredients. Dermatol Ther (Heidelb) 2016; 6:413-25. [PMID: 27358072 PMCID: PMC4972731 DOI: 10.1007/s13555-016-0125-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 12/05/2022] Open
Abstract
Introduction Previous studies have demonstrated the superior efficacy of a novel aerosol foam formulation of fixed combination calcipotriene 0.005% (Cal) and betamethasone dipropionate 0.064% (BD), compared with the ointment formulation. The aim of this study is to ascertain whether enhanced bioavailability of the active ingredients due to supersaturation and/or occlusive properties can explain the observed greater clinical efficacy. Methods Solubility and evaporation experiments were conducted to examine the abilities of Cal/BD aerosol foam ingredients to create a supersaturated environment. Optical microscopy, Raman imaging and X-ray powder diffraction were used to examine the physical state of Cal and BD in the formulations after application, and determine whether a supersaturated state remained stable for clinically relevant time periods. In vitro skin penetration and ex vivo biomarker assays were conducted to compare the skin penetration and bioavailability of Cal and BD from the aerosol foam and ointment formulations, respectively. Occlusive properties were examined via transepidermal water loss. Results Solubility studies showed that Cal and BD solubility increased with increasing dimethyl ether (DME) content. Both active ingredients are completely dissolved in the final aerosol foam formulation. DME rapidly evaporates after spraying, and the amount was reduced to 0.5% of the initial amount after 2 min. This led to the formation of a supersaturated environment, where Cal and BD crystals were absent for at least 26 h after application. Cal/BD aerosol foam had significantly greater in vitro skin penetration and had increased bioavailability compared with Cal/BD ointment. Both formulations effectively occluded the skin. Conclusion A stable supersaturated solution of Cal/BD in the aerosol foam leads to increased bioavailability and explains the improved clinical effect when compared to the Cal/BD ointment. Funding The studies included in the paper are all conducted by LEO Pharma A/S or CROs on behalf of LEO Pharma A/S.
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Dong C, Virtucio C, Zemska O, Baltazar G, Zhou Y, Baia D, Jones-Iatauro S, Sexton H, Martin S, Dee J, Mak Y, Meewan M, Rock F, Akama T, Jarnagin K. Treatment of Skin Inflammation with Benzoxaborole Phosphodiesterase Inhibitors: Selectivity, Cellular Activity, and Effect on Cytokines Associated with Skin Inflammation and Skin Architecture Changes. J Pharmacol Exp Ther 2016; 358:413-22. [PMID: 27353073 DOI: 10.1124/jpet.116.232819] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/23/2016] [Indexed: 12/18/2022] Open
Abstract
Psoriasis and atopic dermatitis are skin diseases affecting millions of patients. Here, we characterize benzoxaborole phosphodiesterase (PDE)-4 inhibitors, a new topical class that has demonstrated therapeutic benefit for psoriasis and atopic dermatitis in phase 2 or phase 3 studies. Crisaborole [AN2728, 4-((1-hydroxy-1,3-dihydrobenzo[c][1,2]oxaborol-5-yl)oxy)benzonitrile], compd2 [2-ethoxy-6-((1-hydroxy-1,3-dihydrobenzo[c][1,2]oxaborol-5-yl)oxy)nicotinonitrile], compd3 [6-((1-hydroxy-1,3-dihydrobenzo[c][1,2]oxaborol-5-yl)oxy)-2-(2-isopropoxyethoxy)nicotinonitrile], and compd4 [5-chloro-6-((1-hydroxy-1,3-dihydrobenzo[c][1,2]oxaborol-5-yl)oxy)-2-((4-oxopentyl)oxy)nicotinonitrile] are potent PDE4 inhibitors with similar affinity for PDE4 isoforms and equivalent inhibition on the catalytic domain and the full-length enzyme. These benzoxaboroles are less active on other PDE isozymes. Compd4 binds to the catalytic domain of PDE4B2 with the oxaborole group chelating the catalytic bimetal and overlapping with the phosphate in cAMP during substrate hydrolysis, and the interaction extends into the adenine pocket. In cell culture, benzoxaborole PDE4 inhibitors suppress the release of tumor necrosis factor-α, interleukin (IL)-23, IL-17, interferon-γ, IL-4, IL-5, IL-13, and IL-22, and these cytokines contribute to the pathologic changes in skin structure and barrier functions as well as immune dysregulation in atopic dermatitis and psoriasis. Treatment with compd3 or N(6),2'-O-dibutyryladenosine 3',5'-cyclic monophosphate increases cAMP response element binding protein phosphorylation in human monocytes and decreases extracellular signal-regulated kinase phosphorylation in human T cells; these changes lead to reduced cytokine production and are among the mechanisms by which compd3 blocks cytokine release. Topical compd3 penetrates the skin and suppresses phorbol myristate acetate-induced IL-13, IL-22, IL-17F, and IL-23 transcription and calcipotriol-induced thymic stromal lymphopoietin expression in mouse skin. Skin thinning is a major dose-limiting side effect of glucocorticoids. By contrast, repeated application of compd3 did not thin mouse skin. These findings show the potential benefits and safety of benzoxaborole PDE4 inhibitors for the treatment of psoriasis and atopic dermatitis.
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Affiliation(s)
- Chen Dong
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | | | - Olga Zemska
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | | | - Yasheen Zhou
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | - Diogo Baia
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | | | - Holly Sexton
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | | | - Joshua Dee
- Anacor Pharmaceuticals, Inc., Palo Alto, California
| | - Yvonne Mak
- Anacor Pharmaceuticals, Inc., Palo Alto, California
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197
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Kin KC, Hill D, Feldman SR. Calcipotriene and betamethasone dipropionate for the topical treatment of plaque psoriasis. Expert Rev Clin Pharmacol 2016; 9:789-97. [DOI: 10.1080/17512433.2016.1179574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin C. Kin
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Dane Hill
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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198
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Iversen L, Jakobsen HB. Patient Preferences for Topical Psoriasis Treatments are Diverse and Difficult to Predict. Dermatol Ther (Heidelb) 2016; 6:273-85. [PMID: 27125383 PMCID: PMC4906113 DOI: 10.1007/s13555-016-0119-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Topicals are a mainstay in psoriasis vulgaris treatment and are used concomitantly even in patients receiving systemic therapy. Patient acceptance of topical treatment can impact adherence and, consequently, real-life effectiveness. This study aimed to identify patient preferences for topical treatment attributes and to evaluate patient acceptability of topical treatments. Methods This 5-day study evaluated three inactive presentations: fixed combination calcipotriol/betamethasone dipropionate (Cal/BD) ointment vehicle in a tube, Cal/BD gel vehicle in a bottle and Cal/BD gel vehicle in a new Applicator delivery system. Participants with psoriasis on ≥2 locations were recruited, aiming for equal proportions in the categories: male/female; <40/≥40 years old; working/not working. Participants ranked a predefined ‘wish list’ of 13 topical treatment attributes, applied each product and evaluated them in a user survey, indicating how well the products delivered on 16 statements matching the 13 attributes. Afterward, participants indicated preference by psoriasis plaque location. Results Patient preferences differed to the extent that the proportion rating an attribute of high importance was similar to the proportion rating the same attribute of low importance. All attributes received similar mean ranking scores. Analysis by demographic characteristics revealed preferences are not associated with gender, age or employment status. Participants did not perceive much difference between the gel and ointment, but expressed preferences for different presentations to treat different plaque locations. The gel Applicator was preferred for 8/14 locations and both gel presentations were strongly preferred for hairy scalp. Conclusions Patients with psoriasis have diverse preferences, which cannot be predicted by demographics. Individual patient choice should be considered to increase the acceptability and a range of topical formulations should be available to support treatment adherence and improve clinical outcomes. Funding LEO Pharma A/S, Ballerup, Denmark.
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199
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Wu J, Lynde C, Kleyn C, Iversen L, Walt J, Carvalho A, Kirby B, Bissonnette R. Identification of key research needs for topical therapy treatment of psoriasis – a consensus paper by the International Psoriasis Council. J Eur Acad Dermatol Venereol 2016; 30:1115-9. [DOI: 10.1111/jdv.13614] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J.J. Wu
- Department of Dermatology Kaiser Permanente Los Angeles Medical Center Los Angeles CA USA
| | - C.W. Lynde
- Department of Medicine University of Toronto Toronto ON Canada
| | - C.E. Kleyn
- The Dermatology Centre Manchester Academic Health Science Centre Salford Royal NHS Foundation Trust Manchester UK
| | - L. Iversen
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - J.M Walt
- International Psoriasis Council St. Louis MO USA
| | - A. Carvalho
- Santa Casa de Misericórdia de Porto Alegre Hospital Complex Porto Alegre Brazil
| | - B. Kirby
- St. Vincents Hospital Dublin Ireland
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Lovato P, Norsgaard H, Tokura Y, Røpke MA. Calcipotriol and betamethasone dipropionate exert additive inhibitory effects on the cytokine expression of inflammatory dendritic cell–Th17 cell axis in psoriasis. J Dermatol Sci 2016; 81:153-64. [DOI: 10.1016/j.jdermsci.2015.12.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 01/20/2023]
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