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Maybury C, Samarasekera E, Douiri A, Barker J, Smith C. Diagnostic accuracy of noninvasive markers of liver fibrosis in patients with psoriasis taking methotrexate: a systematic review and meta-analysis. Br J Dermatol 2014; 170:1237-47. [DOI: 10.1111/bjd.12905] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 01/06/2023]
Affiliation(s)
- C.M. Maybury
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - E. Samarasekera
- National Clinical Guideline Centre; Royal College of Physicians of London; 11 St Andrews Place London NW1 4LE U.K
| | - A. Douiri
- Department of Public Health Sciences; School of Medicine; King's College London; Capitol House; 42 Weston St London SE1 3QD U.K
| | - J.N. Barker
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - C.H. Smith
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
- St John's Institute of Dermatology; Guys and St Thomas' NHS Foundation Trust; London U.K
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252
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Schafer PH, Parton A, Capone L, Cedzik D, Brady H, Evans JF, Man HW, Muller GW, Stirling DI, Chopra R. Apremilast is a selective PDE4 inhibitor with regulatory effects on innate immunity. Cell Signal 2014; 26:2016-29. [PMID: 24882690 DOI: 10.1016/j.cellsig.2014.05.014] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 01/02/2023]
Abstract
Apremilast, an oral small molecule inhibitor of phosphodiesterase 4 (PDE4), is in development for chronic inflammatory disorders, and has shown efficacy in psoriasis, psoriatic arthropathies, and Behçet's syndrome. In March 2014, the US Food and Drug Administration approved apremilast for the treatment of adult patients with active psoriatic arthritis. The properties of apremilast were evaluated to determine its specificity, effects on intracellular signaling, gene and protein expression, and in vivo pharmacology using models of innate and adaptive immunity. Apremilast inhibited PDE4 isoforms from all four sub-families (A1A, B1, B2, C1, and D2), with IC50 values in the range of 10 to 100 nM. Apremilast did not significantly inhibit other PDEs, kinases, enzymes, or receptors. While both apremilast and thalidomide share a phthalimide ring structure, apremilast lacks the glutarimide ring and thus fails to bind to cereblon, the target of thalidomide action. In monocytes and T cells, apremilast elevated intracellular cAMP and induced phosphorylation of the protein kinase A substrates CREB and activating transcription factor-1 while inhibiting NF-κB transcriptional activity, resulting in both up- and down-regulation of several genes induced via TLR4. Apremilast reduced interferon-α production by plasmacytoid dendritic cells and inhibited T-cell cytokine production, but had little effect on B-cell immunoglobulin secretion. In a transgenic T-cell and B-cell transfer murine model, apremilast (5mg/kg/day p.o.) did not affect clonal expansion of either T or B cells and had little or no effect on their expression of activation markers. The effect of apremilast on innate immunity was tested in the ferret lung neutrophilia model, which allows monitoring of the known PDE4 inhibitor gastrointestinal side effects (nausea and vomiting). Apremilast significantly inhibited lung neutrophilia at 1mg/kg, but did not induce significant emetic reflexes at doses <30 mg/kg. Overall, the pharmacological effects of apremilast are consistent with those of a targeted PDE4 inhibitor, with selective effects on innate immune responses and a wide therapeutic index compared to its gastrointestinal side effects.
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Affiliation(s)
- P H Schafer
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA.
| | - A Parton
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA
| | - L Capone
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA
| | - D Cedzik
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA
| | - H Brady
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA
| | - J F Evans
- Department of Biology, PharmAkea, San Diego, CA, USA
| | - H-W Man
- Department of Process Chemistry, Celgene Corporation, Summit, NJ, USA
| | - G W Muller
- GWM Consulting, Rancho Santa Fe, CA, USA
| | | | - R Chopra
- Department of Translational Development, Celgene Corporation, Summit, NJ, USA
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253
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Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, Chamlin SL, Cooper KD, Feldman SR, Hanifin JM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Simpson EL, Tom WL, Williams HC, Elmets CA, Block J, Harrod CG, Begolka WS, Eichenfield LF. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327-49. [PMID: 24813298 DOI: 10.1016/j.jaad.2014.03.030] [Citation(s) in RCA: 550] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.
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Affiliation(s)
- Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - David E Cohen
- Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L Chamlin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn Schwarzenberger
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Wynnis L Tom
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Hywel C Williams
- Center of Evidence-based Dermatology, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Lawrence F Eichenfield
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
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254
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Prieto-Pérez R, Cabaleiro T, Daudén E, Ochoa D, Román M, Abad-Santos F. Pharmacogenetics of topical and systemic treatment of psoriasis. Pharmacogenomics 2014; 14:1623-34. [PMID: 24088133 DOI: 10.2217/pgs.13.163] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease. The cause of psoriasis is unknown, although genetics may play a key role in its development. Treatment of the disease varies with severity. Topical drugs, such as corticosteroids, coal tar, retinoids and vitamin D analogs, are commonly used to treat mild psoriasis. Phototherapy and systemic drugs, such as calcineurin inhibitors, methotrexate, acitretin and biological drugs, are usually used to treat moderate-to-severe psoriasis. Not all patients respond well to treatment, and some can develop severe adverse effects. Interindividual differences in several genes may explain this variation in response to treatment. Pharmacogenetics and pharmacogenomics can facilitate more personalized medicine and prevent the adverse effects associated with treatment.
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Affiliation(s)
- Rocío Prieto-Pérez
- Service of Clinical Pharmacology, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Princesa (IP), Diego de León 62, 28006 Madrid, Spain
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256
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Al-Dabagh A, Al-Dabagh R, Davis SA, Taheri A, Lin HC, Balkrishnan R, Feldman SR. Systemic Corticosteroids Are Frequently Prescribed for Psoriasis. J Cutan Med Surg 2014; 18:195-9. [DOI: 10.2310/7750.2013.13126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: The use of systemic corticosteroids is discouraged in major psoriasis treatment guidelines. Purpose: Our objective was to assess how often systemic corticosteroids are prescribed for psoriasis and trends in their use over time. Methods: We used National Ambulatory Medical Care Survey (NAMCS) data to determine the systemic medications prescribed for psoriasis from 1989 to 2010. We confirmed the findings by analysis of 2003–2007 MarketScan Medicaid data. Results: Systemic corticosteroids were prescribed at 650,000 (95% CI 380,000–920,000) of 21,000,000 psoriasis visits; 93% of these visits were to dermatologists. Of the top nine systemic medications listed at psoriasis visits, three of them were corticosteroids. Corticosteroids were the second most commonly prescribed systemic medication for psoriasis. No significant change in the use of systemic corticosteroids for psoriasis over time was observed ( p = .27). In the MarketScan data, prednisone was prescribed more commonly than either methotrexate or etanercept. Limitations: Corticosteroid doses and the length of treatment were not recorded in the NAMCS data. Conclusions: Systemic corticosteroids are among the most common systemic treatments used for psoriasis despite current guidelines. Data are acutely needed on the risks and benefits so that physicians and patients can make evidence-based decisions about their use.
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Affiliation(s)
- Amir Al-Dabagh
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Rana Al-Dabagh
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Scott A. Davis
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Arash Taheri
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Hsien-Chang Lin
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Rajesh Balkrishnan
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Steven R. Feldman
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
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257
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Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
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Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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258
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Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
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Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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259
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Abstract
PURPOSE To enhance the learner's competence with knowledge of the clinical variants and management of psoriasis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of the types, symptoms, and diagnostic testing of psoriasis.2. Apply knowledge of psoriasis treatment to patient care scenarios. ABSTRACT Psoriasis is an inflammatory skin condition that is associated with various comorbidities. To the wound care physician, the Koebner phenomenon is of importance, as any superficial trauma can induce psoriasis. Particularly, periwound and joints are particularly susceptible to flare-ups of this condition. This review highlights the epidemiology and treatment of psoriasis.
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260
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Abstract
Acitretin, an active metabolite of etretinate, is the most widely used systemic retinoid in the treatment of psoriasis. There are several unique characteristics of this drug, which set it apart from other options in the therapeutic armamentarium of psoriasis. It is highly efficacious as monotherapy in some specific clinical subtypes of psoriasis. It has dose-sparing effects when used as combination therapy with conventional systemic drugs as well as the biologics. It is a good option for long-term maintenance therapy. Side effects are common but usually mild and can be managed by its proper dosing and monitoring. With appropriate patient selection, gradual dose escalation, and patient counseling, we can deliver good results in psoriasis with this useful drug. This review gives a comprehensive recount of acitretin use in the present era of biologics in psoriasis.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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261
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Kavanaugh A, Mease PJ, Gomez-Reino JJ, Adebajo AO, Wollenhaupt J, Gladman DD, Lespessailles E, Hall S, Hochfeld M, Hu C, Hough D, Stevens RM, Schett G. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis 2014; 73:1020-6. [PMID: 24595547 PMCID: PMC4033106 DOI: 10.1136/annrheumdis-2013-205056] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives Apremilast, an oral phosphodiesterase 4 inhibitor, regulates inflammatory mediators. Psoriatic Arthritis Long-term Assessment of Clinical Efficacy 1 (PALACE 1) compared apremilast with placebo in patients with active psoriatic arthritis despite prior traditional disease-modifying antirheumatic drug (DMARD) and/or biologic therapy. Methods In the 24-week, placebo-controlled phase of PALACE 1, patients (N=504) were randomised (1:1:1) to placebo, apremilast 20 mg twice a day (BID) or apremilast 30 mg BID. At week 16, patients without ≥20% reduction in swollen and tender joint counts were required to be re-randomised equally to either apremilast dose if initially randomised to placebo or remained on their initial apremilast dose. Patients on background concurrent DMARDs continued stable doses (methotrexate, leflunomide and/or sulfasalazine). Primary outcome was the proportion of patients achieving 20% improvement in modified American College of Rheumatology response criteria (ACR20) at week 16. Results At week 16, significantly more apremilast 20 mg BID (31%) and 30 mg BID (40%) patients achieved ACR20 versus placebo (19%) (p<0.001). Significant improvements in key secondary measures (physical function, psoriasis) were evident with both apremilast doses versus placebo. Across outcome measures, the 30-mg group generally had higher and more consistent response rates, although statistical comparison was not conducted. The most common adverse events were gastrointestinal and generally occurred early, were self-limiting and infrequently led to discontinuation. No imbalance in major adverse cardiac events, serious or opportunistic infections, malignancies or laboratory abnormalities was observed. Conclusions Apremilast was effective in the treatment of psoriatic arthritis, improving signs and symptoms and physical function. Apremilast demonstrated an acceptable safety profile and was generally well tolerated. Clinical trial registration number NCT01172938.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California at San Diego, , La Jolla, California, USA
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262
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Gan EY, Chong WS, Tey HL. Therapeutic strategies in psoriasis patients with psoriatic arthritis: focus on new agents. BioDrugs 2014; 27:359-73. [PMID: 23580094 DOI: 10.1007/s40259-013-0025-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis affects approximately 6-42 % of patients with psoriasis. It is useful for physicians or dermatologists managing psoriasis patients to be aware of how to concurrently manage the joint manifestations, as it is preferable and convenient to use a single agent in such patients. However, only certain therapies are effective for both. Systemic agents, which can be used for both skin and joint manifestations, include methotrexate and ciclosporin. For the group of biologic agents, the tumor necrosis factor inhibitors such as adalimumab, etanercept, infliximab, golimumab and certolizumab are effective. Ustekinumab is a more recently developed agent belonging to the group of anti-IL-12p40 antibodies and has been shown to be efficacious. Newer drugs in the treatment armamentarium that have shown efficacy for both psoriasis and psoriatic arthritis consist of the anti-IL-17 agent, secukinumab, and a phosphodiesterase-4 inhibitor, apremilast. The other anti-IL-17 agents, ixekizumab and brodalumab, as well as the oral Jak inhibitor, tofacitinib, have very limited but promising data. This review paper provides a good overview of the agents that can be used for the concurrent management of skin and joint psoriasis.
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263
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Abstract
Psoriasis is a disabling chronic inflammatory condition of the skin and joints that typically requires long-term treatment. Recommended treatments for psoriasis include a wide range of topical and systemic options, from topical agents and targeted phototherapy for mild psoriasis to traditional systemic agents such as methotrexate, cyclosporine and acitretin for more serious disease. The introduction of targeted biological agents such as T-cell-modulating agents, tumor necrosis factor α (TNFα) antagonists and interleukin (IL)-12 and IL-23 inhibitors has provided new choices for the management of psoriasis and psoriatic arthritis that may offer better long-term efficacy and tolerability than traditional approaches. Most biological agents are administered by subcutaneous injection. Infliximab, a TNFα antagonist, is the only biological agent approved for psoriasis that is administered by intravenous infusion, in the setting of hospital-based or specialized infusion center-based clinics. Infliximab allows weight-based dosing and may offer more rapid disease control than other biological agents, with significant improvements seen as early as 1 week after treatment initiation. This article gives an overview of psoriasis management, focusing on clinic-based infusion therapy with infliximab.
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264
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Varman KM, Namias N, Schulman CI, Pizano LR. Acute generalized pustular psoriasis, von Zumbusch type, treated in the burn unit. A review of clinical features and new therapeutics. Burns 2014; 40:e35-9. [PMID: 24491419 DOI: 10.1016/j.burns.2014.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
Generalized pustular psoriasis (GPP) is an immune-mediated dermatologic condition that is characterized by a widespread eruption of sterile, subcorneal pustules. Cases of GPP may present to the burn intensive care unit (ICU), and they may be confused with toxic epidermal necrolysis (TEN) due to the generalized erythema and desquamation. GPP often benefits from admission to an ICU for management of fluid and electrolyte imbalances and for complications such as pneumonitis, renal dysfunction and sepsis. We present the case of a 42 year-old man who was transferred to the burn unit for presumed TEN where he was diagnosed with GPP and successfully treated with intravenous cyclosporine and supportive care. Our objective is to increase awareness of this condition in the critical care community, discuss clinical and laboratory findings, and to review the treatment guidelines published by the National Psoriasis Foundation in August 2012. We also discuss the latest reports utilizing biological response modifying drugs.
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Affiliation(s)
- Katherine M Varman
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | - Nicholas Namias
- Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carl I Schulman
- Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Louis R Pizano
- Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, PO Box 016960 (D-40), Miami 33101, FL, USA.
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265
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Edson-Heredia E, Sterling KL, Alatorre CI, Cuyun Carter G, Paczkowski R, Zarotsky V, Maeda-Chubachi T. Heterogeneity of Response to Biologic Treatment: Perspective for Psoriasis. J Invest Dermatol 2014; 134:18-23. [DOI: 10.1038/jid.2013.326] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 12/21/2022]
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266
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Research gaps in psoriasis: Opportunities for future studies. J Am Acad Dermatol 2014; 70:146-67. [DOI: 10.1016/j.jaad.2013.08.042] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 08/24/2013] [Accepted: 08/26/2013] [Indexed: 02/08/2023]
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267
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Bushmakin AG, Mamolo C, Cappelleri JC, Stewart M. The relationship between pruritus and the clinical signs of psoriasis in patients receiving tofacitinib. J DERMATOL TREAT 2013; 26:19-22. [DOI: 10.3109/09546634.2013.861891] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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268
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in the United States. The term NALFD was first used by Ludwig in 1980 to describe the presence of hepatic steatosis and steatohepatitis in a series of patients with no identifiable cause. Since then, our insight into the pathogenesis of NAFLD has expanded significantly. We now know that NAFLD is closely related to metabolic syndrome and chronic low-grade inflammation. In the following review, the authors summarize the current evidence about drugs that lead to hepatic steatosis and steatohepatitis and pathogenic mechanisms thereof.
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269
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Sako EY, Famenini S, Wu JJ. Bullous drug eruption in a patient with psoriasis after a test dose of methotrexate. J Am Acad Dermatol 2013; 69:e264-e265. [DOI: 10.1016/j.jaad.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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270
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Carretero G, Ribera M, Belinchón I, Carrascosa J, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, Gonzalez-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno J. Acitretina: guía de uso en psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2013.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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272
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Cyclosporine regimens in plaque psoriasis: an overview with special emphasis on dose, duration, and old and new treatment approaches. ScientificWorldJournal 2013; 2013:805705. [PMID: 23983647 PMCID: PMC3745987 DOI: 10.1155/2013/805705] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/02/2013] [Indexed: 01/04/2023] Open
Abstract
Cyclosporine A (CsA) is one of the most effective systemic drugs available for the treatment of psoriasis, as evidenced by the results of several randomized studies and by a prolonged experience in dermatological setting. In clinical practice, CsA is usually used for the induction of psoriasis remission at a daily dose included in the range of 2.5–5 mg/kg and with intermittent short-term regimens, lasting on average 3–6 months. The magnitude and rapidity of response are dose dependent, as well as the risk of development of adverse events. Therefore, the dose should be tailored to patient's needs and general characteristics and adjusted during the treatment course according to both the efficacy and tolerability. Some studies support the feasibility of pulse administration of CsA for a few days per week for both the induction and the maintenance of response in psoriasis patients. This paper will review the data on CsA regimens for plaque-type psoriasis and will focus the attention on dose, treatment duration, novel schedules, and role in combination therapies, including the association with biologicals.
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Carretero G, Ribera M, Belinchón I, Carrascosa JM, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, González-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno JC. Guidelines for the use of acitretin in psoriasis. Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:598-616. [PMID: 23891453 DOI: 10.1016/j.adengl.2013.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/20/2013] [Indexed: 02/01/2023] Open
Abstract
Phototherapy, classic systemic treatments (methotrexate, acitretin, and ciclosporin), and biologic agents (etanercept, infliximab, adalimumab, and ustekinumab) constitute a broad therapeutic arsenal that increases the likelihood of achieving control of severe and extensive disease in patients with psoriasis. Acitretin continues to be a very valuable tool in both monotherapy, in which it is combined with other systemic treatments (classic or biologic), and in sequential therapy. Thanks to its lack of a direct immunosuppressive effect and its ability to achieve a long-term response, acitretin has an important role in the treatment of psoriasis, although this has not always been acknowledged in relevant treatment guidelines. We present consensus guidelines for the use of acitretin in psoriasis drawn up by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. These guidelines provide a detailed account of acitretin, including pharmacological properties, indications and contraindications, adverse effects, and factors that should be taken into account to enhance the safe use of this drug. They also propose treatment strategies for use in routine clinical practice. The overall aim of these guidelines is to define the criteria for the use and management of acetretin in psoriasis.
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Affiliation(s)
- G Carretero
- Grupo de Psoriasis de la Academia Española de Dermatología y Venereología, Spain.
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274
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Gupta MA, Gupta AK. Cutaneous body image dissatisfaction and suicidal ideation: mediation by interpersonal sensitivity. J Psychosom Res 2013; 75:55-9. [PMID: 23751239 DOI: 10.1016/j.jpsychores.2013.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cutaneous body image (CBI) dissatisfaction, feelings of social exclusion and stigmatization have been associated with increased suicidality in dermatology patients. We examined the relation between CBI dissatisfaction and suicidal ideation in a non-clinical sample, and examined the possible mediating effect of interpersonal sensitivity (IS), a symptom dimension related to self-consciousness, feelings of inferiority and social exclusion. METHODS As part of a larger study, 312 community-based participants from London, Ontario, Canada (241 women, 71 men; mean±SD age: 38.4±14.9years) rated their CBI satisfaction, measured with the Cutaneous Body Image Scale (Gupta MA et al., 2004). The Brief Symptom Inventory (BSI) (Derogatis L et al.,1982) was used to measure the constructs of suicidal ideation (4 suicide-related items from the BSI) and IS (Interpersonal Sensitivity subscale of BSI). RESULTS Assessing mediation using the Baron & Kenny (1986) model, CBI satisfaction had a significant negative effect on suicidal ideation [c=-0.316, t(296)=-5.73, p<0.001] and IS [a=-0.365, t(297)=-6.76, p<0.001]; when CBI satisfaction and IS were considered together, IS had a significant positive effect on suicidal ideation (b=.690, t(295)=15.80, p<.001) while the effect of CBI satisfaction on suicidal ideation was no longer significant [c*=-.063, t(295)=-1.44, ns]. CONCLUSION Our findings suggest an inverse relationship between CBI satisfaction and suicidal ideation, which is mediated by IS. This relationship likely falls in a continuum between non-clinical and clinical situations, with suicide risk being greater when individuals experience greater CBI dissatisfaction and social alienation.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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275
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The effect of folate supplementation on methotrexate efficacy and toxicity in psoriasis patients and folic acid use by dermatologists in the USA. Am J Clin Dermatol 2013; 14:155-61. [PMID: 23575550 DOI: 10.1007/s40257-013-0017-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Methotrexate (MTX) is an effective treatment for psoriasis but its use is limited by its toxicity. Folate supplementation can be used to reduce the adverse effects of MTX, though this may impact efficacy. The frequency of folic acid supplementation is not well characterized. PURPOSE The objective of this study was to review the literature involving the use of folate in patients (in particular those with psoriasis) treated with MTX and analyze trends in folic acid use. METHODS We searched PubMed from 1 May 1989 through 1 April 2012 using the terms 'folic acid,' 'folinic acid,' 'folate,' 'supplementation,' and 'methotrexate.' We also used the National Ambulatory Medical Care Survey (NAMCS) database to collect data regarding trends in MTX use and folic acid supplementation by physicians in the USA from 1993 through 2009. We assessed data including the number of MTX visits, rate of folic acid use, diagnoses, physician specialty, and demographics of patients. We used linear regression to analyze the change in folic acid use over time. RESULTS Twenty-six published trials were included addressing folic acid supplementation with MTX. The majority found a benefit to folic acid supplementation, but there were only seven studies in psoriasis. Dermatologists were among the highest prescribers of MTX, and psoriasis was commonly treated with MTX. Folic acid supplementation significantly increased over this time period (p < 0.0001). However, dermatologists ranked lowest for their folate use, co-prescribing folate to only 9.1 % of MTX-treated patients. LIMITATIONS In contrast to rheumatoid arthritis, there is a scarcity of literature describing the effect of folate on MTX toxicity and efficacy in psoriasis patients. NAMCS data only included outpatient visits to non-federally employed physicians, and there is the possibility of healthcare providers not documenting over-the-counter folic acid usage. Lastly, doses of MTX and folic acid were not recorded in the database. CONCLUSION Dermatologists were the least likely specialists to supplement MTX with folic acid. The evidence for supplementation of folic acid is mixed. The literature confirms a reduction in the adverse effects of MTX but less strongly that there may be a reduction in efficacy too. Keeping in mind the potential for folate to reduce MTX efficacy, folic acid supplementation should be considered in MTX-treated patients.
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276
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Abstract
Keratin 17 (K17) is an intermediate filament protein present in the basal cells of complex epithelia, such as nails, hair follicles, sebaceous glands, and eccrine sweat glands. Studies have shown that it is expressed aberrantly in the suprabasal keratinocytes of psoriatic lesions, compared to in normal epidermis. K17 is also closely associated with the immune system and plays an important role in the pathogenesis of psoriasis. In this review, we present our experimental findings concerning the role of K17 in psoriasis, and compare them to results published in the literature. Our results show that cytokines related to Th17 and IL-22-producing (where Th17 is T helper cells, type 17 and IL is interleukin) CD4(+) T cells, including IL-17A and IL-22, upregulate the expression of K17 in keratinocytes. In addition, K17 stimulates autoreactive T cells and promotes the production of psoriasis-associated cytokines. Our findings lend support to the hypothesis that a K17/T-cell/cytokine autoimmune loop is involved in the pathogenesis of psoriasis. We therefore review the current understanding of the K17 immunoregulation, including its expression and direct/indirect effects on immune responses. Pertinent strategies for the treatment of psoriasis are also discussed.
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Affiliation(s)
- Liang Jin
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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277
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Fialová J, Vojáčková N, Vaňousová D, Hercogová J. Juvenile generalized pustular psoriasis treated with etanercept. Dermatol Ther 2013; 27:105-8. [DOI: 10.1111/dth.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jorga Fialová
- Deparment of Dermatovenereology; 2nd Medical Faculty, Charles University and Bulovka Hospital; Prague Czech Republic
| | - Nadežda Vojáčková
- Deparment of Dermatovenereology; 2nd Medical Faculty, Charles University and Bulovka Hospital; Prague Czech Republic
| | - Daniela Vaňousová
- Deparment of Dermatovenereology; 2nd Medical Faculty, Charles University and Bulovka Hospital; Prague Czech Republic
| | - Jana Hercogová
- Deparment of Dermatovenereology; 2nd Medical Faculty, Charles University and Bulovka Hospital; Prague Czech Republic
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278
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Borghi A, Corazza M, Mantovani L, Bertoldi AM, Giari S, Virgili A. Prolonged cyclosporine treatment of severe or recalcitrant psoriasis: descriptive study in a series of 20 patients. Int J Dermatol 2013; 51:1512-6. [PMID: 23171021 DOI: 10.1111/j.1365-4632.2012.05571.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although long-term cyclosporine administration may induce toxic effects, it may be the only option for the treatment of severe psoriasis. The objective of the present study was to retrospectively evaluate efficacy and safety of long-term cyclosporine treatment in a cohort of patients affected with moderate to severe psoriasis, recalcitrant or unresponsive to other treatments. Possible risk factors predicting an intolerance to cyclosporine were also investigated. MATERIALS AND METHODS Data were collected on psoriatic patients treated with cyclosporine for at least six months at our Psoriasis Outpatient Unit between January 2005 and September 2010. The primary measure for clinical efficacy was the PASI 75 response. Cyclosporine safety was assessed through the review of both laboratory tests and the adverse events registered during the treatment. RESULTS Twenty patients affected with plaque or erythrodermic psoriasis were evaluated. At Week 16, the PASI 75 response was achieved by 85% of patients. Adverse events occurred in eight patients (40%): four experienced an increase in serum creatinine levels to more than 30% of their pre-treatment values and four developed hypertension. Among these patients, five discontinued cyclosporine. Side effects resolved after stopping treatment. CONCLUSIONS Our findings suggest that long-term cyclosporine regimen can be justified in severe psoriasis not responsive to other treatments. When cyclosporine administration is required, obesity, pre-treatment controlled hypertension, increased age (>70 years), and metabolic syndrome should be taken into consideration, as a significant correlation with occurrence of cyclosporine-induced side effects has been found.
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Affiliation(s)
- Alessandro Borghi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy
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279
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da Silva CAP, Von Kossel K, Leszczynski M, Melnik T, Riera R. Methotrexate for psoriasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Carolina AP da Silva
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Karen Von Kossel
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Marcos Leszczynski
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Tamara Melnik
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Rachel Riera
- Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; R. Borges Lagoa, 564 cj 63 São Paulo São Paulo Brazil 04038000
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280
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Kovalik M, Mellanby RJ, Evans H, Berry J, van den Broek AHM, Thoday KL. Ciclosporin therapy is associated with minimal changes in calcium metabolism in dogs with atopic dermatitis. Vet Dermatol 2013; 23:481-e91. [PMID: 23140314 DOI: 10.1111/j.1365-3164.2012.01119.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ciclosporin is widely used in the management of canine atopic dermatitis. In humans, ciclosporin therapy has been linked to disturbances in calcium metabolism and resultant skeletal disorders. OBJECTIVES The objective of this study was to assess calcium homeostasis in dogs before and after a 6 week course of once daily oral ciclosporin at the licensed dose (5 mg/kg). ANIMALS Sixteen client-owned dogs with spontaneous atopic dermatitis. METHODS Serum concentrations of calcium, phosphate, creatinine, 25-hydroxyvitamin D, 1,25-dihyroxyvitamin D and plasma concentrations of ionized calcium and parathyroid hormone (PTH) were measured, together with the urinary fractional excretion of calcium and phosphate. The extent of skin lesions was scored using the Canine Atopic Dermatitis Extent and Severity Index (CADESI)-03 and the degree of pruritus by the Edinburgh Pruritus Scale prior to and at the end of the study. RESULTS The CADESI-03 and the Edinburgh Pruritus Scale scores decreased satisfactorily in all dogs by the end of the study. Plasma PTH concentrations were significantly increased (P = 0.02) following ciclosporin treatment, whereas all other biochemical parameters were not significantly different from their starting values. The increase in PTH was mild in most cases and the proportion of dogs that had a PTH concentration above the reference range was not significantly different following treatment. CONCLUSIONS AND CLINICAL IMPORTANCE This study indicates that ciclosporin has minimal impact on calcium metabolism in dogs with atopic dermatitis when used at the licensed and clinically effective dosage for 6 weeks.
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Affiliation(s)
- Marcel Kovalik
- Dermatology Group, Division of Veterinary Clinical Sciences, Hospital for Small Animals, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian, UK
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281
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Li J, Chong AH, Green J, Kelly R, Baker C. Mycophenolate use in dermatology: A clinical audit. Australas J Dermatol 2013; 54:296-302. [DOI: 10.1111/ajd.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/04/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Jane Li
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Alvin H Chong
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Jack Green
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Robert Kelly
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Christopher Baker
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
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282
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Akasaka E, Mabuchi T, Manabe Y, Yahagi E, Yamada-Hiruma A, Yamaoka H, Kojima T, Kato M, Ikoma N, Ozawa A, Haruki Y. Long-term efficacy of psoriasis vulgaris treatments: Analysis of treatment with topical corticosteroid and/or vitamin D3analog, oral cyclosporin, etretinate and phototherapy over a 35-year period, 1975-2010. J Dermatol 2013; 40:238-43. [DOI: 10.1111/1346-8138.12069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/19/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Emiko Akasaka
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Tomotaka Mabuchi
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Yasuaki Manabe
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Eiichiro Yahagi
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Azusa Yamada-Hiruma
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Hanako Yamaoka
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Tomoko Kojima
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Masayuki Kato
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Norihiro Ikoma
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Akira Ozawa
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Yasuo Haruki
- Department of Basic Medical Science; Tokai University School of Medicine; Kanagawa; Japan
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283
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Mamolo C, Harness J, Tan H, Menter A. Tofacitinib (CP-690,550), an oral Janus kinase inhibitor, improves patient-reported outcomes in a phase 2b, randomized, double-blind, placebo-controlled study in patients with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol 2013; 28:192-203. [DOI: 10.1111/jdv.12081] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/26/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - J. Harness
- Pfizer Inc; Groton CT USA
- Novartis Pharma AG; Basel Switzerland
| | - H. Tan
- Pfizer Inc; Groton CT USA
| | - A. Menter
- Baylor Research Institute; Dallas TX USA
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284
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Smith GP, Chan ES. Immunomodulating pharmaceuticals. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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285
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Abstract
Psoriasis is a common chronic inflammatory disease of the skin that has a significant impact on quality of life. A small number of systemic therapies are well established in psoriasis management. These have immunosuppressive and/or anti-proliferative effects on the skin and immune system. As understanding of the pathogenesis of psoriasis has advanced over the last 2 decades, there has been clearer appreciation of the genetic, cellular and immunological components of disease expression, which has provided new insight into potential therapeutic targets, including the development of biological therapies. Biologics offer a unique opportunity to block or inhibit specific key components of psoriasis pathogenesis. The introduction of tumour necrosis factor (TNF).α and interleukin (IL)-12/-23 inhibitors has resulted in remarkable clinical responses in patients with severe psoriasis and has led to the development of a range of other cytokine modulators currently undergoing investigation. More recently, research in keratinocyte biology and immune cell function, particularly intracellular signalling, has afforded additional opportunities to develop a range of small-molecule oral preparations that may prove effective in disease control. This paper reviews current and emerging systemic treatments in the management of psoriasis.
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Affiliation(s)
- Philip M Laws
- The University of Manchester, Manchester Academic Health Science Centre, Department of Dermatology, Salford Royal Hospital (Hope), Salford, Manchester, UK
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286
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Abstract
Introduction Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of the patients with psoriasis. It can comprise genital skin folds as part of genital psoriasis, and it is one of the most commonly seen dermatoses of this area. There are few evidence-based studies about the treatment of intertriginous psoriasis involving genital skin folds. Case Presentation The authors present a 42-year-old female patient with erythematous plaques in the vulva, groin, and perianal region. The patient had previously received a broad range of topical and systemic therapies that had to be discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of treatment. She has remained in remission for up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol. Discussion Genital psoriasis is a skin disease that causes great discomfort. It is important to include examination of the genital region and to adopt this conduct in daily clinical practice. Research in this field is still poor, making no discrimination between flexural and genital psoriasis, and is based on case series and expert opinion; therefore, empirical recommendations for the treatment of genital psoriasis remain. Dapsone has been shown to be an effective and convenient alternative for the treatment of inverse psoriasis in genital skin folds, which can provide effective control of the disease. Further studies are required to determine the efficacy and safety of current therapies, and to decide whether dapsone therapy should be considered in the management of this form of psoriasis when topical and other systemic agents are not effective.
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287
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Ryan C, Menter A, Warren RB. The Latest Advances in Pharmacogenetics and Pharmacogenomics in the Treatment of Psoriasis. Mol Diagn Ther 2012; 14:81-93. [DOI: 10.1007/bf03256357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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288
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Carron P, Van Praet L, Jacques P, Elewaut D, Van den Bosch F. Therapy for Spondyloarthritis. Rheum Dis Clin North Am 2012; 38:583-600. [DOI: 10.1016/j.rdc.2012.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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289
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Dupuis E, Bhole V, Dutz J. Differing patterns of methotrexate use for psoriatic disease among dermatologists and rheumatologists. Br J Dermatol 2012; 167:448-50. [DOI: 10.1111/j.1365-2133.2012.10880.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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290
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Simpkin S, Oakley A. Multiple eruptive squamous cell carcinoma in a patient with chronic plaque psoriasis on adalimumab. Australas J Dermatol 2012; 54:55-8. [DOI: 10.1111/j.1440-0960.2012.00920.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Simpkin
- Department of Dermatology; Waikato Hospital; Hamilton; New Zealand
| | - Amanda Oakley
- Department of Dermatology; Waikato Hospital; Hamilton; New Zealand
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291
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Woolf R, West S, Arenas-Hernandez M, Hare N, Peters van Ton A, Lewis C, Marinaki A, Barker J, Smith C. Methotrexate polyglutamates as a marker of patient compliance and clinical response in psoriasis: a single-centre prospective study. Br J Dermatol 2012; 167:165-73. [DOI: 10.1111/j.1365-2133.2012.10881.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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292
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Shutty B, West C, Pellerin M, Feldman S. Apremilast as a treatment for psoriasis. Expert Opin Pharmacother 2012; 13:1761-70. [DOI: 10.1517/14656566.2012.699959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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293
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Gelfand JM, Wan J, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Stierstorfer MB, Brod BA, Schleicher SM, Bebo BF, Troxel AB, Shin DB, Steinemann JM, Goldfarb J, Yeung H, Van Voorhees AS. Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting. ACTA ACUST UNITED AC 2012; 148:487-94. [PMID: 22508874 DOI: 10.1001/archdermatol.2012.370] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis. DESIGN A cross-sectional design was used. SETTING Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study. PARTICIPANTS A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy. MAIN OUTCOME MEASURES The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index. RESULTS The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency. CONCLUSIONS The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.
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Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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294
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Inzinger M, Weger W, Heschl B, Salmhofer W, Quehenberger F, Wolf P. Methotrexate vs. fumaric acid esters in moderate-to-severe chronic plaque psoriasis: data registry report on the efficacy under daily life conditions. J Eur Acad Dermatol Venereol 2012; 27:861-6. [DOI: 10.1111/j.1468-3083.2012.04596.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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295
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Menter A, Thrash B, Cherian C, Matherly LH, Wang L, Gangjee A, Morgan JR, Maeda DY, Schuler AD, Kahn SJ, Zebala JA. Intestinal transport of aminopterin enantiomers in dogs and humans with psoriasis is stereoselective: evidence for a mechanism involving the proton-coupled folate transporter. J Pharmacol Exp Ther 2012; 342:696-708. [PMID: 22653877 DOI: 10.1124/jpet.112.195479] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
N-[4-[[(2,4-diamino-6-pterdinyl)methyl]amino]benzoyl]-L/D-glutamic acid (L/D-AMT) is an investigational drug in phase 1 clinical development that consists of the L-and D-enantiomers of aminopterin (AMT). L/D-AMT is obtained from a novel process for making the L-enantiomer (L-AMT), a potent oral antiinflammatory agent. The purpose of these studies was to characterize oral uptake and safety in the dog and human of each enantiomer alone and in combination and provide in vitro evidence for a mechanism of intestinal absorption. This is the first report of L /D-AMT in humans. In dogs (n = 40) orally dosed with L-AMT or D-AMT absorption was stereoselective for the L-enantiomer (6- to 12-fold larger peak plasma concentration after oral administration and area under the plasma concentration-time curve at 0-4 h; p < 0.001). D-AMT was not toxic at the maximal dose tested (82.5 mg/kg), which was 100-fold larger than the maximal nonlethal L-AMT dose (0.8 mg/kg). Dogs (n = 10) and humans with psoriasis (n = 21) orally administered L-AMT and L /D-AMT at the same L-enantiomer dose resulted in stereoselective absorption (absent D-enantiomer in plasma), bioequivalent L-enantiomer pharmacokinetics, and equivalent safety. Thus, the D-enantiomer in L/D-AMT did not perturb L-enantiomer absorption or alter the safety of L-AMT. In vitro uptake by the human proton-coupled folate transporter (PCFT) demonstrated minimal transport of D-AMT compared with L-AMT, mirroring the in vivo findings. Enantiomer selectivity by PCFT was attributable almost entirely to decreased binding affinity rather than changes in transport rate. Collectively, our results demonstrate a strong in vitro-in vivo correlation implicating stereoselective transport by PCFT as the mechanism underlying stereoselective absorption observed in vivo.
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Affiliation(s)
- Alan Menter
- Baylor Research Institute, Dallas, Texas, USA
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Chen YJ, Chang YT, Shen JL, Chen TT, Wang CB, Chen CM, Wu CY. Association between systemic antipsoriatic drugs and cardiovascular risk in patients with psoriasis with or without psoriatic arthritis: A nationwide cohort study. ACTA ACUST UNITED AC 2012; 64:1879-87. [DOI: 10.1002/art.34335] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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297
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Vena GA, Cassano N. The effects of alcohol on the metabolism and toxicology of anti-psoriasis drugs. Expert Opin Drug Metab Toxicol 2012; 8:959-72. [PMID: 22594656 DOI: 10.1517/17425255.2012.691166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Alcohol has long been suspected to be a triggering and precipitating factor of psoriasis. Alcohol misuse is common in patients with moderate-to-severe psoriasis and appears to impair treatment outcome. AREAS COVERED In this article, the authors review the available data regarding the metabolic and toxicological interactions between anti-psoriasis systemic drugs and ethanol and/or alcoholic beverages. Special attention is given to the influence of alcohol consumption on the hepatotoxic risk of some anti-psoriasis drugs. The article was prepared using a MEDLINE literature search. EXPERT OPINION The available knowledge highlights the existence of a few significant pharmacological interactions, such as the reduced exposure to cyclosporine by red wine, the possible increase of cyclosporine levels following a heavy acute alcohol intake, and, especially, the conversion of acitretin to etretinate, in the presence of ethanol, with important implications in females of child-bearing potential. There are limited data on the contributing role of alcohol in the hepatotoxicity induced by some anti-psoriasis drugs and the existing information on this topic is still controversial. However, further investigation is needed to assess the relevance of interactions between alcohol consumption and drug therapy for psoriasis, under both pharmacological and toxicological perspectives. Long-term prospective studies on large cohorts of patients are warranted to disclose the actual significance of such potential interactions in clinical practice.
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Affiliation(s)
- Gino A Vena
- University of Bari, Department of Biomedical Sciences and Human Oncology, Unit of Dermatology and Venereology, Bari, Italy.
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298
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Reich K, Domm S, Mrowietz U. Methotrexate therapy in dermatology. J Dtsch Dermatol Ges 2012; 10:363-70. [DOI: 10.1111/j.1610-0387.2012.07926.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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299
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Buisson A, Cuny JF, Barbaud A, Schmutz JL, Bigard MA, Guéant JL, Peyrin-Biroulet L. Methotrexate for psoriasiform lesions associated with anti-tumour necrosis factor therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35:1175-80. [PMID: 22469155 DOI: 10.1111/j.1365-2036.2012.05082.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 02/25/2012] [Accepted: 03/10/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psoriasiform lesions associated with anti-tumour necrosis factor (TNF) therapy are frequent in patients with inflammatory bowel disease (IBD). While methotrexate is the most frequently used systemic treatment for psoriasis, its efficacy for psoriasiform lesions related to anti-TNF therapy remains unknown. AIMS To assess the efficacy of methotrexate for psoriasiform lesions associated with anti-TNF therapy refractory to topical therapy in IBD patients. METHODS The charts of eight patients from the Nancy IBD cohort who developed psoriasiform lesions on anti-TNF therapy were reviewed. Clinical response was defined as a decrease of more than 50% in the lesions covering surface. All patients were followed up by the same experienced dermatologist. RESULTS Eight women (seven Crohn's disease) were followed up for a median duration of 29 months (range, 20-45). Of the eight patients receiving methotrexate, three were primary responders without discontinuation of anti-TNF agents. Only one patient had a sustained response at final follow-up and was able to continue both methotrexate and anti-TNF therapy. Of the two other primary responders, one patient had to discontinue anti-TNF because of severe psoriasiform lesions, whereas the other one continued anti-TNF therapy despite persistent skin lesions at final follow-up. Among the five primary nonresponders, four patients had to stop anti-TNF treatment due to disabling skin lesions. CONCLUSION Methotrexate does not appear effective in treating psoriasiform lesions associated with anti-TNF therapy refractory to topical therapy in IBD.
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Affiliation(s)
- A Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, France
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Response to the letter to editor re: “Methotrexate and psoriasis: Consensus conference”. J Am Acad Dermatol 2012; 66:689; author reply 689-90. [DOI: 10.1016/j.jaad.2011.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/22/2011] [Accepted: 09/25/2011] [Indexed: 11/21/2022]
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