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López E, Cabrera R, Lecaros C. Targeted therapy for immune mediated skin diseases. What should a dermatologist know? An Bras Dermatol 2024; 99:546-567. [PMID: 38521706 PMCID: PMC11221168 DOI: 10.1016/j.abd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. RESULTS We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. STUDY LIMITATIONS The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. CONCLUSION Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.
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Affiliation(s)
- Edinson López
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
| | - Raúl Cabrera
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
| | - Cristóbal Lecaros
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
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2
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The impact of gender and sex in psoriasis: What to be aware of when treating women with psoriasis. Int J Womens Dermatol 2022; 8:e010. [PMID: 35619672 PMCID: PMC9112394 DOI: 10.1097/jw9.0000000000000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/02/2022] [Indexed: 12/25/2022] Open
Abstract
Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women.
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3
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Patient satisfaction scores in adults with psoriasis. Arch Dermatol Res 2021; 314:573-581. [PMID: 34152482 DOI: 10.1007/s00403-021-02260-9] [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: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
Patient satisfaction is associated with improved patient retention and clinical outcomes. Previous studies investigated the impact of disease severity and mental health conditions on patient satisfaction among psoriasis patients. However, associations with healthcare utilization were not studied. Moreover, socio-demographic differences in patient satisfaction among adults with psoriasis are not well-delineated. The objectives of this study were to determine the impact of psoriasis disease on patient satisfaction among US adults and examine associations of satisfaction with healthcare utilization and socio-demographic characteristics. We analyzed the 2000-2016 Medical Expenditure Panel Surveys, representative surveys of US population health status and perceptions. Patient satisfaction was evaluated by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Adults with psoriasis were compared to a control group of all adults without current diagnosis of psoriasis. Multivariable linear and logistic regression models were constructed to examine associations of satisfaction among those with psoriasis. Overall, data were analyzed from 1419 adults with psoriasis who completed the entire CAHPS survey. Adults with psoriasis had similar patient satisfaction compared to healthy controls (LS-means: 86.0 vs 85.6, adjusted β [CI 95]: 0.38 [- 0.45, 1.22]). Based on sensitivity analysis, adults with vs without psoriasis had similar rates of high satisfaction in each CAHPS domain: time spent, clear explanations, listening, and respect demonstrated. Among those with psoriasis, high satisfaction was associated with ≥ 1 office visit (adjusted OR [CI 95]: 2.50 [1.63, 3.84]), and consultation with a specialist was associated with increased satisfaction (adjusted β [CI 95]: 1.36 [0.95, 1.77]). Overall satisfaction score among psoriasis adults was associated with increased age and black race, and inversely associated with lower income, public or no insurance, other race or multiracial, and multimorbidity. In conclusion, psoriasis diagnosis was not associated with difference in satisfaction. However, lower-income adults with public or no insurance and multimorbidity had lower satisfaction. Moreover, specialist consultation was associated with higher satisfaction. Multidisciplinary and increased healthcare access are needed to optimize patient satisfaction.
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4
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Maul JT, Augustin M, Sorbe C, Conrad C, Anzengruber F, Mrowietz U, Reich K, French LE, Radtke M, Häusermann P, Maul LV, Boehncke WH, Thaçi D, Navarini AA. Association of sex and systemic therapy treatment outcomes in psoriasis: a two-country, multicentre, prospective, noninterventional registry study. Br J Dermatol 2021; 185:1160-1168. [PMID: 33837519 DOI: 10.1111/bjd.20387] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few systematic data on sex-related treatment responses exist for psoriasis. OBJECTIVES To evaluate sex differences with respect to systemic antipsoriatic treatment. METHODS Data from patients with moderate-to-severe psoriasis in the PsoBest or Swiss Dermatology Network of Targeted Therapies (SDNTT) registries were analysed. Treatment response was defined as achieving a ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75) or PASI ≤ 3 at treatment months 3, 6 and 12, supplemented by patient-reported outcomes [i.e. Dermatology Life Quality Index (DLQI) ≤ 1 and delta DLQI ≥ 4]. RESULTS In total, 5346 patients registered between 2007 and 2016 were included (PsoBest, n = 4896; SDNTT, n = 450). The majority received nonbiological treatment (67·3% male, 69·8% female). Women showed slightly higher PASI response rates after 3 (54·8% vs. 47·2%; P ≤ 0·001), 6 (70·8% vs. 63·8%; P ≤ 0·001) and 12 months (72·3% vs. 66·1%; P ≤ 0·004). A significantly higher proportion of women achieved a reduction in DLQI ≥ 4 [month 3: 61·4% vs 54·8% (P ≤ 0·001); month 6: 69·6% vs. 62·4% (P ≤ 0·001); month 12: 70·7% vs. 64·4% (P ≤ 0·002)]. Regarding PASI ≤ 3, women on biologics showed a significantly superior treatment response compared with men at 3 (57·8% vs. 48·5%; P ≤ 0·004) and 6 months (69·2% vs. 60·9%; P ≤ 0·018). Women in the nonbiological treatment group had a significantly better treatment response (PASI response, PASI 75 and PASI ≤ 3) over 12 months compared with men. CONCLUSIONS We provide evidence that women experience better treatment outcomes with systemic antipsoriatic therapy than men.
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Affiliation(s)
- J-T Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Conrad
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - F Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - U Mrowietz
- Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - M Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - P Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - L V Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.,Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - W-H Boehncke
- Division of Dermatology and Venereology, Geneva University Hospital, Geneva, Switzerland
| | - D Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Narbutt J, Krzyścin J, Sobolewski P, Skibińska M, Noweta M, Owczarek W, Rajewska-Więch B, Lesiak A. A Priori Estimation of the Narrow-Band UVB Phototherapy Outcome for Moderate-to-Severe Psoriasis Based on the Patients' Questionnaire and Blood Tests Using Random Forest Classifier. Clin Cosmet Investig Dermatol 2021; 14:253-259. [PMID: 33776466 PMCID: PMC7987278 DOI: 10.2147/ccid.s296604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
Background Nowadays, patients with moderate-to-severe psoriasis are treated with conventional immunosuppressants or with new biological agents. Phototherapy is the first-line treatment for patients in whom topical therapy is insufficient. Although numerous studies have been carried out, it is still difficult to predict the outcome of phototherapy in individual patients. Methods Prior to standard narrow band (NB) ultraviolet B (UVB) phototherapy, the patients filled out a questionnaire about personal life and health status. Several standard blood tests, including selected cytokine levels, were performed before and after a course of 20 NB-UVB treatments. The questionnaire answers, results of the blood tests, and treatment outcomes were analyzed using an artificial intelligence approach—the random forest (RF) classification tool. Results A total of 82 participants with moderate-to-severe psoriasis were enrolled. Prior to starting phototherapy, the patients with expected good outcome from the phototherapy, shorter remission, and quitting a possible second course of the NB-UVB treatment could be identified by the RF classifier with sensitivity over 84%, and accuracy of 75%, 85%, and 79%, respectively. The inclusion of cytokine data did not improve the performance of the RF classifier. Conclusion This approach offers help in making clinical decisions by identifying psoriatic patients in whom phototherapy will significantly improve their skin, or those in whom other therapies should be recommended beforehand.
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Affiliation(s)
- Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland
| | - Janusz Krzyścin
- Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sobolewski
- Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Małgorzata Skibińska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland
| | - Marcin Noweta
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland
| | - Witold Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | | | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland
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6
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Phototherapy for Psoriasis: New Research and Insights. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-020-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Yanovsky RL, Huang KP, Buzney EA. Optimizing Narrowband UVB Phototherapy Regimens for Psoriasis. Dermatol Clin 2020; 38:1-10. [DOI: 10.1016/j.det.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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8
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Gonzalez JM. Evaluating Risk Tolerance from a Systematic Review of Preferences: The Case of Patients with Psoriasis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:285-300. [DOI: 10.1007/s40271-017-0295-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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9
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Afifi L, Shankle L, Armstrong AW, Boas M, Bridges A, Chiguil V, Doris F, Callis Duffin K, Fielding E, Fleischmann R, Gelfand JM, Kiselica M, Kiselica C, LaFoy B, Latella JJ, Takeshita J, Truman S, Wan MT, Wilkerson V, Wu JJ, Siegel MP, Liao W. National Psoriasis Foundation Priorities for Patient-Centered Research: Proceedings from the 2016 Conference. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2017; 2:73-80. [PMID: 28825055 PMCID: PMC5562437 DOI: 10.1177/247553031700200307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The National Psoriasis Foundation (NPF) is developing an agenda for patient-centered research to help patients and their caregivers make more informed health care decisions by engaging psoriasis patients in prioritizing comparative effectiveness research (CER) topics. The NPF has created a novel patient-centered research platform known as Citizen Pscientist (CP), allowing patients with psoriasis and psoriatic arthritis to register and contribute their health data. The CP Governance Council administered an online 23-question CER survey to the CP community and held a structured meeting on December 3, 2016, with patients and researchers to review CER survey results and discuss patient-centered research priorities. Of the 2,945 patients surveyed, 792 patients responded. Three CER topics were deemed to be of high priority for the research agenda: 1) Treat-to-target therapy for psoriasis, 2) Psoriatic arthritis screening questionnaires for early detection and treatment of psoriatic arthritis, and 3) Comparative effectiveness of home-based phototherapy for psoriasis.
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Affiliation(s)
- Ladan Afifi
- University of California, San Francisco, San Francisco, California
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Lindsey Shankle
- National Psoriasis Foundation, Portland, Oregon
- Citizen Pscientist Governance Council, Portland, Oregon
| | - April W. Armstrong
- University of Southern California, Los Angeles, California
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Marc Boas
- Citizen Pscientist Governance Council, Portland, Oregon
| | | | | | - Frank Doris
- Citizen Pscientist Governance Council, Portland, Oregon
| | | | | | | | - Joel M. Gelfand
- University of Pennsylvania, Philadelphia, Pennsylvania
- Citizen Pscientist Governance Council, Portland, Oregon
| | | | | | | | | | - Junko Takeshita
- University of Pennsylvania, Philadelphia, Pennsylvania
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Sarah Truman
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Marilyn T. Wan
- University of Pennsylvania, Philadelphia, Pennsylvania
- Citizen Pscientist Governance Council, Portland, Oregon
| | | | - Jashin J. Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Michael P. Siegel
- National Psoriasis Foundation, Portland, Oregon
- Citizen Pscientist Governance Council, Portland, Oregon
| | - Wilson Liao
- University of California, San Francisco, San Francisco, California
- Citizen Pscientist Governance Council, Portland, Oregon
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10
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Wu JJ, Guérin A, Gauthier G, Sundaram M. Healthcare resource utilization, healthcare costs and dose escalation in psoriasis patients initiated on ustekinumab versus adalimumab: a retrospective claim study. J DERMATOL TREAT 2016; 28:290-298. [PMID: 27783534 DOI: 10.1080/09546634.2016.1247946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adalimumab and ustekinumab are effective psoriasis treatments. This study compares healthcare resource utilization (HRU), costs and dose escalation and describes starting dose trends in ustekinumab versus adalimumab psoriasis patients. METHODS Adult psoriasis patients initiating adalimumab/ustekinumab on/after 25 September 2009 were selected from a US claims database and classified into biologic-naïve and biologic-experienced samples. RESULTS A total of 602 ustekinumab and 3470 adalimumab biologic-naïve and 1193 ustekinumab and 1467 adalimumab biologic-experienced patients were included. In both samples, ustekinumab patients had significantly more days with medical services (biologic naïve: IRR =1.14; biologic experienced: IRR =1.08) and higher average total costs by more than $14,000 annually. Ustekinumab users were 2.6 and 1.9 times more likely to have a dose escalation (increase ≥45 mg in ustekinumab; ≥40 mg in adalimumab) in biologic-naive and biologic-experienced patients, respectively. Between S2/2009 and S1/2012, the proportion of patient initiating on high dose (ustekinumab: >45 mg/28 days; adalimumab: >160 mg/28 days) increased substantially for ustekinumab patients (biologic naïve: +18.6 percentage points [PP]; biologic experienced: +29.9 PP) but remain stable for adalimumab patients (biologic naïve: -0.3 PP; biologic experienced: +2.3 PP). CONCLUSION Ustekinumab patients had more HRU, higher total costs and were more likely to have a dose escalation. The proportion of patients initiating ustekinumab high dose increased substantially between 2009 and 2012.
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Affiliation(s)
- Jashin J Wu
- a Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA
| | | | | | - Murali Sundaram
- c Health Economics and Outcomes Research, AbbVie , North Chicago , IL , USA
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Matos TR, Ling TC, Sheth V. Ultraviolet B radiation therapy for psoriasis: Pursuing the optimal regime. Clin Dermatol 2016; 34:587-93. [DOI: 10.1016/j.clindermatol.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Phototherapy involves repeated exposure of the skin to ultraviolet light to treat various inflammatory skin conditions such as psoriasis. Recent studies have identified specific immunologic effects of phototherapy that may underlie phototherapy efficacy. Furthermore, recent advancements have been made in developing safe and effective targeted phototherapy modalities for difficult-to-treat areas such as scalp psoriasis. Targeted phototherapy in the form of the excimer laser holds potential for more aggressive, effective treatment and long-lasting remission of psoriasis. Phototherapy is now also used successfully with biologic agents as combination therapy to treat recalcitrant psoriasis. Therefore, though one of the oldest therapeutic modalities for psoriasis, phototherapy remains a mainstay treatment with promise for further advancement.
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Affiliation(s)
- Mio Nakamura
- Department of Dermatology, University of California San Francisco Psoriasis and Skin Treatment Center, San Francisco, California, USA
| | | | - Tina Bhutani
- Department of Dermatology, University of California San Francisco Psoriasis and Skin Treatment Center, San Francisco, California, USA
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13
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Wolf P. Psoralen–ultraviolet A endures as one of the most powerful treatments in dermatology: reinforcement of this ‘triple‐product therapy’ by the 2016 British guidelines. Br J Dermatol 2016; 174:11-4. [DOI: 10.1111/bjd.14341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- P. Wolf
- Department of Dermatology Medical University of Graz Graz Austria
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14
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Eissing L, Radtke M, Zander N, Augustin M. Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 2015; 30:569-75. [DOI: 10.1111/jdv.13452] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
- L. Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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15
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Gooderham MJ, Poulin-Costello M, Shelton J, Bayan N, Papp KA. Predictors of Topical Use in Psoriasis Patients in the REFINE Study. J Cutan Med Surg 2015; 20:106-12. [PMID: 26330052 DOI: 10.1177/1203475415604322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The factors influencing the use of topical agents in combination with biologic therapies for the treatment of plaque psoriasis (PsO) are not well understood. OBJECTIVE To examine potential predictors of topical use in patients with moderate to severe plaque PsO receiving etanercept (ETN). METHODS Post hoc descriptive analyses and a multinomial regression of the REFINE study data were used to examine associations between topical agent potency and covariates, including Psoriasis Area and Severity Index (PASI) score, study site, and province. RESULTS Not achieving PASI 90 at week 12 predicted topical use, with a lower PASI 90 rate in patients who used high-potency topical agents post randomization (P = .003). Additionally, statistically significant differences were found in patterns of topical use among Canadian provinces (P = .007), with the use of high-potency topical agents being greater in Ontario and Quebec than the rest of Canada. CONCLUSION This analysis revealed that region and PASI 90 status at week 12 predict topical use.
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Affiliation(s)
| | | | | | - Nabil Bayan
- Amgen Canada Inc, Mississauga, Ontario, Canada
| | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, Ontario, Canada
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Danesh MJ, Butler DC, Beroukhim K, Nguyen C, Tartar D, Levin E, Koo J. A cross-sectional survey study to evaluate phototherapy training in dermatology residency. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:269-70. [DOI: 10.1111/phpp.12182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Melissa J Danesh
- Department of Dermatology; University of California; San Francisco CA USA
| | - Daniel C. Butler
- Department of Medicine; University of Arizona; Tucson AZ USA
- Department of Dermatology; Brigham and Women's Hospital; Boston MA USA
| | | | - Catherine Nguyen
- Irvine School of Medicine; University of California; Irvine CA USA
| | - Danielle Tartar
- Department of Dermatology; University of California; Davis CA USA
| | - Ethan Levin
- Department of Dermatology; University of California; San Francisco CA USA
| | - John Koo
- Department of Dermatology; University of California; San Francisco CA USA
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Finch T, Shim TN, Roberts L, Johnson O. Treatment Satisfaction Among Patients with Moderate-to-severe Psoriasis. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2015; 8:26-30. [PMID: 26060515 PMCID: PMC4456798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Various treatment options are available for the management of psoriasis; however, there remains a scarcity of literature regarding satisfaction levels among these patients. Given that treatment dissatisfaction is associated with lower levels of adherence, the objective of the present study was to establish satisfaction levels among patients with psoriasis. DESIGN A modified version of a previously validated satisfaction questionnaire was completed by patients. SETTING Dermatology outpatient department (Solihull, United Kingdom). PARTICIPANTS Thirty-eight patients with psoriasis (median age 43). MEASUREMENTS The questionnaire addressed various domains of satisfaction including satisfaction with safety, convenience, information provision, and finally global satisfaction with 1) topical treatments, 2) phototherapy, and 3) systemic treatments. RESULTS Mean global satisfaction with phototherapy and systemic treatments was significantly higher than with topical treatments. The authors' findings also showed that 20 percent of patients receiving topical treatment were dissatisfied with the convenience of the treatment. Interestingly, the only domain causing dissatisfaction among patients receiving systemic therapies (largely biologies) was safety. Despite this, satisfaction with both systemic treatment and phototherapy was higher than has been previously reported. CONCLUSION The findings of this study indicate that levels of satisfaction with phototherapy and systemic treatments are high, which is encouraging for both clinicians and patients. However, there are undoubtedly higher levels of dissatisfaction with topical treatments. Given that topical treatments have the greatest safety profile, they will continue to be the first-line treatment for psoriasis. Advances that focus on patient concerns should become a priority in order to improve compliance and reduce the need for more costly intervention.
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Affiliation(s)
- Tracey Finch
- Solihull Hospital, Heart of England NHS Trust, Birmingham, United Kingdom
| | - Tang Ngee Shim
- Solihull Hospital, Heart of England NHS Trust, Birmingham, United Kingdom
| | - Lesley Roberts
- Warwick Medical School, University of Warwick Coventry, United Kingdom
| | - Oliver Johnson
- Birmingham University Medical School, Birmingham, United Kingdom
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18
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Alshiyab D, Chin M, Edwards C, Anstey A. An evaluation of the preferences of patients with psoriasis between systemic psoralen plus ultraviolet A and bath psoralen plus ultraviolet A. Br J Dermatol 2015; 172:1457-8. [DOI: 10.1111/bjd.13561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D. Alshiyab
- Department of Dermatology; Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - M.F. Chin
- Department of Dermatology; University Hospital of Wales; Cardiff U.K
| | - C. Edwards
- Academic Dermatology Unit; St Woolos Hospital; Newport U.K
| | - A.V. Anstey
- Academic Dermatology Unit; St Woolos Hospital; Newport U.K
- Cardiff University; Cardiff U.K
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First Report of Psoriatic-Like Dermatitis and Arthritis in a 4-Year-Old Female Spayed Pug Mix. Case Rep Vet Med 2015. [DOI: 10.1155/2015/912509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Psoriasis manifests as chronic dermatitis and arthritis (PsA) in people. Psoriasis with concurrent PsA is characterized by erythematous, silvery, scaly plaques, especially on the extremities, and concurrent arthritis with enthesitis, tenosynovitis, and dactylitis. To date, no such disease has spontaneously occurred in domestic animals. This case report aims to describe the clinical, radiographic, and histologic appearance of a psoriasis-like dermatitis and psoriatic-like arthritis in a dog. A 4-year-old female spayed pug mix presented for the evaluation of chronic history of hyperkeratotic footpads and deforming arthritis. After ruling out other differential diagnoses and based on the similarity of clinical, radiographic, and histologic findings to human psoriasis and PsA, a tentative diagnosis of psoriasis-like disease was made. Treatment was begun to control pain (tramadol, gabapentin, and carprofen) and psoriatic dermatitis (clobetasol propionate 0.05%, calcipotriene 0.005%, and urea 40% ointment twice daily). Dramatic positive response to treatment was achieved confirming the tentative diagnosis. This case may provide preliminary evidence for the existence of a psoriasis-like condition in dogs and may elucidate treatment options in otherwise refractory cases of chronic dermatitis and polyarthropathy in dogs.
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Garcia-Doval I, Rustenbach S, Stern R, Dam T, Cohen A, Baker C, Spuls P, Naldi L. Systemic psoriasis therapy shows high between-country variation: a sign of unwarranted variation? Cross-sectional analysis of baseline data from the PSONET registries. Br J Dermatol 2013; 169:710-4. [DOI: 10.1111/bjd.12344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- I. Garcia-Doval
- Department of Dermatology; Complexo Hospitalario de Pontevedra (CHOP); Pontevedra; Research Unit; Fundación Academia Española de Dermatología; Madrid; Spain
| | - S.J. Rustenbach
- German Center for Health Services Research in Dermatology; University Clinics of Hamburg; Hamburg; Germany
| | - R. Stern
- Department of Dermatology; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston; MA; U.S.A
| | - T.N. Dam
- Department of Dermatology; Roskilde Hospital; Roskilde; Denmark
| | - A.D. Cohen
- Department of Quality Measures and Research; Clalit Health Services; Tel Aviv and Siaal Research Center for Family Medicine and Primary Care; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva; Israel
| | - C. Baker
- Department of Dermatology; Skin and Cancer Foundation; St Vincent's Hospital Melbourne; University of Melbourne; Melbourne; VIC; Australia
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Centre; University of Amsterdam; Amsterdam; the Netherlands
| | - L. Naldi
- Centro Studi GISED; Fondazione per la Ricerca; Ospedale Maggiore; Bergamo; Italy
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Gottlieb AB, Armstrong AW. Psoriasis Outcome Measures: A Report from the GRAPPA 2012 Annual Meeting. J Rheumatol 2013; 40:1428-33. [DOI: 10.3899/jrheum.130456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psoriasis is a multisystem disease. The cutaneous and musculoskeletal manifestations (psoriatic arthritis) are well recognized. However, the other manifestations of psoriatic disease including metabolic syndrome, atherosclerotic cardiovascular disease, depression, poor self-esteem, and self-destructive habits including obesity, smoking and excess alcohol consumption are underappreciated. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members addressed the need to develop uniform, validated, standardized outcome measures for psoriatic disease, measures that are useful to all stakeholders including patients, physicians, regulators, and payers.
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Informe de expertos en psoriasis: opinión de los dermatólogos españoles sobre el manejo de la psoriasis moderada-grave con agentes biológicos en pacientes adultos. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Puig L, de la Cueva P, Linares M, Suarez J, Velasco M, Vidal D, Zulaica A, García-Calvo C. Expert report on psoriasis: Spanish dermatologists' opinions on the use of biologic agents to manage moderate to severe psoriasis in adults. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:400-8. [PMID: 23669590 DOI: 10.1016/j.adengl.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/31/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. OBJECTIVE The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. MATERIALS AND METHODS An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. RESULTS The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. CONCLUSIONS This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain.
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Affiliation(s)
- L Puig
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Lee CH, Wu SB, Hong CH, Yu HS, Wei YH. Molecular Mechanisms of UV-Induced Apoptosis and Its Effects on Skin Residential Cells: The Implication in UV-Based Phototherapy. Int J Mol Sci 2013; 14:6414-35. [PMID: 23519108 PMCID: PMC3634415 DOI: 10.3390/ijms14036414] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 12/31/2022] Open
Abstract
The human skin is an integral system that acts as a physical and immunological barrier to outside pathogens, toxicants, and harmful irradiations. Environmental ultraviolet rays (UV) from the sun might potentially play a more active role in regulating several important biological responses in the context of global warming. UV rays first encounter the uppermost epidermal keratinocytes causing apoptosis. The molecular mechanisms of UV-induced apoptosis of keratinocytes include direct DNA damage (intrinsic), clustering of death receptors on the cell surface (extrinsic), and generation of ROS. When apoptotic keratinocytes are processed by adjacent immature Langerhans cells (LCs), the inappropriately activated Langerhans cells could result in immunosuppression. Furthermore, UV can deplete LCs in the epidermis and impair their migratory capacity, leading to their accumulation in the dermis. Intriguingly, receptor activator of NF-κB (RANK) activation of LCs by UV can induce the pro-survival and anti-apoptotic signals due to the upregulation of Bcl-xL, leading to the generation of regulatory T cells. Meanwhile, a physiological dosage of UV can also enhance melanocyte survival and melanogenesis. Analogous to its effect in keratinocytes, a therapeutic dosage of UV can induce cell cycle arrest, activate antioxidant and DNA repair enzymes, and induce apoptosis through translocation of the Bcl-2 family proteins in melanocytes to ensure genomic integrity and survival of melanocytes. Furthermore, UV can elicit the synthesis of vitamin D, an important molecule in calcium homeostasis of various types of skin cells contributing to DNA repair and immunomodulation. Taken together, the above-mentioned effects of UV on apoptosis and its related biological effects such as proliferation inhibition, melanin synthesis, and immunomodulations on skin residential cells have provided an integrated biochemical and molecular biological basis for phototherapy that has been widely used in the treatment of many dermatological diseases.
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Affiliation(s)
- Chih-Hung Lee
- Department of Dermatology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan; E-Mail:
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; E-Mail:
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Shi-Bei Wu
- Department of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei 112, Taiwan; E-Mail:
| | - Chien-Hui Hong
- Department of Dermatology, National Yang-Ming University, Taipei 112, Taiwan; E-Mail:
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan
| | - Hsin-Su Yu
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; E-Mail:
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Yau-Huei Wei
- Department of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei 112, Taiwan; E-Mail:
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-2-2826-7118; Fax: +886-2-2826-4843
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Armstrong AW, Callis Duffin K, Garg A, Gelfand JM, Gottlieb AB, Krueger GG, Qureshi AA, Rosen CF. Exploring priority research areas in psoriasis and psoriatic arthritis from dermatologists' perspective: a report from the GRAPPA 2011 annual meeting. J Rheumatol 2012; 39:2204-10. [PMID: 23118289 DOI: 10.3899/jrheum.120825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At the 2011 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Naples, Italy, the GRAPPA dermatology members led discussions on priority research areas in psoriasis and psoriatic arthritis (PsA). These discussions centered on 3 primary areas: evaluation of PsA screening tools, updates on psoriasis comorbidities, and new developments in genetics and comparative effectiveness research. Introductory presentations were followed by engaging panel discussions and audience interaction. The members agreed that screening tools are highly valuable in early detection of PsA among dermatology patients and that efforts are necessary to develop tools suitable for adoption in clinical practice. Members also agreed that a collaborative investigation to evaluate the effect of psoriasis treatments on cardiovascular comorbidities would be highly informative. Finally, the members supported continued efforts to explore the genetic basis of psoriasis and more studies focused on comparative effectiveness of existing treatments.
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, University of California Davis, Sacramento, California 95816, USA.
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Abuabara K, Wan J, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Variation in dermatologist beliefs about the safety and effectiveness of treatments for moderate to severe psoriasis. J Am Acad Dermatol 2012; 68:262-9. [PMID: 22910105 DOI: 10.1016/j.jaad.2012.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple systemic treatments are available for moderate to severe psoriasis, but dermatologists' perceptions of these treatments are unknown. Physician perceptions can influence prescribing patterns and patient outcomes, and may help to explain variations in clinical practice. OBJECTIVE We sought to describe the variation in dermatologist's beliefs about the safety and effectiveness of psoriasis treatments and evaluate how these relate to dermatologist characteristics and treatment preferences. METHODS We conducted a cross-sectional mail survey of a random sample of 500 National Psoriasis Foundation (NPF) members and 500 American Academy of Dermatology (AAD) members who treat psoriasis. RESULTS Of 989 clinicians who could be contacted, 246 NPF members and 141 AAD members returned the survey (39% response rate). Respondents perceived infliximab, ustekinumab, cyclosporine, and adalimumab to have the highest likelihood of skin clearance in 3 months (67%-75%). Etanercept, adalimumab, ultraviolet B, and ustekinumab had the lowest perceived likelihood of side effects requiring treatment discontinuation (9%-11%). Up to 49% of respondents "didn't know" the effectiveness or likelihood of side effects; calculated coefficients of variation were higher for perceived likelihood of side effects than perceived effectiveness. There were few significant associations between safety and effectiveness perceptions and respondent characteristics, and treatment preferences were not consistently predictive of perceptions. LIMITATIONS Only dermatologists with interest in treating psoriasis were surveyed and general perceptions were elicited via survey format. Perceptions may differ between survey respondents and nonrespondents. CONCLUSIONS Psoriasis providers demonstrate wide variation in their perception of the effectiveness and especially safety of systemic treatments.
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Affiliation(s)
- Katrina Abuabara
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
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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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Wan J, Abuabara K, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Dermatologist preferences for treatments to compare in future randomized controlled comparative effectiveness trials for moderate to severe psoriasis. ACTA ACUST UNITED AC 2012; 148:539-41. [PMID: 22508884 DOI: 10.1001/archdermatol.2011.1399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wan J, Abuabara K, Shin DB, Troxel AB, Bebo BF, Gelfand JM. Dermatologist response rates to a mailed questionnaire: a randomized trial of monetary incentives. J Am Acad Dermatol 2011; 66:e18-20. [PMID: 22036576 DOI: 10.1016/j.jaad.2011.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/25/2011] [Accepted: 03/03/2011] [Indexed: 11/16/2022]
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