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Bi D, Qu F, Xiao W, Wu J, Liu P, Du H, Xie Y, Liu H, Zhang L, Tao J, Liu Y, Zhu J. Reactive Oxygen Species-Responsive Gel-Based Microneedle Patches for Prolonged and Intelligent Psoriasis Management. ACS NANO 2023; 17:4346-4357. [PMID: 36847798 DOI: 10.1021/acsnano.2c08979] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Psoriasis is an inflammatory skin disease. Microneedle (MN) patches can improve psoriasis treatment outcomes by increasing local drug content in the skin. As psoriasis frequently relapses, developing intelligent MN-based drug delivery systems with prolonged therapeutic drug levels and improved treatment efficiency is of great significance. Here, we designed detachable H2O2-responsive gel-based MN patches containing methotrexate (MTX) and epigallocatechin gallate (EGCG) by using EGCG as both cross-linkers for needle-composited materials and anti-inflammatory drugs. The gel-based MNs had dual-mode drug release kinetics, which quickly released MTX diffusively and sustainably released EGCG in an H2O2-responsive way. Compared with dissolving MNs, the gel-based MNs extended skin retention of EGCG, leading to prolonged reactive oxygen species (ROS) scavenging effects. The ROS-responsive MN patches that transdermally delivered antiproliferative and anti-inflammatory drugs improved treatment outcomes in both psoriasis-like and prophylactic psoriasis-like animal models.
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Affiliation(s)
- Duohang Bi
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Fei Qu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Wanyue Xiao
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Jiaxin Wu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Pei Liu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Hongyao Du
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
| | - Youwei Xie
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Hongmei Liu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Lianbin Zhang
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
| | - Yijing Liu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
| | - Jintao Zhu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology (HUST), Wuhan 430074, China
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Kubanov A, Asoskova AВ, Zastrozhin M, Sozaeva Z, Sychev D. Influence of ABCB1 3435C>T polymorphism on methotrexate safety in patients with psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2023. [DOI: 10.25208/vdv1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction:
Methotrexate is a highly effective systemic treatment for moderate to severe psoriasis, but drug toxicity may limit its use. Recent evidence suggests that it is necessary to take into account the individual characteristics of methotrexate pharmacokinetics, which are determined by the presence of polymorphisms of genes encoding methotrexate carrier proteins, to predict the risk of methotrexate-induced toxicity.
Goal:
To identify associations of ABCB1 rs1045642 polymorphism with methotrexate safety in patients with psoriasis.
Materials and methods:
The study included 75 patients diagnosed with psoriasis who received methotrexate. Data on adverse drug reactions were collected using a clinically structured questionnaire, complete and biochemical blood tests, and urinalysis. The severity of adverse drug reactions was assessed using visual analog scales and the CTCAE toxicity scale. The severity of gastrointestinal ADR was assessed using the GSRS questionnaire. Genotyping was carried out by real-time PCR.
Results:
Gastrointestinal toxicity was detected in 38 patients (50.67%). The mean GSRS score was 7.979.18. Analysis of differences in the incidence of adverse drug reactions showed the presence of statistically significant differences in the frequency of adverse drug reactions in the gastrointestinal tract: the toxic effect of methotrexate was more often observed in carriers of the T allele of the ABCB1 rs1045642 polymorphism (3435CT), (CC - 2 (14.3%), TC - 18 (52.9%), TT - 18 (66.7%), p=0.006). Binomial regression demonstrated the presence of a statistically significant effect of the rs1045642 polymorphism of the ABCB1 gene on the incidence of ADR from the gastrointestinal tract: estimation -2.16, OR = 8.64, 95% CI OR: 1.78 - 42.01, p -value = 0.008.
Conclusion:
An association of ABCB1 rs1045642 polymorphism with the safety of gastrointestinal methotrexate therapy in patients with moderate and severe forms of psoriasis was revealed. The data obtained can be used to personalize the prescription of methotrexate to patients with psoriasis.
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Mao M, Kuang Y, Chen M, Yan K, Lv C, Liu P, Lu Y, Chen X, Zhu W, Chen W. The HLA-Cw*06 allele may predict the response to methotrexate (MTX) treatment in Chinese arthritis-free psoriasis patients. Arch Dermatol Res 2022; 315:1241-1247. [PMID: 36513862 DOI: 10.1007/s00403-022-02498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
MTX in genetically distinctive Chinese psoriatic patients remains less explored. The present study aimed to determine the impact of HLA-Cw*06 on MTX response in a Chinese psoriasis patient population. A total of 204 patients with psoriasis were enrolled in this study. Clinical data and DNA samples from all patients were collected. The allele of HLA-Cw*06 genotyping was detected using direct Sanger sequencing. This study enrolled 204 patients with psoriasis, including 47 (23.04%) psoriatic arthritis patients, 157 (76.96%) patients free of psoriatic arthritis. Overall, 110 (53.92%) of all patients carried the HLA-Cw*06 allele. This frequency in patients with arthritis-free psoriasis was higher than that in those with psoriatic arthritis (58.59 vs. 38.30%, P = 0.014). After 8 weeks of MTX treatment, the arthritis-free psoriasis patients, who tested positive for the HLA-Cw*06 allele, showed significant improvement compared to those who tested negative (For PASI50, 78.57 vs. 55.22%, P = 0.02, and for PASI75, 51.11 vs. 34.33%, P = 0.036). The psoriatic arthritis-free patients who carried the HLA-Cw*06 allele in combination with the ABCB1 rs1045642 CC genotype showed the highest improvement. A regression model containing HLA-Cw*06, rs1045642T > C, and initial PASI scores was used to construct the efficacy prediction model of MTX, which yielded AUC values of 73.2 and 75.6% for PASI50 and PASI75 to MTX, respectively, in arthritis-free psoriasis patients. The HLA-Cw*06 allele is associated with optimal response to MTX treatment in arthritis-free Chinese psoriasis patients. When combined with clinical indicators, the polymorphism explained more than 75% of the individual efficacy differences.
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Affiliation(s)
- Manyun Mao
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Yehong Kuang
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Menglin Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Kexiang Yan
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, China
| | - Chenzhi Lv
- Department of Dermatology, Dalian Dermatosis Hospital, Dalian, Liaoning, China
| | - Panpan Liu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Yan Lu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Xiang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Wu Zhu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
| | - Wangqing Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
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Abstract
Since the late 18th century, molecular hydrogen (H2) has been shown to be well tolerated, firstly in animals, and then in humans. However, although research into the beneficial effects of molecular hydrogen in both plant and mammalian physiology is gaining momentum, the idea of utilising this electrochemically neutral and non-polar diatomic compound for the benefit of health has yet to be widely accepted by regulatory bodies worldwide. Due to the precise mechanisms of H2 activity being as yet undefined, the lack of primary target identification, coupled with difficulties regarding administration methods (e.g., dosage and dosage frequencies, long-term effects of treatment, and the patient’s innate antioxidant profile), there is a requirement for H2 research to evidence how it can reasonably and most effectively be incorporated into medical practice. This review collates and assesses the current information regarding the many routes of molecular hydrogen administration in animals and humans, whilst evaluating how targeted delivery methods could be integrated into a modern healthcare system.
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Balak DMW, Gerdes S, Parodi A, Salgado-Boquete L. Long-term Safety of Oral Systemic Therapies for Psoriasis: A Comprehensive Review of the Literature. Dermatol Ther (Heidelb) 2020; 10:589-613. [PMID: 32529393 PMCID: PMC7367959 DOI: 10.1007/s13555-020-00409-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 01/10/2023] Open
Abstract
Oral systemic therapies are important treatment options for patients with moderate-to-severe psoriasis, either as monotherapy or in therapy-recalcitrant cases as combination therapy with phototherapy, other oral systemics or biologics. Long-term treatment is needed to maintain sufficient disease control in psoriasis, but continuous use of systemic treatments is limited by adverse events (AEs) and cumulative toxicity risks. The primary aim of this comprehensive literature review was to examine the long-term safety profiles of oral agents commonly used in the treatment of adults with psoriasis. Searches were conducted in EMBASE and PubMed up to November 2018, and 157 relevant publications were included. Long-term treatment with acitretin could be associated with skeletal toxicity and hepatotoxicity, although evidence for skeletal toxicity is mixed and hepatotoxicity is rare, particularly at low doses. Other safety issues include hyperlipidaemia and potential for teratogenicity up to 2-3 years after discontinuation of treatment. There is a paucity of data on long-term treatment with apremilast. Continued exposure to apremilast does not seem to increase the incidence of common AEs, such as gastrointestinal (GI) AEs, upper respiratory tract infections and headache, while the long-term risks for depression, suicidal thoughts and weight loss are unknown. Long-term ciclosporin treatment is associated with renal toxicity, hypertension, non-melanoma skin cancer, neurological AEs and GI AEs. Long-term methotrexate treatment is associated with hepatotoxicity, GI AEs, haematological toxicity, renal toxicity and alopecia. Finally, long-term treatment with fumaric acid esters (FAE) is associated with GI AEs, flushing, lymphocytopenia, proteinuria and elevated liver enzymes. Median drug survival estimates varied considerably: ~ 2.9-9.7 months for apremilast; ~ 5.4 months for ciclosporin; ~ 8.6 months for acitretin; ~ 12.1-21.6 months for methotrexate; and ~ 54.8 months for FAE. These long-term safety profiles may help to guide clinicians to select the optimal oral systemic treatment for the long-term treatment of psoriasis in adults.
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Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, the Netherlands.
| | - Sascha Gerdes
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Aurora Parodi
- DiSSal Section of Dermatology, University of Genoa-Ospedale-Policlinico San Martino IRCCS, Genoa, Italy
| | - Laura Salgado-Boquete
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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Reolid A, Servitje O, Ginarte M, Pérez-Ferriols A, Vélez A, Aragües M, Pereiro M, Sánchez-Carazo J, Garrido J, Daudén E. Validation of an Optical Pencil Method to Estimate the Affected Body Surface Area in Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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7
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Reolid A, Servitje O, Ginarte M, Pérez-Ferriols A, Vélez A, Aragües M, Pereiro M, Sánchez-Carazo JL, Garrido J, Daudén E. Validation of an Optical Pencil Method to Estimate the Affected Body Surface Area in Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2019; 111:143-148. [PMID: 31472926 DOI: 10.1016/j.ad.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Body surface area (BSA) affected by psoriasis is one of the most often used measures for assessing severity, but this method has shortcomings. OBJECTIVE To validate a new way to estimate BSA. MATERIAL AND METHOD Prospective, multicenter study in 56 patients with psoriasis. Each patient was evaluated by 2 dermatologists in 2 visits to the same hospital. Each dermatologist used 2 methods for estimating BSA: the traditional visual estimation in which the area of the palm equals 1% of the total body surface and an optical pencil (OP) method in which the affected area is drawn on a touch screen. Software in the application then calculates the BSA. RESULTS Overall concordance between the 2 methods was acceptable according to an intraclass correlation coefficient (ICC) of 0.87. However, the limits of agreement were unacceptably large and there was systematic bias: traditional estimates were consistently greater than OP calculations. Concordance between the methods was better (ICC>0.8) on the trunk and lower extremities. Intraobserver reliability was excellent with both methods (ICCs, 0.97 and 0.98 for the traditional and OP estimates, respectively). Interobserver reliability was also high (ICCs, 0.91 and 0.94 for the traditional and OP methods), although the mean BSA differed significantly between observers. The ICCs were much lower for BSA estimates on the head. CONCLUSIONS This study to validate the OP method for estimating the affected BSA in patients with psoriasis shows good agreement between the OP and traditional approaches. The OP calculations also showed less variance and better interobserver reliability.
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Affiliation(s)
- A Reolid
- Servicio de Dermatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, España.
| | - O Servitje
- Servicio de Dermatología, Hospital de Bellvitge, Barcelona, España
| | - M Ginarte
- Servicio de Dermatología, Complexo Hospitalario Universitario, Santiago de Compostela, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - A Vélez
- Servicio de Dermatología, Hospital Reina Sofía, Córdoba, España
| | - M Aragües
- Servicio de Dermatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, España
| | - M Pereiro
- Servicio de Dermatología, Complexo Hospitalario Universitario, Santiago de Compostela, España
| | - J L Sánchez-Carazo
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - J Garrido
- Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - E Daudén
- Servicio de Dermatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, España
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Sathe P, Saka R, Kommineni N, Raza K, Khan W. Dithranol-loaded nanostructured lipid carrier-based gel ameliorate psoriasis in imiquimod-induced mice psoriatic plaque model. Drug Dev Ind Pharm 2019; 45:826-838. [PMID: 30764674 DOI: 10.1080/03639045.2019.1576722] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to formulate nanostructured lipid carriers (NLCs) of dithranol-loaded in gel for ease of application and to evaluate its anti-psoriatic efficacy vis-a-vis conventional ointment formulation. SIGNIFICANCE This study will provide an insight about the use of nanocarriers, esp. NLCs loaded with dithranol for the effective treatment of psoriasis. METHODS Dithranol-loaded NLCs were prepared by hot melt homogenization method and characterized for particle size and percentage entrapment efficiency. The optimized NLCs were loaded into gel and evaluated for drug release, spreadability, rheological behavior, and staining. Anti-psoriatic efficacy of the NLC gel was evaluated in imiquimod (IMQ) induced psoriatic plaque model in comparison with prepared conventional ointment formulation (1.15% w/w dithranol). RESULTS NLCs were prepared with particle size below 300 nm, polydispersity index (PDI) below 0.3 and percentage entrapment efficiency of ∼100%. The prepared NLC gel was then compared with the ointment for drug release, staining property, and efficacy. Topical application of dithranol-loaded NLC gel on IMQ-induced psoriatic plaque model reduced the symptoms of psoriasis assessed by both Psoriasis area severity index (PASI) scoring and enzyme-linked immunosorbent assay. There was a significant reduction in disease severity and cytokines like Interleukins-17, 22, 23 and Tumor necrosis factor-α by the developed system in comparison to the negative control. CONCLUSIONS To conclude dithranol-loaded NLCs in gel base was efficacious in management of psoriasis at the same drug concentration and also offer less cloth staining to that of the ointment product.
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Affiliation(s)
- Priyadarshini Sathe
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Raju Saka
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Nagavendra Kommineni
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Kaisar Raza
- b Department of Pharmacy, School of Chemical Sciences and Pharmacy , Central University of Rajasthan , Ajmer , India
| | - Wahid Khan
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
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Gordon KB, Blum RR, Papp KA, Matheson R, Bolduc C, Hamilton T, Heffernan M, Alan Menter M, Okun MM, Zhong J, Kaul M, Camez A. Efficacy and Safety of Adalimumab Treatment in Patients with Moderate to Severe Psoriasis: A Double-Blind, Randomized Clinical Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553030713a00101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tumor necrosis factor-alpha (TNF-α) is pivotal in the pathogenesis of psoriasis, an immune-mediated disease. Adalimumab is a fully human, IgG1 monoclonal antibody that inhibits TNF-α. Objectives The aims of this study were to assess the efficacy and safety of adalimumab therapy for patients with moderate to severe plaque psoriasis and evaluate the duration of treatment response after withdrawal from or dosage reduction of adalimumab therapy. Methods In this multicenter, randomized, double-blind, placebo-controlled study, patients with moderate to severe plaque psoriasis received 12-week, open-label therapy with subcutaneous adalimumab, consisting of 80 mg of adalimumab at weeks 0 and 1, followed by 40 mg weekly at weeks 2–11. At week 12, patients who had an improvement in Psoriasis Area and Severity Index (PASI) score of ≥50% were randomized to blinded therapy and received either adalimumab 40 mg every other week (eow) or placebo for an additional 12 weeks. Results A total of 148 patients enrolled. Clinical response was rapid, with a PASI 50 response rate of 28% at week 2 of adalimumab therapy. At week 12, 91.9% (136/148) of patients had achieved ≥50% reduction in PASI (PASI 50) vs. baseline, 76.4% (113/148) had achieved PASI 75, and 47.3% (70/148) had achieved PASI 90. Of patients who were randomized to placebo at week 12, 30.9% (21/68) experienced a relapse (<PASI 50 improvement vs. baseline) by week 24, compared with 16.2% (11/68) of patients who received adalimumab 40 mg eow. In addition, 48.5% (33/68) of patients who were randomized to placebo at week 12 were PASI 75 responded at week 24, compared with 67.6% (46/68) of patients randomized to adalimumab 40 mg eow (p=0.032). And, 27.9% (19/68) of patients who were randomized to placebo at week 12 were PASI 90 responders at week 24, compared with 47.1% (32/68) of patients randomized to adalimumab 40 mg eow (p=0.028). Adalimumab was generally well-tolerated, and the rates of adverse events were comparable between the adalimumab and placebo groups. Conclusions Weekly adalimumab therapy rapidly improved psoriasis during an initial 12-week period. Improvement was sustained in most, but not all patients, despite dosage reduction to every other week. No patients randomized to adalimumab withdrawal (placebo at week 12) experienced rebound, and most maintained >PASI 50 improvement, relative to baseline, during the 3 months following adalimumab discontinuation. Overall, greater efficacy rates at week 24 were observed for patients randomized to continuous adalimumab therapy than for patients who were withdrawn from therapy at week 12.
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Affiliation(s)
- Kenneth B. Gordon
- Evanston Northwestern Healthcare and Northwestern University Feinberg School of Medicine, Skokie, Ill
| | | | | | | | - Chantal Bolduc
- University of Montreal Hospital Centre, Montreal, Canada
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Pharmacogenetic markers to predict the clinical response to methotrexate in south Indian Tamil patients with psoriasis. Eur J Clin Pharmacol 2017; 73:965-971. [PMID: 28444425 DOI: 10.1007/s00228-017-2255-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/12/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Despite the advent of several new systemic therapies, methotrexate remains the gold standard for the treatment of moderate to severe psoriasis. However, there exists a significant heterogeneity in individual response to methotrexate. There are no consistently reliable markers to predict methotrexate treatment response till date. OBJECTIVES We aimed to demonstrate the association of certain genetic variants in the HLA (HLA-A2, HLA-B17, and HLA-Cw6) and the non-HLA genes including T-helper (Th)-1, Th-2, Th-17 cytokine genes (IFN-γ, IL-2, IL-4, IL-10, IL-12B, and IL-23R), and T-regulatory gene (FOXP3) with the methotrexate treatment response in South Indian Tamil patients with psoriasis. METHODS Of the 360 patients recruited, 189 patients with moderate to severe psoriasis were treated with methotrexate. Of the 189 patients, 132 patients responded to methotrexate and the remaining 57 patients were non-responders. We analyzed the association of aforesaid polymorphisms with the methotrexate treatment outcome using binary logistic regression. RESULTS We observed that there were significant differences between genotype frequencies of HLA-Cw6 and FOXP3 (rs3761548) among the responders compared to non-responders, with conservative estimation. We observed that pro-inflammatory cytokines such as IFN-γ, IL-2, IL-12, and IL-23 were markedly reduced with the use of methotrexate, in comparison to the baseline levels, while the plasma IL-4 levels were increased posttreatment. CONCLUSION Our results serve as preliminary evidence for the clinical use of genetic markers as predictors of response to methotrexate in psoriasis. This might aid in the future in the development of a point-of-care testing (POCT) gene chip, to predict optimal treatment response in patients with psoriasis, based on their individual genotypic profile.
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Thorneloe RJ, Griffiths CEM, Ashcroft DM, Cordingley L. The challenges of assessing patients' medication beliefs: a qualitative study. BMC Health Serv Res 2017; 17:119. [PMID: 28173867 PMCID: PMC5297180 DOI: 10.1186/s12913-017-2020-y] [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] [Received: 09/09/2016] [Accepted: 01/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background An estimated 50% of patients do not take their medication as prescribed, with medication adherence associated with adverse outcomes and higher costs of care. The Necessity-Concerns Framework identified individual’s beliefs about their medication as playing a key role in adherence, and UK Clinical Adherence Guidelines recommend eliciting and incorporating individual’s perceptions of their medication within the consultation. The Beliefs about Medicines Questionnaire (BMQ) is widely used to assess medication beliefs, however, given the condition-specific nature of some self-management regimens, it is unknown whether this tool is able to fully capture beliefs about more complex medication regimens. Methods We examined the challenges of assessing medication beliefs using the BMQ in 20 people with a complex relapsing-remitting condition recruited from community sources. Data were collected from people with psoriasis; a patient group characterised by complex medication regimens, which include therapies that are applied topically, phototherapy/photochemotherapy, and therapies that are administered orally or via subcutaneous or intravenous injections. Semi-structured cognitive interviews were undertaken, with responses coded using established schedules and analysed using Content analysis. Results Individual’s beliefs about their condition specific therapies were not accurately captured by the BMQ. Medication beliefs as expressed during ‘real-time’ completion of the BMQ were underestimated, or failed to be captured, by the corresponding scores given by participants. There was mismatch between the terminology used in the scale and individuals perceptions of their condition and the complexity of its management and treatment outcomes. Currently the BMQ cannot represent beliefs about medicines underuse, even though some individuals with psoriasis viewed access to therapies as overly restrictive. Some the BMQ items were misinterpreted in part due to ambiguous item wording or due to misreading by participants. Conclusions This is the first study to identify general and condition-specific difficulties experienced by individuals completing the BMQ in ‘real time’. The main implication of this research is the need to develop condition-specific versions of the BMQ in order that this important instrument can capture the full range of medication beliefs in individuals living with a complex relapsing-remitting condition. Access to condition-specific versions could significantly increase our understanding of beliefs which facilitate or reduce medication adherence.
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Affiliation(s)
- Rachael J Thorneloe
- Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, M13 9PB, UK. .,Centre for Dermatology Research, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Christopher E M Griffiths
- Centre for Dermatology Research, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Guenther L, Lynde C, Ho V. Practical Considerations for the Initiation and Maintenance of Etanercept in the Treatment of Psoriasis. J Cutan Med Surg 2016. [DOI: 10.2310/7750.2006.00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Etanercept is a new treatment for moderate to severe psoriasis. In contrast to traditional systemic agents, which can be given orally, etanercept is given by subcutaneous injection. Patient selection, transitioning, dosing, safety, monitoring, duration of therapy, and patient support programs are reviewed.
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Affiliation(s)
- Lyn Guenther
- From the Division of Dermatology, University of Western Ontario, London, ON; The Guenther Dermatology Research Centre, London, ON; University Health Network, University of Toronto, Toronto, ON; Lynde Centre for Dermatology, Markham, ON; and Department of Dermatology, University of British Columbia, Vancouver, BC
| | - Charles Lynde
- From the Division of Dermatology, University of Western Ontario, London, ON; The Guenther Dermatology Research Centre, London, ON; University Health Network, University of Toronto, Toronto, ON; Lynde Centre for Dermatology, Markham, ON; and Department of Dermatology, University of British Columbia, Vancouver, BC
| | - Vincent Ho
- From the Division of Dermatology, University of Western Ontario, London, ON; The Guenther Dermatology Research Centre, London, ON; University Health Network, University of Toronto, Toronto, ON; Lynde Centre for Dermatology, Markham, ON; and Department of Dermatology, University of British Columbia, Vancouver, BC
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13
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8-Halo-substituted naphtho[2,3-b]thiophene-4,9-diones as redox-active inhibitors of keratinocyte hyperproliferation with reduced membrane-damaging properties. Eur J Med Chem 2016; 110:280-90. [DOI: 10.1016/j.ejmech.2016.01.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/23/2022]
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14
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Bariamis SE, Magoulas GE, Grafanaki K, Pontiki E, Tsegenidis T, Athanassopoulos CM, Maroulis G, Papaioannou D, Hadjipavlou-Litina D. Synthesis and biological evaluation of new C-10 substituted dithranol pleiotropic hybrids. Bioorg Med Chem 2015; 23:7251-63. [PMID: 26515039 DOI: 10.1016/j.bmc.2015.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/06/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Abstract
Selective alkylation of the antipsoriatic drug dithranol (DTR) at C-10 with tert-butyl bromoacetate, followed by acid-mediated deprotection, produced the corresponding carboxylic acid 4 which was coupled with selectively protected polyamines (PAs), such as putrescine (PUT), spermidine (SPD) and spermine (SPM), dopamine and aliphatic amines and substituted benzylamines producing a series of DTR-PA hybrids, after acid-mediated deprotection, as well as simple amides. The compounds were tested as antioxidants and inhibitors of lipoxygenase (LOX). The amides 4,4'-dimethoxybenzhydrylamide 13 (86% and 95%), 2,4-dimethoxybenzylamide 12 (87% and 81%) and dodecylamide 9 (98% and 74%), and the hybrid DTR-SPM (7) (93% and 87%), showed the highest antioxidant activity in the DPPH and AAPH assays, whereas the most potent inhibitors of LOX were amide 13 (IC50=7 μM), the benzylamide 10 (IC50=7.9 μM) and the butylamide 8 (IC50=10 μM). Molecular binding studies showed that binding of these derivatives into the hydrophobic domain blocks approach of substrate to the active site, inhibiting soybean LOX. Amide 13 presented the highest anti-inflammatory activity (79.7%). The DTR moiety was absolutely necessary for securing high anti-inflammatory potency. Ethyl ester 3 (IC50=0.357 μM) and the amides 9 (IC50=0.022 μM) and 13 (IC50=0.56 μM) exhibited higher antiproliferative activity than DTR (IC50=0.945 μM) on HaCaT keratinocytes whereas amide 13 generally presented better cytocompatibility. Amide 13 is a very promising lead compound for further development as an anti-inflammatory and antiproliferative agent.
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Affiliation(s)
- Stavros E Bariamis
- Department of Chemistry, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | - George E Magoulas
- Department of Chemistry, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | - Katerina Grafanaki
- Laboratory of Biochemistry, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Eleni Pontiki
- Department of Pharmaceutical Chemistry, School of Pharmacy, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Theodore Tsegenidis
- Department of Chemistry, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | | | - George Maroulis
- Department of Chemistry, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | - Dionissios Papaioannou
- Department of Chemistry, School of Natural Sciences, University of Patras, 26504 Patras, Greece.
| | - Dimitra Hadjipavlou-Litina
- Department of Pharmaceutical Chemistry, School of Pharmacy, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
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15
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Kühborth K, Haidl G, Allam JP. [Penile dermatoses]. Urologe A 2015; 54:684-9. [PMID: 25987335 DOI: 10.1007/s00120-015-3798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostics of penile skin alterations represent a urological and dermatological challenge. The spectrum of differential diagnoses ranges from benign skin alterations with no clinical significance, through infections, vesiculobullous diseases and neoplasms up to acute diseases necessitating emergency interventions. Evidence-based therapy concepts are not available for all these diseases and due to the rarity an interdisciplinary cooperation is expedient and promising.
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Affiliation(s)
- K Kühborth
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland
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Anderson KL, Feldman SR. A guide to prescribing home phototherapy for patients with psoriasis: The appropriate patient, the type of unit, the treatment regimen, and the potential obstacles. J Am Acad Dermatol 2015; 72:868-78.e1. [DOI: 10.1016/j.jaad.2015.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 11/29/2022]
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17
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Eltaher S, Mohammed GF, Younes S, Elakhras A. Efficacy of the apitherapy in the treatment of recalcitrant localized plaque psoriasis and evaluation of tumor necrosis factor-alpha (TNF-α) serum level: A double-blind randomized clinical trial. J DERMATOL TREAT 2014; 26:335-9. [PMID: 25424047 DOI: 10.3109/09546634.2014.990411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND No universal consensus about optimal modality for treating the recalcitrant localized plaque psoriasis (RLPP) is available. OBJECTIVE To evaluate the immunological and clinical therapeutic effect of using apitherapy in the treatment of RLPP. METHODS Randomized 50 patients with RLPP received apitherapy (n = 25) and placebo (n = 25) every week. Both treatments were injected into lesions at weekly intervals for a maximum of 12 treatments. Following up was 6 months later. Tumor necrosis factor-alpha (TNF-α) level was measured at pre-study and at 12th week. RESULTS A significant difference was found between the therapeutic responses of RLPP to the apitherapy and placebo groups (p<0.001). In the apitherapy group, complete response was achieved in 92% of patients. There was statistically significant decrease in TNF-α in the apitherapy group compared to the placebo group. No recurrence was observed in the apitherapy group. CONCLUSION Apitherapy is effective and a safe treatment for recalcitrant localized plaque psoriasis, when other topical or physical therapies have failed.
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Affiliation(s)
- Soha Eltaher
- Department of Dermatology and Venereology, Faculty of Medicine, Suez Canal University , Ismailia , Egypt and
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18
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Duffin KC, Yeung H, Takeshita J, Krueger GG, Robertson AD, Troxel AB, Shin DB, Van Voorhees AS, Gelfand JM. Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. Br J Dermatol 2014; 170:672-680. [PMID: 24266717 PMCID: PMC4302409 DOI: 10.1111/bjd.12745] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment satisfaction among patients with moderate-to-severe psoriasis has not been studied and compared across treatments using a validated instrument. OBJECTIVES To assess patient-reported satisfaction with systemic and phototherapy treatments for moderate-to-severe psoriasis in clinical practice and to correlate satisfaction with disease severity and quality-of-life measures. METHODS This was a cross-sectional study of 1182 patients with moderate-to-severe psoriasis in the Dermatology Clinical Effectiveness Research Network in the U.S.A. Patients receiving either topical therapies only; monotherapy with oral systemic therapies, biologics or narrowband ultraviolet B phototherapy; or combination therapy with biologics and methotrexate completed the Treatment Satisfaction Questionnaire for Medication version II. RESULTS Median unadjusted overall satisfaction scores were highest for patients receiving biologic monotherapies, biologic-methotrexate combinations, or phototherapy (83.3); scores were lowest for those receiving topical therapies only or acitretin (66.7). In fully adjusted models, compared with patients receiving methotrexate monotherapy, those receiving adalimumab, etanercept, ustekinumab, phototherapy or adalimumab with methotrexate had significantly higher median overall satisfaction scores by 7.2-8.3 points, while those receiving topical therapies only had significantly lower overall satisfaction by 8.9 points. Adjusted convenience scores were lowest for patients receiving topical therapies only or infliximab. Modest but significant correlations were found between the overall satisfaction subscale and both the Psoriasis Area and Severity Index (ρ = -0.36, P < 0.001) and the Dermatology Life Quality Index (ρ = -0.47, P < 0.001). CONCLUSIONS Discernible differences were found in treatment satisfaction among therapies, particularly regarding treatment effectiveness and convenience. Further application of treatment satisfaction measures may inform treatment decisions and guideline development.
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Affiliation(s)
- K Callis Duffin
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - H Yeung
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - G G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - A B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A S Van Voorhees
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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19
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Nelson PA, Barker Z, Griffiths CEM, Cordingley L, Chew-Graham CA. 'On the surface': a qualitative study of GPs' and patients' perspectives on psoriasis. BMC FAMILY PRACTICE 2013; 14:158. [PMID: 24138455 PMCID: PMC3828399 DOI: 10.1186/1471-2296-14-158] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/11/2013] [Indexed: 11/14/2022]
Abstract
Background Psoriasis is a chronic, inflammatory skin disease affecting approximately 2% of the UK population and is currently incurable. It produces profound effects on psychological wellbeing and social functioning and has significant associated co-morbidities. The majority of patients with psoriasis are managed in primary care, however in-depth patient and GP perspectives about psoriasis management in this setting are absent from the literature. This article reports an in-depth study which compares and contrasts the perspectives of people with psoriasis and of GPs on the challenges of managing psoriasis in primary care. Methods In-depth, qualitative semi-structured interviews were conducted with a diverse sample of 29 people with psoriasis and 14 GPs. Interviews were coded using principles of Framework Analysis to enable a comparison of patient and practitioner perspectives on key issues and concepts arising from the data. Results Patients perceived GPs to be lacking in confidence in the assessment and management of psoriasis and both groups felt lacking in knowledge and understanding about the condition. While practitioners recognised that psoriasis has physical, emotional and social impact, they assumed patients had expertise in the condition and may not address these issues in consultations. This resulted in patient dissatisfaction and sub-optimal assessment of severity and impact of psoriasis by GPs. Patients and GPs recognised that psoriasis was not being managed as a complex long-term condition, however this appeared less problematic for GPs than for patients who desired a shared management with their GP incorporating appropriate monitoring and timely reviews. Conclusions The research suggests that current routine practice for psoriasis management in primary care is mismatched with the expressed needs of patients. To address these needs, psoriasis must be recognised as a complex long-term condition involving exacting physical, psychological and social demands, co-morbidity and the development of new treatments. General practitioners need to improve both their knowledge and skills in the assessment and management of psoriasis. This in turn will facilitate management of the condition in partnership with patients. Commissioning multi-disciplinary services, which focus on long-term impacts on wellbeing and quality of life, might address current deficits in care.
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Affiliation(s)
- Pauline A Nelson
- Dermatology Research Centre, Institute of Inflammation and Repair, The University of Manchester and Manchester Academic Health Science Centre, Suite 14, 5th Floor, Williamson Building, University of Manchester, Oxford Rd, Manchester M13 9PL, UK.
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Perlamutrov YN, Olkhovskaya KB. Rational external therapy of scalp psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Scalp psoriasis results in evident cosmetic defects and is refractory to treatment. The therapy for scalp psoriasis using the Elocom lotion results in a prompt and evident clinical effect while its further intermittent application prevents relapses without the onset of adverse events and adrenal cortex dysfunction.
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21
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Dogra S, Mahajan R. Systemic methotrexate therapy for psoriasis: past, present and future. Clin Exp Dermatol 2013; 38:573-88. [DOI: 10.1111/ced.12062] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 01/20/2023]
Affiliation(s)
- S. Dogra
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh; India
| | - R. Mahajan
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh; India
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Puig L, Carrascosa J, Belinchón I, Fernández-Redondo V, Carretero G, Ruiz-Carrascosa J, Careaga J, de la Cueva P, Gárate M, Ribera M. Adherencia y satisfacción del paciente y características organolépticas y de uso de los tratamientos tópicos utilizados para la psoriasis: Consenso Delphi del panel de expertos y miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:488-96. [DOI: 10.1016/j.ad.2012.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022] Open
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Adherence and Patient Satisfaction With Topical Treatment in Psoriasis, and the Use, and Organoleptic Properties of Such Treatments: A Delphi Study With an Expert Panel and Members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Badilli U, Amasya G, Şen T, Tarimci N. Topical emulgel formulation containing inclusion complex of calcipotriol with cyclodextrin. J INCL PHENOM MACRO 2013. [DOI: 10.1007/s10847-013-0293-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nelson PA, Chew-Graham CA, Griffiths CEM, Cordingley L. Recognition of need in health care consultations: a qualitative study of people with psoriasis. Br J Dermatol 2012; 168:354-61. [PMID: 22880951 DOI: 10.1111/j.1365-2133.2012.11217.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis is a life-long inflammatory condition that can impact on quality of life, psychological and social functioning. Previous literature suggests patient dissatisfaction with psoriasis management; however, little is known about people's specific experiences of health care consultations. OBJECTIVES The study aimed to explore in depth the perspectives of people living with psoriasis including coping responses, self-care strategies and how consultations with health care professionals in both primary and secondary care are experienced. METHODS Qualitative semistructured interviews were carried out with a diverse sample of 29 people with psoriasis generated purposively and recruited from community sources in North West England. Interviews were coded using Framework Analysis to produce a thematic framework incorporating key emerging issues and concepts. RESULTS Participants experienced psoriasis as a complex condition involving physical, psychological and social challenges, as well as issues of control, but perceived that these were largely unacknowledged by practitioners in health care consultations. Practitioners were perceived as lacking knowledge and expertise in the management of psoriasis, lacking empathy with the effects of psoriasis and failing to manage it as a long-term condition. This perceived lack of support resulted in some participants withdrawing from conventional health service providers and seeking alternative sources of help. CONCLUSIONS Psoriasis needs to be recognized and managed as a complex long-term condition with emotional and social needs that are addressed alongside appropriate diagnosis and regular reviews of treatments which may involve referrals to specialist care.
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Affiliation(s)
- P A Nelson
- Dermatology Research Centre, Institute Inflammation and Repair, The University of Manchester, Manchester, Academic Health Science Centre, Manchester, UK.
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26
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Yeung H, Wan J, Van Voorhees AS, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Brod BA, Schleicher SM, Bebo BF, Shin DB, Troxel AB, Gelfand JM. Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis. J Am Acad Dermatol 2012; 68:64-72. [PMID: 22846688 DOI: 10.1016/j.jaad.2012.06.035] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/20/2012] [Accepted: 06/26/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood. OBJECTIVES We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice. METHODS A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments. RESULTS A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95% confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72). LIMITATIONS The study is limited by its reliance on patient recall. CONCLUSIONS Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Schaarschmidt ML, Umar N, Schmieder A, Terris DD, Goebeler M, Goerdt S, Peitsch WK. Patient preferences for psoriasis treatments: impact of treatment experience. J Eur Acad Dermatol Venereol 2012; 27:187-98. [PMID: 22225546 DOI: 10.1111/j.1468-3083.2011.04440.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patient preferences for psoriasis treatments can impact treatment satisfaction and adherence and may therefore influence clinical outcome. OBJECTIVE To assess the impact of treatment experience (satisfaction with current treatment, number of prior visits, disease duration, number of preceding therapies and currently prescribed treatment modalities) on treatment preferences. METHODS A computer-based conjoint analysis experiment was conducted to analyse preferences of patients with moderate or severe psoriasis (n = 163) treated at a German University Medical Center for outcome (probability, magnitude and duration of benefit; probability, severity and reversibility of side effects) and process attributes (location, frequency, duration, delivery method, individual cost) of psoriasis treatments. Relative importance scores (RIS) were calculated for each attribute and compared using anova, post hoc test and multivariate regression analysis. RESULTS Participants with longer disease duration attached significantly greater importance to duration of benefit (β = 0.206, P = 0.018), whereas participants on oral therapy were more concerned about magnitude of benefit by trend (β = 0.218, P = 0.058). Participants receiving injectables not only set higher value to probability of benefit (RIS = 32.80 vs. 21.89, P = 0.025) but also to treatment location (RIS = 44.74 vs. 23.03, P = 0.011), delivery method (RIS = 43.75 vs. 19.29, P = 0.019), treatment frequency (RIS = 31.24 vs. 16.89, P = 0.005) and duration (RIS = 32.54 vs. 16.57, P = 0.003) when compared with others. Treatment satisfaction was significantly higher in participants on infusions or injections compared with those on phototherapy and mere topical therapy. CONCLUSIONS Treatment preferences may change over time course and with treatment experience. Participants on injectables attach great importance to efficiency and convenience of therapies, and are highly satisfied with their treatment.
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Affiliation(s)
- M-L Schaarschmidt
- Department of Dermatology, University Medical Center Mannheim, Mannheim, Germany
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Lee SH, Kim DW, Back SS, Hwang HS, Park EY, Kang TC, Kwon OS, Park JH, Cho SW, Han KH, Park JS, Eum WS, Choi SY. Transduced Tat-Annexin protein suppresses inflammation-associated gene expression in lipopolysaccharide (LPS)-stimulated Raw 264.7 cells. BMB Rep 2011; 44:484-9. [DOI: 10.5483/bmbrep.2011.44.7.484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Gattu S, Busse K, Bhutani T, Chiang C, Nguyen T, Becker E, Koo JYM. Psoriasis responds to intralesional injections of alefacept and may predict systemic response to intramuscular alefacept: interim results of a single-arm, open-label study. J DERMATOL TREAT 2011; 23:103-8. [PMID: 21254875 DOI: 10.3109/09546634.2010.500323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Alefacept is a remittive treatment for generalized psoriasis but is rarely used due to its erratic efficacy. OBJECTIVE To determine if psoriasis plaques will respond to intralesional alefacept and if this predicts a systemic response to intramuscular (IM) alefacept. METHODS We describe a 25-week, single-center, open-label study. Patients received weekly intralesional alefacept of increasing concentrations into target plaques for 3 weeks followed by IM injections for 12 weeks and concluded with an observation period of 9 weeks. The psoriasis area and severity index (PASI) was used to assess the efficacy of IM alefacept. RESULTS Interim results are reported for the first seven patients enrolled. Two patients responded intralesionally to the most dilute 1:100 concentration of alefacept to sterile water and achieved a 59% and 100% improvement in PASI. Five patients did not respond intralesionally to the most dilute form of alefacept and none achieved PASI 75. Two of these five patients did not respond to any concentration and achieved a 26% and 38% improvement in PASI. Limitations to this study include a small sample size and being non-placebo-controlled. CONCLUSION Alefacept is effective intralesionally and may predict a systemic response - challenging the concept that biologics must work systemically.
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Affiliation(s)
- Shilpa Gattu
- University of California Irvine Medical Center, Irvine, CA, USA
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Smith DRW, Bottomley JM, Auland M, Jackson P, Sharp J. Heterogeneity in the treatment of moderately severe scalp psoriasis in Scotland - results of a survey of Scottish health professionals. Curr Med Res Opin 2011; 27:239-49. [PMID: 21142837 DOI: 10.1185/03007995.2010.541021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient. OBJECTIVE Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland. RESEARCH DESIGN AND METHODS Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed. RESULTS Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations. CONCLUSIONS There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed 'current standard practice' in Scotland was best described as an average across five plausible treatment pathways.
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Affleck AG, Bottomley JM, Auland M, Jackson P, Ryttov J. Cost effectiveness of the two-compound formulation calcipotriol and betamethasone dipropionate gel in the treatment of scalp psoriasis in Scotland. Curr Med Res Opin 2011; 27:269-84. [PMID: 21142836 DOI: 10.1185/03007995.2010.541023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare the cost effectiveness of the two-compound formulation (TCF) calcipotriol plus betamethasone dipropionate gel used first-, second- or third-line to standard topical treatments for moderately severe scalp psoriasis from a Scottish NHS perspective. RESEARCH DESIGN AND METHODS Treatment pathways for scalp psoriasis patients in primary care were defined by Scottish prescribing statistics, an interview programme and published sources. The extensive 1-year Markov model included 12 different topical treatment pathways, each simulating three lines of therapy. Seven pathways contained the TCF gel in first-, second- or third-line. The remaining five pathways were included as comparators, reflecting the heterogeneity across clinical practice. The cost effectiveness of TCF gel was compared to the average of five non-TCF gel pathways. The clinical effectiveness measure was the ability of topical treatments to control disease at 4 weeks. Response rates were derived from indirect comparisons of ten randomised controlled trials. Utilities were elicited from SF-36 (v2) scores in one TCF gel trial. The main outcome was the incremental cost per quality-adjusted life-year (QALY). Extensive sensitivity analyses were performed to assess the robustness of the results. RESULTS TCF gel used first-, second- or third-line was projected to increase QALYs (around 0.0025) with cost savings per patient (£20-30) over 1 year. The study analysis acknowledged a number of limitations including lack of quality comparator data, the need to make assumptions in the absence of evidence and lack of model validation. However the results showed that TCF gel was the dominant treatment strategy across a broad range of credible scenarios. CONCLUSIONS Scalp psoriasis is difficult to treat. Many different topical preparations can be used but several factors such as greasiness, irritation, time needed to apply, and lack of efficacy often result in reduced adherence to treatment regimens. Where cosmetic properties are important for patient acceptability and compliance is a major issue contributing to treatment failure, the once-daily TCF gel offers patients with scalp psoriasis an attractive, cost-saving treatment option.
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32
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Puig L, Ribera M, Hernanz J, Belinchón I, Santos-Juanes J, Linares M, Querol I, Colomé E, Caballé G. Tratamiento de la psoriasis del cuero cabelludo. Revisión de la evidencia y Consenso Delphi del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Realidad terapéutica de la psoriasis moderada-grave en España. Encuesta de opinión. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reich K, Signorovitch J, Ramakrishnan K, Yu AP, Wu EQ, Gupta SR, Bao Y, Mulani PM. Benefit-risk analysis of adalimumab versus methotrexate and placebo in the treatment of moderate to severe psoriasis: Comparison of adverse event–free response days in the CHAMPION trial. J Am Acad Dermatol 2010; 63:1011-8. [DOI: 10.1016/j.jaad.2009.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/17/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022]
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35
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Kratz U, Prinz H, Müller K. Synthesis and biological evaluation of novel 10-benzyl-substituted 4,5-dichloro-10H-anthracen-9-ones as inhibitors of keratinocyte hyperproliferation. Eur J Med Chem 2010; 45:5278-85. [DOI: 10.1016/j.ejmech.2010.08.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/17/2010] [Accepted: 08/22/2010] [Indexed: 11/25/2022]
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36
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Foley PA, Quirk C, Sullivan JR, Dolianitis C, Hack SP, Thirunavukkarasu K, Cooper AJ. Combining etanercept with traditional agents in the treatment of psoriasis: a review of the clinical evidence. J Eur Acad Dermatol Venereol 2010; 24:1135-43. [DOI: 10.1111/j.1468-3083.2010.03613.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Bjarkøy RØ, Gjengedal E, Wahl AK. Care in the Context of the Complexity of Psoriasis. Clin Nurs Res 2010; 20:47-63. [DOI: 10.1177/1054773810375542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has demonstrated the multidimensional challenges of living with psoriasis and dermatology wards provide a unique setting in which to reach people strongly affected by this disease. The aim of this study is to determine the components of care that psoriasis patients and dermatology nurses consider to be important during hospitalization. A purposeful sample of seven psoriasis inpatients and seven dermatology nurses were interviewed in depth during a 3-month period in 2006-2007. The data are analyzed with a modified version of Giorgi’s phenomenological method. Patients consider hospitalization a relief from everyday life with psoriasis and describe its treatment as the focus of nursing care. Despite their knowledge of the psychosocial aspects of psoriasis, nurses consider the physical manifestations of the disease most important. The patients’ descriptions of the challenges in their everyday lives illustrate an area of concern among psoriasis inpatients that is not actively addressed by nursing care.
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Affiliation(s)
- Ragnhild Øye Bjarkøy
- University of Bergen, Bergen, Norway, Bergen University College, Bergen, Norway,
| | - Eva Gjengedal
- University of Bergen, Bergen, Norway, Molde University College, Molde, Norway
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Medicherla S, Ma JY, Reddy M, Esikova I, Kerr I, Movius F, Higgins LS, Protter AA. Topical alpha-selective p38 MAP kinase inhibition reduces acute skin inflammation in guinea pig. J Inflamm Res 2010; 3:9-16. [PMID: 22096353 PMCID: PMC3218738 DOI: 10.2147/jir.s6718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Certain skin pathologies, including psoriasis, are thought to be immune-mediated inflammatory diseases. Available literature clearly indicates the involvement of inflammatory cells (neutrophils, T cells, and macrophages), their cytokines, and the p38 mitogen-activated protein kinase (MAPK) signaling pathway in the pathophysiology of psoriasis. Neutrophils play an important role in the formation of acute inflammatory changes in psoriasis. Acute inflammation or acute flares in psoriasis remain poorly addressed in clinical medicine. In this communication, we first establish a simple and reproducible model for studying neutrophil-mediated acute skin inflammation. Using the hairless guinea pig, due to the similarity of skin architecture to that of human, acute inflammation was induced with an intradermal injection of 50 μg/mL lipopolysaccharide (LPS) in 50 μL solution. Myeloperoxidase (MPO) activity was measured by MPO-positive neutrophils and shown to increase for 24-hours post-injection. Simultaneously, the level of phosphorylated p38 MAPK was documented for 48-hours post-LPS injection in the skin. Next, we used this model to examine the therapeutic potential of an α-selective p38 MAPK inhibitor, SCIO-469. A comparison of topical application of SCIO-469 at 5 mg/mL or 15 mg/mL to vehicle revealed that SCIO-469 dose-dependently reduces acute skin inflammation and that this effect is statistically significant at the higher dose. Further examination of tissues that received this dose also revealed statistically significant reduction of MPO activity, phosphorylated p38 MAPK, interleukin-6, and cyclooxygenase-2. These data suggest that the α-selective p38 MAPK inhibitor, SCIO-469, acts as a topical anti-inflammatory agent via the p38 MAPK pathway to reduce neutrophil induced acute inflammation in the skin. These observations suggest that α-selective p38 MAPK inhibition may be an effective therapeutic strategy to manage acute skin inflammation
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Affiliation(s)
- Markus Wuenschel
- Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
| | - Per Trobisch
- Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
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Poulin Y, Papp K, Bissonnette R, Barber K, Kerrouche N, Villemagne H. Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis. J DERMATOL TREAT 2010; 21:185-92. [DOI: 10.3109/09546630903493311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Treatment of Moderate-to-Severe Psoriasis in Clinical Practice: A Survey of Spanish Dermatologists. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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42
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Puig L, Ribera M, Hernanz J, Belinchón I, Santos-Juanes J, Linares M, Querol I, Colomé E, Caballé G. Treatment of Scalp Psoriasis: Review of the Evidence and Delphi Consensus of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70730-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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43
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Mazzotta A, Esposito M, Carboni I, Schipani C, Chimenti S. Clobetasol propionate foam 0.05% as a novel topical formulation for plaque‐type and scalp psoriasis. J DERMATOL TREAT 2009; 18:84-7. [PMID: 17520464 DOI: 10.1080/09546630601123835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To establish the efficacy of clobetasol propionate foam 0.05% in patients with plaque-type psoriasis and scalp psoriasis. METHODS We conducted an open-label study on 24 patients. Twelve patients affected by plaque-type psoriasis (group 1) and 12 patients with scalp psoriasis (group 2) applied clobetasol propionate foam 0.05% twice daily for 4 weeks. RESULTS Clobetasol propionate foam 0.05% led to a reduction of the disease severity. After 2 weeks the PASI score decreased from 7.5 at baseline to 2.5 (range: 0.8-4.6, SD: 1.1) in group 1 and from 5.7 to 1.7 (range: 0.2-4.8, SD: 1.1) in group 2. At week 4, the mean PASI was 2 (range: 0.6-4, SD: 1) and 1.1 (range: 0.2-2.2, SD: 0.6) in groups 1 and 2, respectively. In particular, at week 2, 83.3% of patients with plaque psoriasis and 75% with scalp psoriasis achieved an improvement of the PASI score from baseline> or =50% (PASI-50). At week 4, 91.6% of patients from group 1 and 100% from group 2 achieved or maintained PASI-50, while 41.6% in group 1 and 58.3% in group 2 demonstrated a further improvement, reaching PASI-75. CONCLUSION The rapidity of effect and the good safety profile suggest a role for clobetasol propionate foam 0.05% in the management of both plaque-type and scalp psoriasis.
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Gisondi P, Giglio MD, Girolomoni G. Effective management of psoriasis symptom worsening during efalizumab therapy without discontinuing treatment: A case study. J DERMATOL TREAT 2009; 17:172-5. [PMID: 16854760 DOI: 10.1080/09546630600714279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Efalizumab is an effective therapy for the long-term treatment of chronic plaque psoriasis. However, regardless of the type of antipsoriatic treatment a patient is receiving, natural fluctuations in symptom severity occur throughout the course of the disease, and need to be managed appropriately. Here, we report the case of a patient with moderate chronic plaque psoriasis resistant to conventional treatments, who initially showed an excellent response to efalizumab (1 mg/kg per week, subcutaneous injection), but then experienced symptom exacerbation after 8 weeks of treatment. This worsening of symptoms was successfully controlled using a short course of concomitant methotrexate treatment (15 mg/week, intramuscular injection). After 1 month, the clinical signs had cleared, methotrexate treatment was stopped and efalizumab therapy was continued. These results show the effective use of a short course of concomitant methotrexate to control fluctuations in psoriasis severity in a patient receiving efalizumab therapy in general clinical practice.
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Affiliation(s)
- Paolo Gisondi
- Department of Biomedical and Surgical Science, Dermatology Section, University of Verona, Verona, Italy.
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45
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Horn EJ, Domm S, Katz HI, Lebwohl M, Mrowietz U, Kragballe K. Topical corticosteroids in psoriasis: strategies for improving safety. J Eur Acad Dermatol Venereol 2009; 24:119-24. [PMID: 20175860 DOI: 10.1111/j.1468-3083.2009.03358.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Corticosteroids are a mainstay of topical therapy for psoriasis. While efficacious and relatively safe when used carefully, the potential for side effects, notably skin atrophy and adrenal suppression, have been associated with excesses in potency, prolonged or widespread use. The International Psoriasis Council Working Group on Topical Therapy has reviewed the efficacy and safety of topical corticosteroids and recommends strategies for safe, long-term use of these agents.
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Affiliation(s)
- E J Horn
- International Psoriasis Council, Dallas, Texas, USA
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46
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Abstract
Biologics are protein molecules which are used in various diseases to target the specific points in the immunopathogenesis of the diseases. The molecules are produced by recombinant DNA technology. The molecules bind to the specific targets without interfering wtih rest of the pathogenetic pathways. Therefore the so called 'immunosuppressives' have, although, a broader broader spectrum of action on immune system, their side-effects are also equally more. The biologics, because of their spefic action on the immune system, have very little side effects. The biologics which have revolutionized the treatment of various dermatologic diseases have been discussed here.
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Affiliation(s)
- Arijit Coondoo
- From the Department of Dermatology, Vivekananda Institute of Medical Science, Kolkata, India.
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47
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Treatment of severe scalp psoriasis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2009; 60:962-71. [DOI: 10.1016/j.jaad.2008.11.890] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 11/10/2008] [Accepted: 11/17/2008] [Indexed: 11/19/2022]
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48
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Abstract
We examined overall and specific cancer risks among Swedish subjects who had been hospitalised one or more times for psoriasis. A database was created by identifying such patients from the Swedish Hospital Discharge Register and linking them with the Cancer Registry. Follow-up of patients was carried out from the last hospitalisation through 2004. A total of 15 858 patients were hospitalised for psoriasis during 1965-2004, of whom 1408 developed cancer, giving an overall standardised incidence ratios (SIRs) of 1.33. A significant excess was noted for squamous cell skin cancer, and for cancers of the upper aerodigestive tract, oesophagus, stomach, liver, pancreas, lung, kidney and bladder as well as non-Hodgkin lymphoma. Many of these may reflect the effects of alcohol drinking and tobacco smoking. Patients with multiple hospitalisations showed high risk, particularly for oesophageal (SIR 6.97) and skin (SIR 4.76) cancers.
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49
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Abstract
Treating children with psoriasis represents one of the most rewarding yet constantly challenging endeavors in dermatology. These patients require time, energy, enthusiasm, empathy, and current, comprehensive knowledge of the unique clinical presentations in children and available therapies, including clinical action spectrum, mechanism of action, potential toxicity, and monitoring. Longitudinal trials examining the epidemiology and natural history of psoriasis, as well as the safety and efficacy of current and emerging treatments, are desperately needed in the pediatric population. Partner with the patient, family, and other multidisciplinary providers to form an educational and therapeutic alliance. Early in the course of disease, schedule frequent visits for reinforcement of the therapeutic plan, education, clinical and treatment monitoring, and support. As the disease and the patient's physical, psychosocial and emotional level of functioning evolve, so too will the requirement for follow-up and monitoring. Patient advocacy and education groups, such as the National Psoriasis Foundation (www.psoriasis.org; 800-723-9166) are excellent resources and can serve as an extension of your comprehensive care.
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Affiliation(s)
- Kelly M Cordoro
- University of California, San Francisco, 1701 Divisadero Street, Box 0316, San Francisco, CA 94115, USA.
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50
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Lloyd A, Reeves P, Conway P, Reynolds A, Baxter G. Economic evaluation of etanercept in the management of chronic plaque psoriasis. Br J Dermatol 2009; 160:380-6. [DOI: 10.1111/j.1365-2133.2008.08863.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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