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Alamer A, Alyazidi W, Aldosari S, Mobarki F, Almakki S, Alahmari A, Alomar M, Almalki Z, Alkaff T, Fazel M. Prescribing patterns and persistence of biological therapies for psoriasis management: a retrospective cohort study from Saudi Arabia. J DERMATOL TREAT 2024; 35:2386973. [PMID: 39103160 DOI: 10.1080/09546634.2024.2386973] [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: 05/24/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation. OBJECTIVES To identify physicians' prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation. METHODS We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months. RESULTS A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability. CONCLUSION This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.
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Affiliation(s)
- Ahmad Alamer
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Wejdan Alyazidi
- Pharmaceutical Care Services, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Saad Aldosari
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Fatimah Mobarki
- Pharmaceutical Care Services, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Sarah Almakki
- Pharmaceutical Care Services, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Abdullah Alahmari
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mukhtar Alomar
- Pharmaceutical Care Services, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ziyad Almalki
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Tuqa Alkaff
- Department of Dermatology, Allure Clinics, Riyadh, Saudi Arabia
| | - Mohammad Fazel
- Division of Dermatology/Banner, University of Arizona, Tucson, Arizona, USA
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Lai Y, Wu X, Jiang Z, Fang Y, Liu X, Hong D, Jiang Y, Tan G, Tang S, Lu S, Wei D, Hwang ST, Lam KS, Wang L, Huang Y, Shi Z. Topical treatment of tyrosine kinase 2 inhibitor through borneol-embedded hydrogel: Evaluation for preventive, therapeutic, and Recurrent management of psoriasis. Bioact Mater 2024; 41:83-95. [PMID: 39104775 PMCID: PMC11298611 DOI: 10.1016/j.bioactmat.2024.07.013] [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: 11/02/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024] Open
Abstract
Psoriasis, an immune-mediated inflammatory skin disorder characterized by a chronically relapsing-remitting course, continues to be primarily managed through topical therapy. While oral administration of tyrosine kinase 2 inhibitors (TYK2i) stands as an effective approach for psoriasis treatment, the potential efficacy of topical application of TYK2i remains unexplored. Herein, the carbomer/alginic acid hydrogel is embedded with borneol (BO) as a new topical carrier of TYK2i for achieving enhanced transdermal permeation and anti-psoriasis efficacy. The hydrogel system, i.e., TYK2i-BO-gel, exhibits significantly improved preventative and therapeutic effects in mice models of psoriasiform dermatitis, as evidenced by phenotypical images, psoriasis severity score index (PSI), histology, immunohistochemical staining, and PCR analysis. Remarkably, TYK2i-BO-gel outperforms conventional topical corticosteroid therapy by significantly preventing psoriatic lesion recurrence as measured by a nearly 50 % reduction in ear thickness changes (p < 0.0001), PSI (p < 0.0001) and epidermal thickness (p < 0.05). Moreover, a strengthened anti-inflammatory effect caused by TYK2i-BO-gel is seen in a human skin explant model, implying its potential application for human patients. With the addition of BO, the TYK2i-BO-gel not only increases skin permeability but also inhibits the expression of antimicrobial peptides in keratinocytes and facilitates the anti-Th17 response of TYK2i with suppressed activation of STAT3. Therefore, this work represents the accessibility and effectiveness of TYK2i-BO-hydrogel as a new topical formulation for anti-psoriasis management and shows great potential for clinical application.
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Affiliation(s)
- Yuhsien Lai
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Xuesong Wu
- Department of Dermatology, University of California-Davis, Sacramento, CA, 95817, USA
| | - Zhuoyu Jiang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Yifei Fang
- School of Biomedical Engineering, Sun Yat-sen University, 518107, China
| | - Xiuting Liu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Dan Hong
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Yanyun Jiang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Guozhen Tan
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Shiqi Tang
- Department of Biochemistry and Molecular Medicine, University of California-Davis, Sacramento, CA, 95817, USA
| | - Siyao Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - David Wei
- Department of Dermatology, University of California-Davis, Sacramento, CA, 95817, USA
| | - Sam T. Hwang
- Department of Dermatology, University of California-Davis, Sacramento, CA, 95817, USA
| | - Kit S. Lam
- Department of Biochemistry and Molecular Medicine, University of California-Davis, Sacramento, CA, 95817, USA
| | - Liangchun Wang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
| | - Yanyu Huang
- Department of Biochemistry and Molecular Medicine, University of California-Davis, Sacramento, CA, 95817, USA
| | - Zhenrui Shi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, China
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3
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Wang H, Shi J, Hou S, Kang X, Yu C, Jin H, Yang B, Shi Y, Li F, Li W, Gu J, Lei M, Lin Y, Dang L, Lin J, Guo Q, Wang G, Liu X. A large-scale retrospective study in China explores risk factors for disease severity in plaque psoriasis. Sci Rep 2024; 14:25749. [PMID: 39468139 DOI: 10.1038/s41598-024-73408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 09/17/2024] [Indexed: 10/30/2024] Open
Abstract
Severe psoriasis has a long course and poor outcome, and it has long been a problem for patients. Understanding the independent risk factors that contribute to patients with severe psoriasis is critical for the development of effective treatment strategies. This large, multicenter study recruited 2,109 plaque psoriasis patients from 12 hospitals across China (October 31, 2019 - May 31, 2022). The logistic regression model underwent internal validation and external validation using two independent cohorts over future time periods (June 1, 2022 - January 31, 2023). The discriminative power of our model was substantiated by a C-index of 0.863 (95% CI: 0.848-0.879) in internal validation, further affirmed through 1,000 bootstrap validation (C-index: 0.860, 95% CI: 0.836-0.885) and external validation cohorts, where the C-index reached up to 0.910 (95% CI: 0.868-0.953) and 0.951 (95% CI: 0.924-0.977) in 2 external validation cohorts. To enhance accessibility for clinicians, the model has been made available as a dynamic nomogram and QR code. Our study identified 10 risk factors (the "DELPHI" consensus dichotomy, the DLQI index, the extent of skin involvement as measured by body surface area, the age of the patient at the time of clinical visit, sex, body weight in kilograms, career, the presence of scalp involvement, facial involvement, and arthropathy) for the overall severity of psoriasis (PASI ≥ 10). "Nomogram-10" provides clinicians with a practical tool to develop personalized intervention strategies based on an individual's risk profile.Trial registration: Chinese Clinical Trial Registry: ChiCTR1900024852.
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Affiliation(s)
- Huiwei Wang
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan 1 Rd, Futian District, Shenzhen, 518053, Guangdong, China
| | - Jialiang Shi
- Department of Dermatology, Shenzhen University General Hospital, No. 1098 Xue Yuan Avenue, Xi Li University Town, Nanshan District, Shenzhen, 518055, Guangdong, China
| | - Suchun Hou
- Department of Dermatology, Shenzhen University General Hospital, No. 1098 Xue Yuan Avenue, Xi Li University Town, Nanshan District, Shenzhen, 518055, Guangdong, China
| | - Xiaojing Kang
- Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang, China
| | - Chen Yu
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifu Garden, Dongcheng District, 100730, Beijing, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou City, 510091, Guangdong, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Baode Road, Jing'an District, 200443, Shanghai, China
| | - Fuqiu Li
- Department of Dermatology, The Second Norman Bethune Hospital of Jilin University, Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin, China
| | - Wei Li
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jun Gu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Jing'an District, 200072, Shanghai, China
| | - Mingjun Lei
- Department of Dermatology, Affiliated Hospital of Hebei University of Chinese Medicine, No. 389 Zhongshan East Road, Shijiazhuang, 200072, Hebei, China
| | - Youkun Lin
- Department of Dermatology/Venerology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Lin Dang
- Department of Dermatology, Longgang Central Hospital, No. 6082, Longgang Avenue, Longgang District, Shenzhen, 518116, Guangdong, China
| | - Jialin Lin
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan 1 Rd, Futian District, Shenzhen, 518053, Guangdong, China
| | - Qing Guo
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan 1 Rd, Futian District, Shenzhen, 518053, Guangdong, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Xiaoming Liu
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital (The 6th Affiliated Hospital of Shenzhen University Medical School), No. 89 Taoyuan Road, Nanshan District, Shenzhen, 518052, Guangdong, China.
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Surve D, Fish A, Debnath M, Pinjari A, Lorenzana A, Piya S, Peyton S, Kulkarni A. Sprayable inflammasome-inhibiting lipid nanorods in a polymeric scaffold for psoriasis therapy. Nat Commun 2024; 15:9035. [PMID: 39426974 PMCID: PMC11490495 DOI: 10.1038/s41467-024-53396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 10/11/2024] [Indexed: 10/21/2024] Open
Abstract
Localized delivery of inflammasome inhibitors in phagocytic macrophages could be promising for psoriasis treatment. The present work demonstrates the development of non-spherical lipid nanoparticles, mimicking pathogen-like shapes, consisting of an anti-inflammatory inflammasome inhibiting lipid (pyridoxine dipalmitate) as a trojan horse. The nanorods inhibit inflammasome by 3.8- and 4.5-fold compared with nanoellipses and nanospheres, respectively. Nanorods reduce apoptosis-associated speck-like protein and lysosomal rupture, restrain calcium influx, and mitochondrial reactive oxygen species. Dual inflammasome inhibitor (NLRP3/AIM-2-IN-3) loaded nanorods cause synergistic inhibition by 21.5- and 59-folds compared with nanorods and free drug, respectively alongside caspase-1 inhibition. The NLRP3/AIM-2-IN-3 nanorod when transformed into a polymeric scaffold, simultaneously and effectively inhibits RNA levels of NLRP3, AIM2, caspase-1, chemokine ligand-2, gasdermin-D, interleukin-1β, toll-like receptor 7/ 8, and IL-17A by 6.4-, 1.6-, 2.0-, 13.0-, 4.2-, 24.4-, 4.3-, and 1.82-fold, respectively in psoriatic skin in comparison to Imiquimod positive control group in an in-vivo psoriasis-like mice model.
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Affiliation(s)
- Dhanashree Surve
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Adam Fish
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Maharshi Debnath
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Aniruddha Pinjari
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Adrian Lorenzana
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Sumi Piya
- Pathology Department, University of Massachusetts-Chan Medical School, Baystate Medical Center, Springfield, MA, 01199, USA
| | - Shelly Peyton
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| | - Ashish Kulkarni
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, 01003, USA.
- Center for Bioactive Delivery, Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA, 01003, USA.
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5
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Igarashi A, Tsuji G, Fukasawa S, Murata R, Yamane S. Tapinarof cream for the treatment of plaque psoriasis: Efficacy and safety results from 2 Japanese phase 3 trials. J Dermatol 2024; 51:1269-1278. [PMID: 39150292 PMCID: PMC11484133 DOI: 10.1111/1346-8138.17423] [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: 05/30/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 08/17/2024]
Abstract
Tapinarof is a non-steroidal, topical, aryl hydrocarbon receptor agonist. We evaluated the efficacy and safety of tapinarof cream (1%) in Japanese patients aged ≥18 years with plaque psoriasis in two phase 3 trials, ZBA4-1 and ZBA4-2. ZBA4-1 (N = 158) consisted of a 12-week, double-blind, vehicle-controlled treatment period (period 1) and a 12-week extension treatment period (period 2). Patients were randomized 2:1 to tapinarof or vehicle in period 1; subsequently, all patients who were enrolled in period 2 received tapinarof. ZBA4-2 (N = 305) was a 52-week, open-label, uncontrolled trial in which all patients received tapinarof. In period 1 of ZBA4-1, the proportion of patients who achieved a Physician Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) with ≥2-grade improvement from baseline at week 12 (PGA treatment success, the primary endpoint) was 20.06% in the tapinarof group and 2.50% in the vehicle group (p = 0.0035). The proportion of patients with ≥75% improvement from baseline in the Psoriasis Area and Severity Index (PASI) score at week 12 (PASI75 response, a key secondary endpoint) was 37.7% in the tapinarof group and 3.8% in the vehicle group (p < 0.0001). In ZBA4-2, PGA treatment success rate was 30.0% at week 12, 51.3% at week 24, and 56.3% at week 52, and PASI75 response rate was 50.4% at week 12, 77.5% at week 24, and 79.9% at week 52, indicating that efficacy responses improved over time and were maintained over 52 weeks. Across the two trials, most adverse events (AEs) were mild or moderate; common AEs included folliculitis and contact dermatitis. In summary, tapinarof cream (1%) was efficacious and generally safe for up to 52 weeks of treatment in Japanese patients with plaque psoriasis.
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Affiliation(s)
| | - Gaku Tsuji
- Research and Clinical Center for Yusho and DioxinKyushu UniversityFukuokaJapan
- Department of Dermatology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Dlott AH, Spencer SA, Di Pasqua AJ. Calcipotriol and 5-Fluorouracil Combination Therapy for the Treatment of Actinic Keratosis in the Clinic: A Review Article. Clin Drug Investig 2024; 44:733-737. [PMID: 39342018 PMCID: PMC11499312 DOI: 10.1007/s40261-024-01392-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/01/2024]
Abstract
This review examines the pharmacology, efficacy and safety, dosage and administration, and place in therapy of the combination of 5-fluorouracil (5-FU) and calcipotriol for the treatment of actinic keratosis. Currently, 5% 5-FU topical cream is approved for actinic keratosis treatment, while calcipotriol is indicated for plaque psoriasis in adults. The typical administration of 5-FU involves topical application twice daily for up to 4 weeks, whereas calcipotriol is applied in a thin layer once or twice daily as directed by a physician. Adverse effects of 5-FU are primarily localized, including skin irritation, ulceration, pruritus, erythema, crusting, and eczematous reactions due to minimal systemic absorption. Calcipotriol may cause burning, itching, and skin irritation. This review details clinical trials that investigate the innovative approach of combining topical 5-FU with calcipotriol for actinic keratosis treatment, highlighting the significant outcomes. Notably, the clinical trials indicate that all participants experienced either a reduction in lesion size or complete lesion clearance, with minimal adverse effects impacting treatment success. The combination of 5-FU and calcipotriol effectively treats actinic keratosis by enhancing the immune response and targeting cell overgrowth, while reducing local site reactions and the lengthy treatment time often associated with existing therapies.
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Affiliation(s)
- Anna H Dlott
- School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, Richmond, VA, 23298, USA
| | - Sara A Spencer
- Otsuka Pharmaceutical, 508 Carnegie Center Dr, Princeton, NJ, 08540, USA
| | - Anthony J Di Pasqua
- Department of Pharmaceutical Sciences, Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA, 02115, USA.
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Olszewski R, Watros K, Mańczak M, Owoc J, Jeziorski K, Brzeziński J. Assessing the response quality and readability of chatbots in cardiovascular health, oncology, and psoriasis: A comparative study. Int J Med Inform 2024; 190:105562. [PMID: 39059084 DOI: 10.1016/j.ijmedinf.2024.105562] [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: 05/21/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Chatbots using the Large Language Model (LLM) generate human responses to questions from all categories. Due to staff shortages in healthcare systems, patients waiting for an appointment increasingly use chatbots to get information about their condition. Given the number of chatbots currently available, assessing the responses they generate is essential. METHODS Five chatbots with free access were selected (Gemini, Microsoft Copilot, PiAI, ChatGPT, ChatSpot) and blinded using letters (A, B, C, D, E). Each chatbot was asked questions about cardiology, oncology, and psoriasis. Responses were compared to guidelines from the European Society of Cardiology, American Academy of Dermatology and American Society of Clinical Oncology. All answers were assessed using readability scales (Flesch Reading Scale, Gunning Fog Scale Level, Flesch-Kincaid Grade Level and Dale-Chall Score). Using a 3-point Likert scale, two independent medical professionals assessed the compliance of the responses with the guidelines. RESULTS A total of 45 questions were asked of all chatbots. Chatbot C gave the shortest answers, 7.0 (6.0 - 8.0), and Chatbot A the longest 17.5 (13.0 - 24.5). The Flesch Reading Ease Scale ranged from 16.3 (12.2 - 21.9) (Chatbot D) to 39.8 (29.0 - 50.4) (Chatbot A). Flesch-Kincaid Grade Level ranged from 12.5 (10.6 - 14.6) (Chatbot A) to 15.9 (15.1 - 17.1) (Chatbot D). Gunning Fog Scale Level ranged from 15.77 (Chatbot A) to 19.73 (Chatbot D). Dale-Chall Score ranged from 10.3 (9.3 - 11.3) (Chatbot A) to 11.9 (11.5 - 12.4) (Chatbot D). CONCLUSION This study indicates that chatbots vary in length, quality, and readability. They answer each question in their own way, based on the data they have pulled from the web. Reliability of the responses generated by chatbots is high. This suggests that people who want information from a chatbot need to be careful and verify the answers they receive, particularly when they ask about medical and health aspects.
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Affiliation(s)
- Robert Olszewski
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences.
| | - Klaudia Watros
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Małgorzata Mańczak
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Jakub Owoc
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Krzysztof Jeziorski
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | - Jakub Brzeziński
- Gerontology, Public Health and Education Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
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Elkoshi Z. Autoimmune diseases refractory to corticosteroids and immunosuppressants. Front Immunol 2024; 15:1447337. [PMID: 39351223 PMCID: PMC11439723 DOI: 10.3389/fimmu.2024.1447337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/21/2024] [Indexed: 10/04/2024] Open
Abstract
Corticosteroids and immunosuppressive drugs can alleviate the symptoms of most autoimmune diseases and induce remission by restraining the autoimmune attack and limiting the damage to the target tissues. However, four autoimmune non-degenerative diseases-adult advanced type 1 diabetes mellitus, Hashimoto's thyroiditis, Graves' disease, and advanced primary biliary cholangitis-are refractory to these drugs. This article suggests that the refractoriness of certain autoimmune diseases is due to near-total loss of secreting cells coupled with the extremely low regenerative capacity of the affected tissues. The near-complete destruction of cells responsible for secreting insulin, thyroid hormones, or biliary HCO3 - diminishes the protective effects of immunosuppressants against further damage. The slow regeneration rate of these cells hinders tissue recovery, even after drug-induced immune suppression, thus preventing remission. Although the liver can fully regenerate after injury, severe primary biliary cholangitis may impair this ability, preventing liver recovery. Consequently, these four autoimmune diseases are resistant to immunosuppressive drugs and corticosteroids. In contrast, early stages of type 1 diabetes and early primary biliary cholangitis, where damage to secreting cells is partial, may benefit from immunosuppressant treatment. In contrast to these four diseases, chronic degenerative autoimmune conditions like multiple sclerosis may respond positively to corticosteroid use despite the limited regenerative potential of the affected tissue (the central nervous system). The opposite is true for acute autoimmune conditions like Guillain-Barré syndrome.
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Affiliation(s)
- Zeev Elkoshi
- Research and Development Department, Taro Pharmaceutical Industries Ltd, Haifa, Israel
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9
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Tan N, Vary JC, O'Connor KM. Treatment of Common Dermatologic Conditions. Med Clin North Am 2024; 108:795-827. [PMID: 39084835 DOI: 10.1016/j.mcna.2024.02.002] [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] [Indexed: 08/02/2024]
Abstract
Dermatologic concerns are discussed in about a third of all primary care visits. This review discusses treatments for common dermatologic diagnoses addressed in primary care settings, with an emphasis on new and emerging treatments. Topical, oral, and injectable treatment of common forms of alopecia, facial rashes, atopic dermatitis, psoriasis, seborrheic dermatitis, and stasis dermatitis will be discussed to help increase comfort in prescribing and alert providers to common side effects or complications of more intensive treatments used by dermatologists.
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Affiliation(s)
- Nina Tan
- Department of Internal Medicine, Division of General Internal Medicine, University of Washington, Box 354760, 4245 Roosevelt Way Northeast, 3rd Floor, Seattle, WA 98105, USA.
| | - Jay C Vary
- Department of Dermatology, University of Washington, University of Washington Dermatology Center, Box 354697, 4225 Roosevelt Way NE, 4th Floor, Seattle, WA 98105, USA
| | - Kim M O'Connor
- Department of Internal Medicine, Division of General Internal Medicine, University of Washington, Box 354760, 4245 Roosevelt Way Northeast, 3rd Floor, Seattle, WA 98105, USA
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Chung CS, Park SE, Hsiao JL, Lee KH. A Review of Hidradenitis Suppurativa in Special Populations: Considerations in Children, Pregnant and Breastfeeding Women, and the Elderly. Dermatol Ther (Heidelb) 2024; 14:2407-2425. [PMID: 39230800 PMCID: PMC11393272 DOI: 10.1007/s13555-024-01249-2] [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: 05/28/2024] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic skin condition that significantly impacts patients' quality of life. HS is often challenging to treat. In this review, we discuss the unique characteristics of HS in four special populations: children, the elderly, pregnant individuals, and breastfeeding mothers. In children, diagnosis may be delayed due to atypical and early HS disease presentations. HS management plans must take into consideration the lack of rigorous efficacy and safety data of HS treatments in this population. However, it is important to weigh the risk of treatments against the risk of untreated HS and the morbidity and mortality risk that having HS confers. Pregnancy poses unique challenges for women with HS, with their condition possibly worsening during pregnancy and increased risk of fetal death. Management strategies during pregnancy must consider both maternal and fetal safety. Similarly, breastfeeding mothers require thoughtful medication selection to balance symptom management with infant safety. In the elderly, HS may present more severely and is often complicated by comorbidities. Treating HS in this population should safely accommodate patients' additional health conditions. Furthermore, this review highlights the overall paucity of primary literature addressing management in these populations, underscoring the need for further research to optimize HS care across all stages of life.
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Affiliation(s)
- Claire S Chung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah E Park
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Hsiao
- Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA, 90033-9174, USA
| | - Katrina H Lee
- Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA, 90033-9174, USA.
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Wang J, Zhang CS, Zhang AL, Changli Xue C, Lu C. Chinese herbal medicine bath therapy for psoriasis vulgaris using topical calcipotriol as the comparator: A systematic review with meta-analysis and association rule analysis. JOURNAL OF ETHNOPHARMACOLOGY 2024; 330:118166. [PMID: 38621466 DOI: 10.1016/j.jep.2024.118166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/09/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Psoriasis is a chronic inflammatory skin disease. Vitamin D analogues are the first-line topical agents for the long-term management of psoriasis. Chinese herbal medicine (CHM) bath therapy is commonly employed for psoriasis. However, the effects and safety of CHM bath therapy for psoriasis vulgaris, using topical calcipotriol as the comparator, remain inconclusive. Furthermore, the combination of herbs, a distinctive feature of CHM, is essential for its therapeutic effects due to the individual and synergistic properties of the herbs involved. AIM OF THE STUDY The review was conducted to evaluate the effectiveness and safety of CHM bath therapy for psoriasis vulgaris, using calcipotriol as the comparator. Potential herbs and herb combinations of CHM bath therapy were also explored for further drug discovery. MATERIALS AND METHODS Nine databases were searched from inception until March 05, 2024. Randomised controlled trials (RCTs) investigating CHM bath therapy, using calcipotriol as the comparator, were included. Statistical analyses were performed using RevMan 5.4, Stata 12.0 and SPSS Clementine 12.0 software. The evidence certainty for outcomes was assessed using the approach proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group. Moreover, association rule analysis on herbs identified in the systematic review was conducted to explore the potential herbs and herb combinations. RESULTS A total of 17 RCTs involving 1,379 participants were included in this systematic review. The findings of this review revealed that: 1) CHM bath therapy produced comparable effects to calcipotriol in reducing Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), and itch visual analogue scale (VAS) at the end of the treatment phase; as well as exhibited a superior long-term effect than calcipotriol through decreasing relapse rates at the end of the follow-up phase; 2) CHM bath therapy showed an additional benefit when combined with calcipotriol in managing psoriasis vulgaris at the end of the treatment phase, in terms of PASI, PSSI, itch VAS, IL-17, IL-23, CD3+ and CD4+ T cells. The certainty of the evidence was rated as 'very low', 'low' or 'moderate' based on the GRADE assessment, considering some concerns or high risk of bias of included studies, substantial heterogeneity, and existing publication bias of some outcomes. Additionally, the proportions of participants reporting adverse events were similar in both groups. Association rule analysis of all included herbs identified 23 herb combinations including Prunus persica (L.) Batsch and Carthamus tinctorius L., as well as 11 frequently used herbs, such as Kochia scoparia (L.) Schrad., Dictamnus dasycarpus Turcz. And Sophora flavescens Ait. CONCLUSIONS The effects of CHM bath therapy were comparable with those of topical calcipotriol but demonstrated a longer-lasting effect. Combining CHM bath therapy with calcipotriol also provided an additional benefit for adult psoriasis vulgaris. However, the certainty of the evidence was downgraded due to the methodological limitations of included studies. To confirm the findings of this review, future investigations should involve double-blinded, placebo-controlled RCTs. Importantly, it appears worthwhile to consider further research for drug development utilising the identified herbs or herb combinations.
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Affiliation(s)
- Junyue Wang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
| | - Claire Shuiqing Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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12
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Yang X, Liu Y. Comparison of adalimumab with methotrexate for psoriasis: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2024; 103:e37216. [PMID: 39121282 PMCID: PMC11315506 DOI: 10.1097/md.0000000000037216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION The efficacy of adalimumab versus methotrexate for psoriasis remained controversial. We conducted this systematic review and meta-analysis to explore the influence of adalimumab versus methotrexate on treatment efficacy for psoriasis patients. METHODS We have searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through August 2023 for randomized controlled trials (RCTs) assessing the efficacy of adalimumab versus methotrexate for psoriasis. This meta-analysis was performed using the random-effect or fixed-effect model based on the heterogeneity. RESULTS Four RCTs and 733 patients with psoriasis were included in this meta-analysis. Overall, compared with methotrexate treatment, adalimumab treatment was associated with improved Psoriasis Area and Severity Index 75 (PASI 75, odd ratio [OR] = 4.50; 95% confidence interval [CI] = 2.81-7.22; P < .00001), physician global assessment (PGA) 0/1 response (OR = 4.86; 95% CI = 3.02-7.82; P < .00001), PASI 100 (OR = 3.01; 95% CI = 1.33-6.80; P = .008) and decreased Dermatology Life Quality Index (DLQI, standard mean difference [SMD] = -0.60; 95% CI = -0.84 to -0.36; P < .00001), but exhibited no impact on PASI 90 (OR = 3.30; 95% CI = 0.77-14.20; P = .11), adverse events (OR = 1.23; 95% CI = 0.26-5.87; P = .79) or serious adverse events (OR = 2.59; 95% CI = 0.49-13.79; P = .26). CONCLUSIONS Adalimumab was superior to methotrexate for the treatment of psoriasis.
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Affiliation(s)
- Xiaolin Yang
- Department of Skin Burn Wound Repair, Chongqing Kaizhou District People’s Hospital, Chongqing, China
| | - Yan Liu
- Department of Otolaryngology Head and Neck Surgery, Chongqing Kaizhou District People’s Hospital, Chongqing, China
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13
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Webster DE, Haberman RH, Perez-Chada LM, Tummalacherla M, Tediarjo A, Yadav V, Neto EC, MacDuffie W, DePhillips M, Sieg E, Catron S, Grant C, Francis W, Nguyen M, Yussuff M, Castillo RL, Yan D, Neimann AL, Reddy SM, Ogdie A, Kolivras A, Kellen MR, Mangravite LM, Sieberts SK, Omberg L, Merola JF, Scher JU. Clinical Validation of Digitally Acquired Clinical Data and Machine Learning Models for Remote Measurement of Psoriasis and Psoriatic Arthritis: A Proof-of-Concept Study. J Rheumatol 2024; 51:781-789. [PMID: 38879192 DOI: 10.3899/jrheum.2024-0074] [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] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Psoriatic disease remains underdiagnosed and undertreated. We developed and validated a suite of novel, sensor-based smartphone assessments (Psorcast app) that can be self-administered to measure cutaneous and musculoskeletal signs and symptoms of psoriatic disease. METHODS Participants with psoriasis (PsO) or psoriatic arthritis (PsA) and healthy controls were recruited between June 5, 2019, and November 10, 2021, at 2 academic medical centers. Concordance and accuracy of digital measures and image-based machine learning models were compared to their analogous clinical measures from trained rheumatologists and dermatologists. RESULTS Of 104 study participants, 51 (49%) were female and 53 (51%) were male, with a mean age of 42.3 years (SD 12.6). Seventy-nine (76%) participants had PsA, 16 (15.4%) had PsO, and 9 (8.7%) were healthy controls. Digital patient assessment of percent body surface area (BSA) affected with PsO demonstrated very strong concordance (Lin concordance correlation coefficient [CCC] 0.94 [95% CI 0.91-0.96]) with physician-assessed BSA. The in-clinic and remote target plaque physician global assessments showed fair-to-moderate concordance (CCCerythema 0.72 [0.59-0.85]; CCCinduration 0.72 [0.62-0.82]; CCCscaling 0.60 [0.48-0.72]). Machine learning models of hand photos taken by patients accurately identified clinically diagnosed nail PsO with an accuracy of 0.76. The Digital Jar Open assessment categorized physician-assessed upper extremity involvement, considering joint tenderness or enthesitis (AUROC 0.68 [0.47-0.85]). CONCLUSION The Psorcast digital assessments achieved significant clinical validity, although they require further validation in larger cohorts before use in evidence-based medicine or clinical trial settings. The smartphone software and analysis pipelines from the Psorcast suite are open source and freely available.
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Affiliation(s)
- Dan E Webster
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Rebecca H Haberman
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghasyam Tummalacherla
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Aryton Tediarjo
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Vijay Yadav
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Elias Chaibub Neto
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Woody MacDuffie
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | | | - Eric Sieg
- M. DePhillips, BS, E. Sieg, BS, SDP Digital, Seattle, Washington, USA
| | - Sydney Catron
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Carly Grant
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wynona Francis
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marina Nguyen
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muibat Yussuff
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rochelle L Castillo
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Di Yan
- D. Yan, MD, A.L. Neimann, MD, MSCE, Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea L Neimann
- D. Yan, MD, A.L. Neimann, MD, MSCE, Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Soumya M Reddy
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Athanassios Kolivras
- A. Kolivras, MD, PhD, Departments of Dermatology and Dermatopathology, Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Brussels, and UCB Pharma, Brussels, Belgium
| | - Michael R Kellen
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Lara M Mangravite
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Solveig K Sieberts
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Larsson Omberg
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Department of Medicine, Division of Rheumatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jose U Scher
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA;
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14
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Stein Gold L, Adam DN, Albrecht L, Alonso-Llamazares J, Ferris LK, Gooderham MJ, Hong HCH, Kempers SE, Kircik LH, Lebwohl M, Loo WJ, Nahm WK, Papp KA, Stewart D, Toth DP, Zirwas M, Krupa D, Snyder S, Burnett P, Higham R, Berk DR. Long-term safety and effectiveness of roflumilast cream 0.3% in adults with chronic plaque psoriasis: A 52-week, phase 2, open-label trial. J Am Acad Dermatol 2024; 91:273-280. [PMID: 38556093 DOI: 10.1016/j.jaad.2024.03.030] [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: 09/20/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Efficacy and/or safety profiles limit topical psoriasis treatments. OBJECTIVE Evaluate long-term effects of once-daily roflumilast cream 0.3% in patients with psoriasis. METHODS In this open-label phase 2 trial, adult patients (N = 332) with psoriasis who completed the phase 2b parent trial or were newly enrolled applied roflumilast once-daily for 52 weeks. Safety and effectiveness were assessed. RESULTS Overall, 244 patients (73.5%) completed the trial; 13 patients (3.9%) discontinued due to adverse events (AEs) and 3 (0.9%) due to lack of efficacy. Twelve patients (3.6%) reported treatment-related AEs; none were serious. ≥97% of patients had no irritation. No tachyphylaxis was observed with 44.8% of the patients achieving Investigator Global Assessment (IGA) Clear or Almost Clear at Week 52. LIMITATIONS Intertriginous-IGA and Psoriasis Area and Severity Index (PASI) were not evaluated in all patients. CONCLUSIONS In this long-term trial, once-daily roflumilast cream was well-tolerated and efficacious up to 64 weeks in patients in the earlier trial, suggesting it is suitable for chronic treatment, including the face and intertriginous areas.
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Affiliation(s)
| | - David N Adam
- CCA Medical Research, Toronto, Ontario, Canada; Probity Medical Research, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Albrecht
- Enverus Medical Research, Surrey, British Columbia, Canada
| | | | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melinda J Gooderham
- SkiN Centre for Dermatology, Peterborough, Ontario, Canada; Probity Medical Research, Peterborough, Ontario, Canada; Queen's University, Peterborough, Ontario, Canada
| | - H Chih-Ho Hong
- Probity Medical Research, Surrey, British Columbia, Canada; Department of Dermatology and Skin Science, University of British Columbia, Surrey, British Columbia, Canada
| | | | - Leon H Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York; Indiana Medical Center, Indianapolis, Indiana; Physicians Skin Care, PLLC, Louisville, Kentucky; Skin Sciences, PLLC, Louisville, Kentucky
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wei Jing Loo
- DermEffects, London, Ontario, Canada; Probity Medical Research, London, Ontario, Canada; Western University, London, Ontario, Canada
| | - Walter K Nahm
- University of California, San Diego, School of Medicine, San Diego, California
| | - Kim A Papp
- Probity Medical Research, Waterloo, Ontario, Canada; Alliance Clinical Trials, Waterloo, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Daniel Stewart
- Michigan Center for Skin Care Research, Clinton Township, Michigan
| | - Darryl P Toth
- XLR8 Medical Research, Windsor, Ontario, Canada; Probity Medical Research, Windsor, Ontario, Canada
| | - Matthew Zirwas
- Dermatologists of the Central States, Bexley, Ohio; Probity Medical Research, Bexley, Ohio; Ohio University, Bexley, Ohio
| | - David Krupa
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | - Scott Snyder
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | | | - Robert Higham
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | - David R Berk
- Arcutis Biotherapeutics, Inc., Westlake Village, California
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15
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Khafaji AWM, Al-Zubaidy AAK, Farhood IG, Salman HR. Ameliorative effects of topical ramelteon on imiquimod-induced psoriasiform inflammation in mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6231-6248. [PMID: 38446218 DOI: 10.1007/s00210-024-03017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
Psoriasis is a long-lasting, immune-related inflammatory skin disease that affects 2-3% of the global population. It is distinguished by erythematous, silvery, and scaly patches. Ramelteon is a type of melatonin agonist that is used to treat insomnia. It has enhanced non-classical immunomodulatory and anti-inflammatory activities. The aim of the study is to assess the ameliorative effects of topical ramelteon on imiquimod (IMQ)-aggravated psoriasiform-like dermatosis in mice. The 32 albino mouse males were placed into six groups of eight animals, all of them. With the exception of the control group, all groups gained a once-a-day regimen of topical imiquimod 5% cream at a dose of 62.5 mg for eight uninterrupted days, while mice in the control group gained vaseline-based ointment alternately. Immediately after an 8-day induction period in the imiquimod group, mice in the clobetasol and ramelteon treatment groups obtained a twice-daily regimen of topical clobetasol propionate 0.05% ointment and 0.1% ointment, respectively, for a further 8 days. This extends the total duration of the experimental study to 16 continuous days. The findings of our study found that ramelteon significantly mitigated the concentrations of inflammatory cytokines in the skin tissue, including interleukin (IL)-6, IL-17A, IL-23, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF), as well as the scores associated with psoriatic lesions, including erythema, scaling, skin thickening, ear thickness, and overall cumulative PASI scores. Additionally, the anti-inflammatory impact of ramelteon was achieved by markedly increasing IL-10 levels in the skin tissue and correcting cutaneous histopathological alterations. Ramelteon ointment (0.1%) was comparable to that of clobetasol (0.05%) ointment in alleviating a mouse model of imiquimod-induced psoriasiform inflammation; this is probably due to its potential anti-inflammatory and immunomodulatory activities. Therefore, ramelteon could be a good additive option for therapeutic management of immune-triggered inflammatory conditions such as psoriasis.
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Affiliation(s)
| | | | - Iqbal Ghalib Farhood
- Section of Dermatology and Venereology, Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Hayder Ridha Salman
- Department of Pharmacology, College of Pharmacy, Al-Mustaqbal University, 510001, Hillah, Iraq
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Gisondi P, Gracia-Cazaña T, Kurzen H, Galván J. Calcipotriol/Betamethasone Dipropionate for the Treatment of Psoriasis: Mechanism of Action and Evidence of Efficacy and Safety versus Topical Corticosteroids. J Clin Med 2024; 13:4484. [PMID: 39124750 PMCID: PMC11313259 DOI: 10.3390/jcm13154484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
The combined treatment with calcipotriol (Cal) and betamethasone dipropionate (BDP) has emerged as the leading anti-psoriatic topical treatment. Fixed-dose Cal/BDP is available in different formulations, including ointment, gel, foam, and cream. This review examines the mechanism of action of Cal/BDP underlying its therapeutic effect and compiles the evidence regarding its efficacy and safety compared to monotherapy with topical corticosteroids. The dual-action of Cal/BDP targets the inflammatory pathways and abnormal keratinocyte proliferation, both of them fundamental mechanisms of psoriasis pathogenesis. A large number of randomized, double-blind studies support Cal/BDP superiority over topical corticosteroids, demonstrating its broad efficacy across several degrees of psoriasis severity and its capability to provide early significant clinical improvements. This increased efficacy is achieved without negative effects on the safety profile, since the incidence of adverse effects reported with Cal/BDP is usually similar to that of BDP and even lower than that of Cal alone. The combination therapy rapid onset of action, coupled with a simplified dosing regimen, has been identified as crucial for improving long-term adherence and patient outcomes. In conclusion, Cal/BDP is confirmed as a versatile, effective, and convenient option for the patient in psoriasis management.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | | | - Hjalmar Kurzen
- Haut- und Laserzentrum Freising, 85354 Freising, Germany;
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, 80802 Munich, Germany
| | - Jordi Galván
- Global Medical Affairs Department, Almirall S.A., 08022 Barcelona, Spain;
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An P, Zhao Q, Hao S, Wang X, Tian J, Ma Z. Recent Advancements and Trends of Topical Drug Delivery Systems in Psoriasis: A Review and Bibliometric Analysis. Int J Nanomedicine 2024; 19:7631-7671. [PMID: 39099792 PMCID: PMC11296365 DOI: 10.2147/ijn.s461514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Psoriasis is an immune-mediated inflammatory skin disease where topical therapy is crucial. While various dosage forms have enhanced the efficacy of current treatments, their limited permeability and lack of targeted delivery to the dermis and epidermis remain challenges. We reviewed the evolution of topical therapies for psoriasis and conducted a bibliometric analysis from 1993 to 2023 using a predictive linear regression model. This included a comprehensive statistical and visual evaluation of each model's validity, literature profiles, citation patterns, and collaborations, assessing R variance and mean squared error (MSE). Furthermore, we detailed the structural features and penetration pathways of emerging drug delivery systems for topical treatment, such as lipid-based, polymer-based, metallic nanocarriers, and nanocrystals, highlighting their advantages. This systematic overview indicates that future research should focus on developing novel drug delivery systems characterized by enhanced stability, biocompatibility, and drug-carrying capacity.
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Affiliation(s)
- Pingyu An
- Basic Medical College, Harbin Medical University, Harbin, People’s Republic of China
| | - Qiyue Zhao
- School of Nursing, Southern Medical University, Guangzhou, People’s Republic of China
| | - Siyu Hao
- Department of Dermatology, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xiaodong Wang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of China
| | - Jiangtian Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, People’s Republic of China
| | - Zhiqiang Ma
- Department of Dermatology, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
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18
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Battat R, Chang JT, Loftus EV, Sands BE. IBD Matchmaking - Rational Combination Therapy. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00633-5. [PMID: 39025253 DOI: 10.1016/j.cgh.2024.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
A growing number of patients with Crohn's disease and ulcerative colitis have disease that is refractory to multiple advanced therapies, have undergone multiple surgeries, and require further treatment options. For this reason, there has been increasing use of multiple simultaneous advanced targeted therapies. Although the knowledge on combined advanced targeted therapy (CATT) in inflammatory bowel disease (IBD) has been largely limited to observational data and early-phase randomized controlled trials, combination of therapies is commonplace in many other diseases. This review discusses conceptual frameworks of CATT in IBD, provides context of combined therapies in other diseases, provides current evidence for CATT in IBD, and projects future applications and positioning of CATT using existing, novel, and orthogonal mechanisms of action. CATT aims to address the need to overcome low efficacy rates and frequent loss of response of current individual therapies. Both treatment exposure and disease duration are major determinants of response to therapy. Identification of safe and effective CATT may impact positioning of this strategy to apply to a broader IBD population.
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Affiliation(s)
- Robert Battat
- Division of Gastroenterology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - John T Chang
- Department of Medicine, University of California San Diego, La Jolla, California; Department of Medicine, Veteran Affairs San Diego Healthcare System, San Diego, California
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Guenther L, Turchin I, Vender R, Albrecht LE, Maari C, Yanofsky H, Prajapati VH. Canadian Expert Consensus on the Use of Halobetasol Propionate/Tazarotene Lotion for Plaque Psoriasis. Dermatol Ther (Heidelb) 2024; 14:1917-1928. [PMID: 38916719 PMCID: PMC11264667 DOI: 10.1007/s13555-024-01204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION An expert panel of Canadian dermatologists was assembled to develop consensus statements regarding the current landscape of topical therapies for plaque psoriasis and the place in therapy of the recently approved fixed-dose combination halobetasol propionate (HP)/tazarotene (TAZ) lotion (HP/TAZ) in the treatment algorithm for plaque psoriasis. METHOD A modified nominal group technique, which combined both independent and group input from the expert panel, was used to develop the consensus statements. The expert panel completed surveys to elicit their independent views on the current landscape of topical therapies for plaque psoriasis in Canada. The first expert panel session was held to discuss the existing body of literature and develop draft consensus statements about topical therapies and the place in therapy of HP/TAZ. Independent feedback on the draft consensus statements was solicited from expert panel members prior to another expert panel session where the amended consensus statements were further discussed, edited and, finally, voted on. RESULTS The expert panel reached consensus on 20 statements. CONCLUSION Expert panel members agreed, based on the existing body of literature, that there is a place in therapy for HP/TAZ to address several current unmet treatment needs of patients with plaque psoriasis. Studies have shown that HP/TAZ is an effective and safe first-line treatment for moderate-to-severe plaque psoriasis. Due to its cosmetically pleasing vehicle and once-daily administration, HP/TAZ may improve patient acceptance and treatment adherence.
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Affiliation(s)
- Lyn Guenther
- Guenther Research Inc., 835 Richmond St., London, ON, N6A 3H7, Canada.
| | - Irina Turchin
- Brunswick Dermatology Centre, Fredericton, NB, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Ron Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | | | | | | | - Vimal H Prajapati
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Skin Health and Wellness Centre, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
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20
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Greiling T, Young M, Seal MS, Higham RC, Armstrong A. Patient Perspectives on the Prevalence and Burden of Intertriginous Psoriasis: Results from a National Survey of Adults with Psoriasis in the United States. Dermatol Ther (Heidelb) 2024; 14:1839-1847. [PMID: 38874893 PMCID: PMC11265023 DOI: 10.1007/s13555-024-01190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION A survey was conducted by The Harris Poll on behalf of Arcutis Biotherapeutics in the USA to understand perspectives and burden of patients with psoriasis using prescription topical treatments for their disease. This manuscript presents results from the subset of patients with intertriginous psoriasis. METHODS The survey was conducted online October 21-November 24, 2021, among 507 US adults aged 18+ years with psoriasis diagnosed by a healthcare provider and currently using prescription topical treatment. Participants with intertriginous psoriasis were patients with plaque psoriasis reporting symptoms in the armpit, groin, under breast, stomach fold, or between the buttocks. RESULTS Of the 507 respondents, 320 (64%) reported symptoms in intertriginous areas at some point, typically between the buttocks (31%). Most patients with intertriginous psoriasis reported it made them feel embarrassed (80%), anxious (79%), or depressed (69%). In addition, 45% of these patients reported intertriginous psoriasis caused a negative impact on sexual anxiety or distress. Quality of life impact was reported as "very strong negative impact" in 16% of patients with groin involvement vs. 6% in patients with no groin involvement and 15% in women vs. 6% in men. Patients with intertriginous psoriasis reported that itch (61%), scaling (53%), redness (49%), and skin cracking (46%) related to intertriginous psoriasis had the greatest negative impact on quality of life. Most (86%) of these patients said they would be more adherent if a single treatment option could be used to treat all affected areas of their body. CONCLUSION Psoriasis involvement in intertriginous areas over the course of disease is common and has a negative impact on these patients' quality of life, particularly emotional well-being and sexual health.
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Affiliation(s)
- Teri Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Melodie Young
- Mindful Dermatology, Modern Research Associates, Dallas, TX, USA
| | - Melissa S Seal
- Arcutis Biotherapeutics, Inc., Westlake Village, CA, USA.
| | | | - April Armstrong
- Department of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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21
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Aoki KC, Wong S, Duong JQ, Feldman SR. Adherence to Psoriasis Therapies. Dermatol Clin 2024; 42:495-506. [PMID: 38796278 DOI: 10.1016/j.det.2024.02.010] [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] [Indexed: 05/28/2024]
Abstract
Understanding the underlying causes of nonadherence among patients with psoriasis and adopting strategies to address these issues may allow providers to share responsibility and work alongside patients to overcome these barriers. The review explores patient adherence to different types of psoriasis treatment, suggestions for interventions to overcome barriers, and methods to promote adherence that have been published in the literature.
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Affiliation(s)
- Kawaiola C Aoki
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Summer Wong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Jessica Q Duong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Steven R Feldman
- Department of Dermatology, Pathology, and Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
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22
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Li CP, Lo SW, Tsai RY, Chang HC, Gau SY. New-Onset Hidradenitis Suppurativa in Psoriasis Patients: A Multi-Center, Retrospective Cohort Study. Life (Basel) 2024; 14:730. [PMID: 38929713 PMCID: PMC11205059 DOI: 10.3390/life14060730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Previous research has indicated a potential correlation between hidradenitis suppurativa (HS) and psoriasis (PSO), two chronic inflammatory dermatological diseases. However, there is a lack of comprehensive evaluations that consider a variety of clinical and demographic factors, and the risk of developing HS in PSO patients remains unclear. Our study aims to examine HS risk over time among PSO patients versus matched controls while considering the influence of confounders to provide insights into the potential link between these two diseases. METHOD In this multi-institutional cohort study using the TriNetX database, we matched 202,318 patients with PSO with an equivalent number of individuals without PSO, using propensity score matching. The study period extended from 1 January 2005 to 31 December 2018. We computed hazard ratios and their respective 95% confidence intervals (CIs) to evaluate the probability of HS manifestation over a period of 5 years in patients with PSO in comparison to those without PSO. RESULTS PSO patients demonstrated a consistently higher risk of developing HS than matched controls across all analytic models with the hazard ratios (HR) ranging from 1.43 (95% CI 1.30-1.56) to 5.91 (95% CI 2.49-14.04). Stratified analyses showed the increased HS risk was observed in both genders but only significant in those aged 18-64 years. Kaplan-Meier analysis indicated PSO patients had a higher cumulative probability of developing HS over time (HR 1.77, 95% CI 1.49-1.89). CONCLUSIONS PSO was associated with increased HS risk, highlighting the importance of considering HS as a potential comorbidity in PSO patients and may have implications for early detection, prevention, and management strategies for both conditions. Shared inflammatory pathways, genetic components, and skin dysbiosis may contribute. Further research should elucidate underlying mechanisms.
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Affiliation(s)
- Chen-Pi Li
- Department of Nursing, Tungs’ Taichung MetroHarbor Hospital, Taichung 435403, Taiwan;
| | - Shao-Wei Lo
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Ru-Yin Tsai
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Hui-Chin Chang
- Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Orthopedics Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
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23
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Portarapillo A, Potestio L, Tommasino N, Lauletta G, Feo F, Salsano A, Martora F, Caso F, Megna M. Novel pharmacotherapies and breakthroughs in psoriasis treatment: 2024 and beyond. Expert Opin Pharmacother 2024; 25:1187-1198. [PMID: 38916590 DOI: 10.1080/14656566.2024.2373354] [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: 05/09/2024] [Accepted: 06/24/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The use of the current available therapies for psoriasis management may sometimes be limited by reduced patients' compliance, safety issues for patients' comorbidities, primary lack of efficacy, loss of effectiveness, development of side effects. In this context, several clinical trials investigating the use of both topical and systemic therapies are ongoing, and other new drugs will be approved soon. AREAS COVERED The aim of this manuscript is to review current literature and to provide an overview of the current and future trends in psoriasis treatment. A comprehensive review of the English-language medical literature was performed using Pubmed and clinicaltrials.gov databases. EXPERT OPINION Although several therapies are currently available for psoriasis' treatment, unmet needs still exist for patients with moderate and severe psoriasis and hence expanding the therapeutic armamentarium is desirable for a more personalized approach. The ongoing development of innovative therapies could provide effective and safe therapies in the future enhancing the therapeutic management of moderate-severe unresponsive psoriasis.
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Affiliation(s)
- Antonio Portarapillo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nello Tommasino
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Lauletta
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Federica Feo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonia Salsano
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Caso
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Wang J, Zhang CS, Zhang AL, Chen H, Xue CC, Lu C. Adding Chinese herbal medicine bath therapy to conventional therapies for psoriasis vulgaris: A systematic review with meta-analysis of randomised controlled trials. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 128:155381. [PMID: 38537444 DOI: 10.1016/j.phymed.2024.155381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/26/2023] [Accepted: 01/20/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Chinese herbal medicine (CHM) bath is commonly used in China as an adjuvant therapy for managing psoriasis vulgaris. Previous systematic reviews showed that CHM bath therapy was effective and safe for psoriasis vulgaris, however, without exploration of the specifics of CHM bath therapy such as the optimal temperature, duration of each session, and the total treatment duration. PURPOSE To evaluate the add-on effects of CHM bath therapy to conventional therapies for adult psoriasis vulgaris. METHODS We conducted a comprehensive search in nine medical databases from inception to September 2022 to identify relevant randomised controlled trials (RCTs) published in Chinese or English. The included studies compared the combination of CHM bath therapy and conventional therapies to conventional therapies alone for adult psoriasis vulgaris. Methodological quality assessment of the included RCTs was performed using the Cochrane risk-of-bias tool 2 (RoB 2). Statistical analysis was carried out using RevMan 5.4, R 4.2.3 and Stata 12.0 software. The certainty of evidence of outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Working Group (GRADE) system. RESULTS A total of 23 RCTs involving 2,183 participants were included in this systematic review. Findings suggested that the combination of CHM bath therapy and conventional therapies was more effective in reducing Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and itch visual analogue scale, compared to using conventional therapies alone. These enhanced effects were notably observed when the CHM bath was set above 38 °C and had a duration of 20 and 30 min, as assessed by DLQI. Moreover, an eight-week treatment duration resulted in better effects for PASI compared to shorter durations. Additionally, the top ten frequently used herbs in the included studies were identified. Despite the findings, the certainty of evidence was rated as 'low' or 'moderate' based on the GRADE assessment, and significant heterogeneity was detected in subgroup and sensitivity analyses. CONCLUSION The CHM bath therapy combined with conventional therapies is more effective and safer than conventional therapies alone for adult psoriasis vulgaris. The results suggest a potential correlation between treatment effects and factors such as extended treatment duration, increased bath temperature, and longer bath sessions. However, the certainty of evidence was downgraded due to methodological limitations of the included studies. To confirm the findings of this systematic review, a double-blinded, placebo-controlled RCT is needed in the future.
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Affiliation(s)
- Junyue Wang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Claire Shuiqing Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Haiming Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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25
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Lee YG, Jung Y, Choi HK, Lee JI, Lim TG, Lee J. Natural Product-Derived Compounds Targeting Keratinocytes and Molecular Pathways in Psoriasis Therapeutics. Int J Mol Sci 2024; 25:6068. [PMID: 38892253 PMCID: PMC11172960 DOI: 10.3390/ijms25116068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Psoriasis is a chronic autoimmune inflammatory skin disorder that affects approximately 2-3% of the global population due to significant genetic predisposition. It is characterized by an uncontrolled growth and differentiation of keratinocytes, leading to the formation of scaly erythematous plaques. Psoriasis extends beyond dermatological manifestations to impact joints and nails and is often associated with systemic disorders. Although traditional treatments provide relief, their use is limited by potential side effects and the chronic nature of the disease. This review aims to discuss the therapeutic potential of keratinocyte-targeting natural products in psoriasis and highlight their efficacy and safety in comparison with conventional treatments. This review comprehensively examines psoriasis pathogenesis within keratinocytes and the various related signaling pathways (such as JAK-STAT and NF-κB) and cytokines. It presents molecular targets such as high-mobility group box-1 (HMGB1), dual-specificity phosphatase-1 (DUSP1), and the aryl hydrocarbon receptor (AhR) for treating psoriasis. It evaluates the ability of natural compounds such as luteolin, piperine, and glycyrrhizin to modulate psoriasis-related pathways. Finally, it offers insights into alternative and sustainable treatment options with fewer side effects.
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Affiliation(s)
- Yu Geon Lee
- Division of Food Functionality Research, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (Y.G.L.); (Y.J.); (H.-K.C.); (J.-I.L.)
| | - Younjung Jung
- Division of Food Functionality Research, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (Y.G.L.); (Y.J.); (H.-K.C.); (J.-I.L.)
| | - Hyo-Kyoung Choi
- Division of Food Functionality Research, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (Y.G.L.); (Y.J.); (H.-K.C.); (J.-I.L.)
| | - Jae-In Lee
- Division of Food Functionality Research, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (Y.G.L.); (Y.J.); (H.-K.C.); (J.-I.L.)
| | - Tae-Gyu Lim
- Department of Food Science & Biotechnology, College of Life Sciences, Sejong University, Seoul 05006, Republic of Korea;
- Carbohydrate Bioproduct Research Center, Department of Food Science & Biotechnology, Sejong University, Seoul 05006, Republic of Korea
| | - Jangho Lee
- Division of Food Functionality Research, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (Y.G.L.); (Y.J.); (H.-K.C.); (J.-I.L.)
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26
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Samari M, Kashanian S, Zinadini S, Derakhshankhah H. Designing of a new transdermal antibiotic delivery polymeric membrane modified by functionalized SBA-15 mesoporous filler. Sci Rep 2024; 14:10418. [PMID: 38710793 DOI: 10.1038/s41598-024-60727-x] [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: 02/07/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
A new drug delivery system using an asymmetric polyethersulfone (PES) membrane modified by SBA-15 and glutamine-modified SBA-15 (SBA-Q) was prepared in this study by the aim of azithromycin delivery enhancement in both in vitro and ex vivo experiments. The research focused on optimizing membrane performance by adjusting critical parameters including drug concentration, membrane thickness, modifier percentage, polymer percentage, and pore maker percentage. To characterize the fabricated membranes, various techniques were employed, including scanning electron microscopy, water contact angle, and tensile strength assessments. Following optimization, membrane composition of 17% PES, 2% polyvinylpyrrolidone, 1% SBA-15, and 0.5% SBA-Q emerged as the most effective. The optimized membranes demonstrated a substantial increase in drug release (906 mg/L) compared to the unmodified membrane (440 mg/L). The unique membrane structure, with a dense top layer facilitating sustained drug release and a porous sub-layer acting as a drug reservoir, contributed to this improvement. Biocompatibility assessments, antibacterial activity analysis, blood compatibility tests, and post-diffusion tissue integrity evaluations confirmed the promising biocompatibility of the optimized membranes. Moreover, long-term performance evaluations involving ten repeated usages underscored the reusability of the optimized membrane, highlighting its potential for sustained and reliable drug delivery applications.
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Affiliation(s)
- Mahya Samari
- Department of Applied Chemistry, Faculty of Chemistry, Razi University, Kermanshah, Iran
| | - Soheila Kashanian
- Department of Applied Chemistry, Faculty of Chemistry, Razi University, Kermanshah, Iran.
- Nanobiotechnology Department, Faculty of Innovative Science and Technology, Razi University, Kermanshah, Iran.
| | - Sirus Zinadini
- Department of Applied Chemistry, Faculty of Chemistry, Razi University, Kermanshah, Iran
- Environmental Research Center (ERC), Razi University, Kermanshah, Iran
| | - Hossein Derakhshankhah
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- USERN Office, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhang J, Schuttelaar MLA. How can we better address patients' needs in topical psoriasis treatment? Br J Dermatol 2024; 190:613-614. [PMID: 38315891 DOI: 10.1093/bjd/ljae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Junfen Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
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Liu Q, Zhang Y, Xu B, Jin X, Yang T, Fan L. Blood MALT1 expression could help predict treatment outcomes in psoriasis patients, especially in those receiving biologics. Immun Inflamm Dis 2024; 12:e1235. [PMID: 38578002 PMCID: PMC10996377 DOI: 10.1002/iid3.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Mucosa-associated lymphoid tissue 1 (MALT1) modulates T helper cell differentiation, pro-inflammatory cytokine production, and epidermal hyperplasia to participate in the pathology of psoriasis. This study aimed to explore the correlation of blood MALT1 with treatment outcomes in psoriasis patients. METHODS MALT1 was detected in peripheral blood mononuclear cells by reverse transcription-quantitative polymerase chain reaction in 210 psoriasis patients before starting or converting to a new therapy, 50 disease controls, and 50 healthy controls. The psoriasis area severity index (PASI) score was evaluated at month (M)1, M3, and M6 in psoriasis patients. RESULTS MALT1 was increased in psoriasis patients versus disease controls and healthy controls (both p < .001); and positively related to body mass index (p = .019) and PASI score (p < .001) in psoriasis patients. PASI75 rate at M1, M3, and M6 was 22.9%, 46.2%, and 71.0%, respectively; while PASI90 rate at M1, M3, and M6 was 3.8%, 29.0%, and 50.5%, respectively, in psoriasis patients. PASI75/90 rates at M1, M3, and M6 were increased in psoriasis patients receiving biologics versus those without (all p < .05). Pretreatment MALT1 was higher in psoriasis patients who achieved PASI75 (p = .001) and PASI90 (p < .001) at M6 compared to those who did not achieve that. Subgroup analyses discovered that pretreatment MALT1 had a stronger ability to predict PASI75 and 90 realizations in psoriasis patients receiving biologics (area under the curve [AUC]: 0.723 and 0.808) versus those without (AUC: 0.594 and 0.675). CONCLUSION Blood MALT1 measurement may assist in predicting outcomes in psoriasis patients, especially in those receiving biologics.
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Affiliation(s)
- Qiaoli Liu
- Department of Emergency, Chengde Central Hospital, Chengde, China
| | - Yanfeng Zhang
- Department of Dermatology, Chengde Central Hospital, Chengde, China
| | - Bing Xu
- Department of Dermatology, Chengde Central Hospital, Chengde, China
| | - Xiaobo Jin
- Department of Orthopaedics, Chengde Central Hospital, Chengde, China
| | - Tao Yang
- Department of Clinical Laboratory, Chengde Central Hospital, Chengde, China
| | - Leiqiang Fan
- Department of Dermatology, Chengde Central Hospital, Chengde, China
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Prieto K, Duong JQ, Feldman SR. Tapinarof cream for the topical treatment of plaque psoriasis in adults. Expert Rev Clin Immunol 2024; 20:327-337. [PMID: 38117596 DOI: 10.1080/1744666x.2023.2296607] [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: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Plaque psoriasis, a chronic immune-mediated skin disorder, is characterized by well-demarcated erythematous plaques with silvery scales. This condition stems from complex interactions between genetic predisposition, immune dysregulation, and environmental triggers. Tapinarof downregulates the cytokine IL-17, diminishes the inflammatory infiltrate, and provides antioxidant properties while enhancing the expression of skin barrier proteins. AREAS COVERED This review begins by assessing tapinarof's mechanism in treating plaque psoriasis. Subsequently, it examines the effectiveness and safety of tapinarof 1% cream in adult patients. EXPERT OPINION Tapinarof 1% cream, which works by activating the aryl hydrocarbon receptor, is an FDA-approved treatment for adult plaque psoriasis. This therapy introduces a novel, nonsteroidal method for addressing inflammation and skin barrier issues, potentially serving as an alternative to conventional treatments. The once-daily, convenient cream formulation and favorable safety profile may enhance patient adherence, which is often poor with topical treatments. Tapinarof also maintains disease clearance for a mean of 4 months after treatment cessation.
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Affiliation(s)
- Kaley Prieto
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica Q Duong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Bodnár K, Fehér P, Ujhelyi Z, Bácskay I, Józsa L. Recent Approaches for the Topical Treatment of Psoriasis Using Nanoparticles. Pharmaceutics 2024; 16:449. [PMID: 38675110 PMCID: PMC11054466 DOI: 10.3390/pharmaceutics16040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Psoriasis (PSO) is a chronic autoimmune skin condition characterized by the rapid and excessive growth of skin cells, which leads to the formation of thick, red, and scaly patches on the surface of the skin. These patches can be itchy and painful, and they may cause discomfort for patients affected by this condition. Therapies for psoriasis aim to alleviate symptoms, reduce inflammation, and slow down the excessive skin cell growth. Conventional topical treatment options are non-specific, have low efficacy and are associated with adverse effects, which is why researchers are investigating different delivery mechanisms. A novel approach to drug delivery using nanoparticles (NPs) shows promise in reducing toxicity and improving therapeutic efficacy. The unique properties of NPs, such as their small size and large surface area, make them attractive for targeted drug delivery, enhanced drug stability, and controlled release. In the context of PSO, NPs can be designed to deliver active ingredients with anti-inflammatory effect, immunosuppressants, or other therapeutic compounds directly to affected skin areas. These novel formulations offer improved access to the epidermis and facilitate better absorption, thus enhancing the therapeutic efficacy of conventional anti-psoriatic drugs. NPs increase the surface-to-volume ratio, resulting in enhanced penetration through the skin, including intracellular, intercellular, and trans-appendage routes. The present review aims to discuss the latest approaches for the topical therapy of PSO using NPs. It is intended to summarize the results of the in vitro and in vivo examinations carried out in the last few years regarding the effectiveness and safety of nanoparticles.
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Affiliation(s)
- Krisztina Bodnár
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary; (K.B.); (P.F.); (Z.U.); (I.B.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
- Institute of Healthcare Industry, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary; (K.B.); (P.F.); (Z.U.); (I.B.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
| | - Zoltán Ujhelyi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary; (K.B.); (P.F.); (Z.U.); (I.B.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary; (K.B.); (P.F.); (Z.U.); (I.B.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
- Institute of Healthcare Industry, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
| | - Liza Józsa
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary; (K.B.); (P.F.); (Z.U.); (I.B.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
- Institute of Healthcare Industry, University of Debrecen, Nagyerdei körút 98, 4032 Debrecen, Hungary
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Wang J, Zhang CS, Zhang AL, Yu J, Deng H, Chen H, Xue CC, Lu C. Add-on effects of Chinese herbal medicine external application (FZHFZY) to topical urea for mild-to-moderate psoriasis vulgaris: Protocol for a double-blinded randomized controlled pilot trial embedded with a qualitative study. PLoS One 2024; 19:e0297834. [PMID: 38512933 PMCID: PMC10956750 DOI: 10.1371/journal.pone.0297834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 01/01/2024] [Indexed: 03/23/2024] Open
Abstract
Psoriasis vulgaris is a chronic dermatological disease with a high global prevalence. It significantly reduces patients' quality of life and is associated with a substantial economic burden. Conventional therapies for mild-to-moderate psoriasis are often associated with insufficient long-term symptomatic relief and side effects. Chinese herbal medicine (CHM) is commonly used for psoriasis management. A CHM formula, namely Fu zheng he fu zhi yang (FZHFZY), has shown promising treatment effects in clinical practice when used as a bath therapy. However, its efficacy and safety has not been evaluated by a rigorous randomized controlled trial (RCT). Therefore, we designed a double-blinded pilot RCT embedded with a qualitative study on CHM formula FZHFZY plus topical urea for mild-to-moderate psoriasis vulgaris to advance the evidence development and practice of CHM external application for psoriasis. This will be a mixed-method design consisting of a pilot RCT and a qualitative study. The pilot RCT is a two-arm, parallel, placebo-controlled, double-blinded trial. Sixty eligible participants will be randomized at a 1:1 ratio to receive eight weeks' treatment of either FZHFZY plus 10% urea cream, or placebo plus 10% urea cream, with 12-week follow-up visits after the treatment phase. The CHM or placebo will be administered externally as a bath therapy. Outcome measures include trial feasibility, efficacy and safety. The primary efficacy outcome will be Psoriasis Area Severity Index (PASI). Secondary efficacy outcomes include Physician Global Assessment, PASI-75, PASI-50, Body Surface Area, Dermatology Life Quality Index, Skindex-16, itch visual analogue scale and relapse. The qualitative study will be conducted to collect participants' feedback on CHM external application and their experience with the pilot RCT. This study will advance the evidence-based clinical practice of using CHM for psoriasis vulgaris and then to support translation of findings into clinical practice in the future. Trial registration number: ChiCTR2200064092.
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Affiliation(s)
- Junyue Wang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Claire Shuiqing Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Jingjie Yu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hao Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Haiming Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Elmets CA, Menter A, Malik S, Castillo DA. Response to letter to the editor "It's time to consider a new topical algorithm for psoriasis". J Am Acad Dermatol 2024; 90:e83. [PMID: 37821054 DOI: 10.1016/j.jaad.2023.08.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Craig A Elmets
- Department of Dermatology, University of Alabama, Birmingham, Alabama
| | | | - Sameer Malik
- American Academy of Dermatology, Rosemont, Illinois
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33
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Engel PV, Smith B, Javadi SS, Wu JJ. It is time to consider a new topical algorithm for psoriasis. J Am Acad Dermatol 2024; 90:e84-e85. [PMID: 37813190 DOI: 10.1016/j.jaad.2023.07.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Priya V Engel
- California University of Science and Medicine, Colton, Calif
| | - Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pa
| | | | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Fla.
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Eichenfield LF, Tarabar S, Forman S, García-Bello A, Feng G, Fetterly G, Mahling P, Peeva E, Vincent MS, Chandra DE. Efficacy and Safety of PF-07038124 in Patients With Atopic Dermatitis and Plaque Psoriasis: A Randomized Clinical Trial. JAMA Dermatol 2024; 160:156-163. [PMID: 38117526 PMCID: PMC10733847 DOI: 10.1001/jamadermatol.2023.4990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023]
Abstract
Importance Atopic dermatitis (AD) and plaque psoriasis are inflammatory skin diseases with unmet need for effective topical treatments with few application site reactions. Objective To assess the efficacy and safety of the topical phosphodiesterase 4 inhibitor PF-07038124 in patients with AD and plaque psoriasis. Design, Setting, and Participants This phase 2a, randomized, double-blind clinical trial was conducted from December 21, 2020, to August 18, 2021, at 34 sites across 4 countries. Eligible patients (aged 18-70 years) had mild to moderate AD (covering 5%-20% body surface area) or plaque psoriasis (covering 5%-15% body surface area). Data were analyzed until December 15, 2021. Interventions Patients were randomized (1:1) to PF-07038124, 0.01%, topical ointment or vehicle once daily for 6 weeks. Main Outcomes and Measures The primary end point was the percent change from baseline (CFB) in the Eczema Area and Severity Index (EASI) total score among patients with AD and in the Psoriasis Area and Severity Index (PASI) score among patients with plaque psoriasis at week 6. Safety measures included treatment-emergent adverse events, including application site reactions. Results Overall, 104 patients were randomized (mean [SD] age, 43.0 [15.4] years; 55 [52.9%] women; 4 [3.8%] Asian, 13 [12.5%] Black, and 87 [83.7%] White), including 70 with AD (41 women [58.6%]; mean [SD] ages, 41.4 [16.6] years in the PF-07038124 group and 36.1 [13.9] years in the vehicle group) and 34 with plaque psoriasis (20 men [58.8%]; mean [SD] ages, 51.8 [12.3] years in the PF-07038124 group and 51.2 [10.8] years in the vehicle group). Baseline characteristics were generally balanced. At week 6, the PF-07038124 groups showed significantly greater improvements compared with vehicle groups in EASI (least-squares mean CFB, -74.9% vs -35.5%; difference, -39.4% [90% CI, -58.8% to -20.1%]; P < .001) and PASI scores (CFB, -4.8 vs 0.1; difference, -4.9 [90% CI, -7.0 to -2.8]; P < .001). The number of patients with treatment-emergent adverse events was comparable between treatment groups in patients with AD (PF-07038124, 9 [25.0%]; vehicle, 9 [26.5%]) and plaque psoriasis (PF-07038124, 3 [17.6%]; vehicle, 6 [35.3%]). There were no application site reactions with PF-07038124 treatment. Conclusions and Relevance Topical PF-07038124 was well tolerated and demonstrated superior efficacy compared with vehicle in patients with mild to moderate AD and plaque psoriasis. Trial Registration ClinicalTrials.gov Identifier: NCT04664153.
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Affiliation(s)
- Lawrence F. Eichenfield
- Department of Dermatology, University of California, San Diego, School of Medicine
- Department of Pediatrics, University of California, San Diego, School of Medicine
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital–San Diego, San Diego, California
| | | | | | | | - Gang Feng
- Pfizer Inc, Cambridge, Massachusetts
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Krajewski PK, Tsoukas M, Szepietowski JC. Pathological and Therapeutical Implications of Pyroptosis in Psoriasis and Hidradenitis Suppurativa: A Narrative Review. Curr Issues Mol Biol 2024; 46:663-676. [PMID: 38248345 PMCID: PMC10814322 DOI: 10.3390/cimb46010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
This manuscript explores the role of pyroptosis, an inflammatory programmed cell death, in the pathogenesis of two chronic dermatoses, psoriasis and hidradenitis suppurativa (HS). The diseases, though clinically diverse, share common pathogenetic pathways involving the unbalanced interaction between the adaptive and innate immune systems. This review focuses on the molecular changes in psoriatic and HS skin, emphasizing the activation of dendritic cells, secretion of interleukins (IL-17, IL-22, and TNF-α), and the involvement of inflammasomes, particularly NLRP3. This manuscript discusses the role of caspases, especially caspase-1, in driving pyroptosis and highlights the family of gasdermins (GSDMs) as key players in the formation of pores leading to cell rupture and the release of proinflammatory signals. This study delves into the potential therapeutic implications of targeting pyroptosis in psoriasis and HS, examining existing medications like biologics and Janus kinase inhibitors. It also reviews the current limitations and challenges in developing therapies that selectively target pyroptosis. Additionally, the manuscript explores the role of pyroptosis in various inflammatory disorders associated with psoriasis and HS, such as inflammatory bowel disease, diabetes mellitus, and cardiovascular disorders. The review concludes by emphasizing the need for further research to fully elucidate the pathomechanisms of these dermatoses and develop effective, targeted therapies.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland;
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland;
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Lie E, Choi M, Wang SP, Eichenfield LF. Topical Management of Pediatric Psoriasis: A Review of New Developments and Existing Therapies. Paediatr Drugs 2024; 26:9-18. [PMID: 37847480 PMCID: PMC10769900 DOI: 10.1007/s40272-023-00592-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 10/18/2023]
Abstract
Psoriasis is a chronic immune-mediated disorder that commonly affects adults and children. In recent years, pediatric psoriasis has increased in prevalence and the disease is often associated with various comorbidities and psychological distress. The conventional topical treatments for psoriasis, such as corticosteroids, calcineurin inhibitors, vitamin D analogs, anthralin, and coal tar, are often limited by their side effects, tolerability, and/or efficacy, particularly for use in children and on sensitive and intertriginous areas. Recently, the US Food and Drug Administration approved two new topical non-steroidal agents for treating psoriasis that target different pathogenic pathways than the conventional treatments. Roflumilast is a phosphodiesterase type 4 inhibitor approved for the treatment of plaque psoriasis in patients aged 12 years and older. Tapinarof is a novel aryl hydrocarbon receptor modulator approved for adult psoriasis and currently undergoing studies for pediatric psoriasis. Ongoing efforts are also being made to optimize conventional treatments, for instance, a new foam formulation of halobetasol propionate was recently approved for pediatric psoriasis. Clinical trials of various new drugs targeting one or multiple pathogenic pathways of psoriasis, such as Janus kinase inhibitors, different formulations of phosphodiesterase type 4 inhibitors, and aryl hydrocarbon receptor modulators have also been explored. The recent emergence of novel topical agents provides promising new options for managing pediatric psoriasis with the potential to improve clinical outcomes and quality of life. In this article, we review the mechanism of action, efficacy, and safety profile of novel topical agents and discuss their potential roles in the management of pediatric psoriasis.
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Affiliation(s)
- Erina Lie
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Mira Choi
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sheng-Pei Wang
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA.
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Kwa M, Guttentag A, Chase L, van Meijgaard J, Lim HW. Trends in price for topical corticosteroids from 2017 to 2021 and the opportunity for cost savings identifiable at the point of care: A retrospective cross-sectional study. J Am Acad Dermatol 2024; 90:74-81. [PMID: 37730020 DOI: 10.1016/j.jaad.2023.09.032] [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: 05/17/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Topical corticosteroids possess numerous generics and similar-strength substitutes. Affordability can impact obtaining the medication prescribed. OBJECTIVE To determine recent trends in topical corticosteroid pricing and potential for cost saving. METHODS A retrospective cross-sectional study analyzing all prescriptions dispensed for topical corticosteroids from January 1, 2017 through December 31, 2021, using a US all-payer pharmacy-claims database and commercial coupon dataset, was performed. RESULTS Two hundred thirty-seven unique drug products (≥1 claim) were identified. Factors that predicted for higher cost (P < .05) were branded products (105% more expensive than generics) and ultrapotent class (55% more expensive than low potency) while ointments predicted for lower cost (19% less expensive than creams). Cash prices remained relatively stable, except for ultrapotent branded topical corticosteroids (63% increase). Cost savings were available for both brand-to-generic ($14.75 per unit) and generic-to-generic ($6.82 per unit) switching. Coupon prices were consistently lower than cash prices (r = 0.89). LIMITATIONS Contracted rates through insurance plans were not included. CONCLUSIONS Topical corticosteroid prices over the past 5 years have stabilized, the exception being branded ultrapotent corticosteroids. Savings from switching among similar-strength substitutes remain significant despite price stabilization. Coupon prices mirror the hierarchy of cash prices and can help assess real-time costs.
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Affiliation(s)
- Michael Kwa
- Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan.
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38
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Horner ME, Orroth KK, Ma J, Duan Y, Cordey M. Redefining Disease Severity with Special Area Involvement and Reflecting on Treatment Patterns in a Real-World Psoriasis Population. Dermatol Ther (Heidelb) 2024; 14:187-199. [PMID: 38216820 PMCID: PMC10828323 DOI: 10.1007/s13555-023-01065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The International Psoriasis Council (IPC) recommends an approach that considers body surface area (BSA), involvement in special areas, and treatment history for classifying patients as candidates for topical or systemic treatment. This study aimed to quantify the burden of psoriasis by describing BSA distribution, special area involvement, and treatments in a real-world population. METHODS This retrospective cohort study included patients with psoriasis from the Optum® deidentified Electronic Health Records database with a BSA value (< 3%, 3-10%, and > 10%) recorded between 1 March 2014 and 1 September 2020. Treatments and special area involvement (face, scalp, palms/soles, nails, genitals) were identified within 90 days of the BSA value and stratified by BSA category. RESULTS Among eligible patients (N = 5120), mean age was 51.4 years and 49.3% were women. The majority of patients (78.9%) were treated with any topical. Proportions of patients with BSA < 3%, 3-10%, and > 10% were 23.4%, 41.9%, and 34.6%, respectively; proportions with 0, 1, and 2+ special areas were 21.6%, 31.6%, and 45.7%, respectively; and 44.4%, 45.7%, and 45.9% of patients with BSA < 3%, 3-10%, and > 10%, respectively, had 2+ special areas. CONCLUSION The IPC classification can likely identify many more patients who may benefit from systemic therapy than BSA alone.
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Affiliation(s)
- Mary E Horner
- Dermatology Consultants of Sacramento, 5340 Elvas Ave, Ste 600, Sacramento, CA, 95819, USA.
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Grossmann MC, Pixley JN, Feldman SR. A Review of Topical Tapinarof for the Treatment of Plaque Psoriasis. Ann Pharmacother 2024; 58:76-85. [PMID: 37076998 DOI: 10.1177/10600280231164775] [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] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This article reviews the efficacy and safety of 1% tapinarof cream for plaque psoriasis. DATA SOURCES A literature search was conducted from August 2022 to February 2023. The terms tapinarof, VTAMA, benvitimod, GSK2894512, DMVT-505, and WBI-1001 were queried in PubMed. ClinicalTrials.gov was searched to identify ongoing or unpublished studies. STUDY SELECTION AND DATA EXTRACTION All clinical trials written in English and relevant to pharmacology, efficacy, and safety were included. DATA SYNTHESIS In two 12-week phase III clinical trials, disease severity assessed by a Physician's Global Assessment (PGA) score of clear or almost clear and a 2-point PGA improvement was 35.4% and 40.2% at week 12 in the 2 trials, respectively. In the 40-week, open-label extension trial, the efficacy and safety results were similar: 40.9% of patients achieved a PGA of 0 at least once during the trial, and 58.2% of patients with PGA ≥ 2 achieved PGA 0/1 at least once. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Tapinarof is a topical aryl hydrocarbon receptor agonist and a first-in-class, potentially promising treatment for plaque psoriasis recently approved by the U.S. Food and Drug Administration. CONCLUSION Compared with placebo, tapinarof may be an effective and safe topical treatment for mild to severe plaque psoriasis. Head-to-head trials to compare the efficacy and adverse effect profile of tapinarof to other topical treatments are still needed, as are investigation in patients with recent or current use of phototherapy or biologic or nonbiologic systemics. Cost and adherence to treatment may be barriers for treatment efficacy.
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Affiliation(s)
- Meghan C Grossmann
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica N Pixley
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Cui J, Zhang X, Deng J, Yan Y, Yao D, Deng H, Yu J, Ye S, Han L, Yu X, Lu C. Potential biomarkers for psoriasis topical treatment by in-depth serum proteomics. J DERMATOL TREAT 2023; 34:2248318. [PMID: 37621164 DOI: 10.1080/09546634.2023.2248318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Psoriasis is a chronic skin disease, and topical sequential therapy with a combination of calcipotriol and calcipotriol betamethasone is currently approved topical treatment. However, the exact mechanism by which this treatment regimen relieves psoriasis is unknown. METHOD We assembled a cohort of 65 psoriasis patients and divided post-treatment cohort into responder group and non-responder group according to the Psoriasis Area Severity Index (PASI) score after 12-week treatment. We measured the expression levels of proteins in collected 130 serum samples using our in-depth proteomics platform with a data-independent acquisition mass spectrometer and antibody microarray. We performed bioinformatics analyses of the biologic processes and signaling pathways that were changed in the responder group and constructed a proteomics landscape of psoriasis pathogenesis response to treatment. We then validated the biomarkers of disease severity in an independent cohort of 88 samples using an enzyme-linked immunosorbent assay. RESULTS We first identified 174 differentially expressed proteins (DEPs) for comparative analysis of proteins between responders and non-responders at baseline (p < 0.05). Then pathway analysis showed that the responders focused more on signaling molecules and interaction, complement and coagulation cascades, whereas the non-responders more on signal transduction and IL-17 signaling pathways. We further identified four candidate biomarkers (COLEC11, C1QA, BNC2, ITIH4) response to treatment. We also found 125 DEPs (p < 0.05) after treatment compared with before treatment in responder group. Pathway analysis showed an enrichment in pathways related to complement and coagulation cascades, phagosome, ECM-receptor interaction, cholesterol metabolism, vitamin digestion and absorption. CD14 was validated as potential biomarkers for the disease severity of psoriasis and treatment targets. CONCLUSION In this work, we analyzed the response to topical sequential therapy and finally identified four biomarkers. Additionally, we found that topical sequential therapy may alleviate psoriasis by regulating lipid metabolism and modulating the immune response by affecting the complement activation process.
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Affiliation(s)
- Jingwen Cui
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaomei Zhang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences, Beijing Institute of Lifeomics, Beijing, China
| | - Jingwen Deng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yuhong Yan
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Danni Yao
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hao Deng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jingjie Yu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Shuyan Ye
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Ling Han
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xiaobo Yu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences, Beijing Institute of Lifeomics, Beijing, China
| | - Chuanjian Lu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
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Armstrong AW, McConaha JL. Tapinarof cream 1% once daily for the treatment of adults with mild to severe plaque psoriasis: A novel topical therapy targeting the aryl hydrocarbon receptor. J Manag Care Spec Pharm 2023; 29:S1-S13. [PMID: 38051146 PMCID: PMC10996039 DOI: 10.18553/jmcp.2023.29.12-a.s1] [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: 12/07/2023]
Abstract
Plaque psoriasis is a chronic, immunemediated skin disease characterized by scaly, erythematous, pruritic plaques. The effects of psoriasis are often debilitating and stigmatizing, significantly impacting patients' physical and psychological well-being and quality of life. Current guideline-recommended psoriasis therapies (topicals, oral systemics, and biologics) have substantial limitations that include overall efficacy, safety, tolerability, sites of application, disease severity, and duration and extent of body surface area treated. Due to these limitations, psoriasis treatment regimens often require combination therapy, especially for moderate to severe disease, leading to increased treatment burden. Psoriasis is also associated with increased indirect costs (eg, reduced work productivity), leading to greater total costs expenditures. Thus, more effective, safe, well-tolerated, and cost-effective therapeutic options are needed. Tapinarof cream 1% once daily is a first-in-class, nonsteroidal, topical aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration in 2022 for the treatment of plaque psoriasis in adults. Tapinarof cream has been evaluated in plaque psoriasis, including 2 pivotal phase 3 trials (NCT03956355 and NCT03983980) and a long-term extension trial (NCT04053387). These trials demonstrated high rates of complete skin clearance with tapinarof cream, durable effects while on treatment (a lack of tachyphylaxis for up to 52 weeks), an approximately 4-month remittive effect off therapy after achieving complete clearance and stopping treatment (ie, duration during which psoriasis does not recur off therapy), and no rebound effects after cessation of therapy. According to the US Food and Drug Administration-approved prescribing information, tapinarof may be used to treat plaque psoriasis of any severity and in any location, has no restrictions on duration of use or extent of total body surface area treated, and has no contraindications, warnings, precautions, or drug-drug interactions. Tapinarof cream is thus an efficacious, well-tolerated, steroid-free topical option that addresses many of the limitations of current recommended therapies. Here we review current knowledge on the physical, psychological, and financial burdens of plaque psoriasis and identify how the clinical profile of tapinarof cream can address key treatment gaps important in the management of plaque psoriasis and patient quality of life. In this article, we aim to assist pharmacists and other managed care practitioners by providing an evidence-based overview of tapinarof cream to support patient-centric decision-making.
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Affiliation(s)
| | - Jamie L McConaha
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
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Tao RE, Pixley JN, Holovach PG, Fleischer AB, Feldman SR. Management of Pediatric Psoriasis: A U.S. Survey Based on Visits from the National Ambulatory Medical Care Survey (NAMCS). Dermatol Ther (Heidelb) 2023; 13:3221-3227. [PMID: 37831297 PMCID: PMC10689594 DOI: 10.1007/s13555-023-01051-6] [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: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Approximately one-third of psoriasis cases present in the first two decades of life. Many psoriasis treatments are approved by the U.S. Food and Drug Administration (FDA) for adults, including topical agents, systemic non-biologic agents, and systemic biologic agents. Only a handful of psoriasis treatments are FDA approved for children. Given the constantly evolving landscape of pediatric psoriasis management, our aim is to characterize how children with psoriasis are treated in the U.S. METHODS Data from the 2003-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used to evaluate patient demographics and treatment patterns for visits of children with psoriasis. Visits were stratified by those with a diagnosis of psoriasis and those for children with a diagnosis of psoriasis. Separate analyses for visits of children with a diagnosis of psoriasis were performed, including for sex, race, ethnicity, age, specialty of provider seen, and medications prescribed. RESULTS Pediatric psoriasis visits accounted for 3.3% of visits with psoriasis from 2003 to 2016 and in 2018; about one-third of those visits were to primary care providers. Children with psoriasis were prescribed a variety of topical and systemic medications, of which the most frequently prescribed treatments were topical tacrolimus, followed by topical clobetasol and topical betamethasone dipropionate or betamethasone valerate. Etanercept was the only biologic prescribed to children. At least 59% of the visits for children with a diagnosis of psoriasis included a topical prescription while at least 5.3% of the visits included a systemic prescription. CONCLUSION Use of off-label treatments was common for pediatric psoriasis. Most children with psoriasis were treated with topicals, of which tacrolimus, an unapproved treatment, was the most common. The frequent use of tacrolimus could indicate an avoidance of corticosteroids in children.
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Affiliation(s)
- Rachel E Tao
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Jessica N Pixley
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA.
| | - Phillip G Holovach
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
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Wu JJ, Wang CA, Jobson G, Davidson D, Kalirai S, Zhu J, Suryavanshi M, Mittal M, Patel V, Seigel L. Treatment patterns and healthcare costs among patients with psoriasis initiating apremilast or biologics: a retrospective claims database cohort analysis. J DERMATOL TREAT 2023; 34:2177095. [PMID: 36736349 DOI: 10.1080/09546634.2023.2177095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to compare treatment patterns and healthcare costs for patients with psoriasis who initiate apremilast, tumor necrosis factor inhibitor, or interleukin inhibitor. METHODS This retrospective cohort study used Optum Clinformatics® Data Mart to identify propensity score-matched patients initiating apremilast, tumor necrosis factor inhibitors, or interleukin inhibitors, with 12-month baseline and 24-month follow-up data. Switch, discontinuation, persistence, healthcare resource utilization, and total healthcare costs were assessed. RESULTS Twenty-four-month switch rates were highest for tumor necrosis factor inhibitors (32%), followed by apremilast (21%) then interleukin inhibitors (14%). Mean (SD) per-patient-per-month costs for switchers were lowest for apremilast ($4213 [$2304]), higher for tumor necrosis factor inhibitors ($5274 [$2280]), and highest for interleukin inhibitors ($5539 [$2296]; p < .001), primarily attributable to pharmacy costs: $3466 (apremilast), $4432 (tumor necrosis factor inhibitor), and $4721 (interleukin inhibitor). LIMITATIONS Psoriasis severity is absent from claims data; cost outcomes may be influenced by more severe psoriasis being more costly. CONCLUSION Switching psoriasis treatment is common and increases over time. Apremilast initiators had lower switch rates and costs compared with tumor necrosis factor inhibitors, despite lower effectiveness reported in previous studies, perhaps indicating patient preference for oral treatment. Additional oral options may be desirable for this population.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ching An Wang
- Real-World Analytics & Data Science (RADS), CORDS-CIF for Cardiovascular, Immunology and Fibrosis, Bristol Myers Squibb, Princeton, NJ, USA
| | | | - David Davidson
- Immunology and Fibrosis, Bristol Myers Squibb, Princeton, NJ, USA
| | - Samaneh Kalirai
- Worldwide HEOR - US Market, Immunology, Bristol Myers Squibb, Princeton, NJ, USA
| | - Julia Zhu
- Real-World Analytics & Data Science (RADS), CORDS-CIF for Cardiovascular, Immunology and Fibrosis, Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Vardhaman Patel
- Worldwide HEOR - US Market, Immunology, Bristol Myers Squibb, Princeton, NJ, USA
| | - Lauren Seigel
- Worldwide HEOR - US Market, Immunology, Bristol Myers Squibb, Princeton, NJ, USA
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Draelos ZD, Draelos MM, Lin T, Jacobson A. Fixed-combination halobetasol propionate and tazarotene topical lotion decreases TNF-α and IL-17A levels in psoriatic lesions. J DERMATOL TREAT 2023; 34:2245081. [PMID: 37577786 DOI: 10.1080/09546634.2023.2245081] [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: 06/28/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Fixed-combination halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) is approved for the treatment of plaque psoriasis in adults, with a demonstrated efficacy and safety profile in phase 3 trials. This study examined the effect of HP/TAZ on the reduction of tumor necrosis factor alpha (TNF-α) and interleukin 17 A (IL-17A) and its correlation to psoriasis improvement. MATERIALS AND METHODS Ten adults with mild-to-moderate plaque psoriasis and 2 symmetrical plaques self-applied HP/TAZ (treated plaque) or vehicle lotion (untreated plaque) for 12 weeks. At baseline and each study visit (weeks 2, 4, 8, and 12), Investigator's Global Assessment (IGA) score and erythema, scaling, and induration were assessed. Additionally, D-squame tape strips were utilized to quantify TNF-α and IL-17A in target lesions by enzyme-linked immunosorbent assay. RESULTS Significant improvements in mean IGA score in HP/TAZ-treated compared with untreated plaques were evident at week 2 and maintained through week 12 (p < 0.003). HP/TAZ significantly reduced TNF-α levels at weeks 4 through 12 (p < 0.03) and IL-17A levels at weeks 2 through 8 (p < 0.05) in treated compared with untreated plaques. CONCLUSIONS HP/TAZ was highly effective in treating psoriasis plaques and, although HP/TAZ is not a biologic, effectively reduced cytokine-associated inflammatory markers that drive psoriatic disease.
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Affiliation(s)
| | | | - Tina Lin
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, NJ, USA
| | - Abby Jacobson
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, NJ, USA
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Armstrong AW, McConaha JL. Tapinarof cream 1% once daily for the treatment of adults with mild to severe plaque psoriasis: A novel topical therapy targeting the aryl hydrocarbon receptor. J Manag Care Spec Pharm 2023; 29:S2-S14. [PMID: 38014659 DOI: 10.18553/jmcp.2023.29.12-a.s2] [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: 11/29/2023]
Abstract
Plaque psoriasis is a chronic, immunemediated skin disease characterized by scaly, erythematous, pruritic plaques. The effects of psoriasis are often debilitating and stigmatizing, significantly impacting patients' physical and psychological well-being and quality of life. Current guideline-recommended psoriasis therapies (topicals, oral systemics, and biologics) have substantial limitations that include overall efficacy, safety, tolerability, sites of application, disease severity, and duration and extent of body surface area treated. Due to these limitations, psoriasis treatment regimens often require combination therapy, especially for moderate to severe disease, leading to increased treatment burden. Psoriasis is also associated with increased indirect costs (eg, reduced work productivity), leading to greater total costs expenditures. Thus, more effective, safe, well-tolerated, and cost-effective therapeutic options are needed. Tapinarof cream 1% once daily is a first-in-class, nonsteroidal, topical aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration in 2022 for the treatment of plaque psoriasis in adults. Tapinarof cream has been evaluated in plaque psoriasis, including 2 pivotal phase 3 trials (NCT03956355 and NCT03983980) and a long-term extension trial (NCT04053387). These trials demonstrated high rates of complete skin clearance with tapinarof cream, durable effects while on treatment (a lack of tachyphylaxis for up to 52 weeks), an approximately 4-month remittive effect off therapy after achieving complete clearance and stopping treatment (ie, duration during which psoriasis does not recur off therapy), and no rebound effects after cessation of therapy. According to the US Food and Drug Administration-approved prescribing information, tapinarof may be used to treat plaque psoriasis of any severity and in any location, has no restrictions on duration of use or extent of total body surface area treated, and has no contraindications, warnings, precautions, or drug-drug interactions. Tapinarof cream is thus an efficacious, well-tolerated, steroid-free topical option that addresses many of the limitations of current recommended therapies. Here we review current knowledge on the physical, psychological, and financial burdens of plaque psoriasis and identify how the clinical profile of tapinarof cream can address key treatment gaps important in the management of plaque psoriasis and patient quality of life. In this article, we aim to assist pharmacists and other managed care practitioners by providing an evidence-based overview of tapinarof cream to support patient-centric decision-making.
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Affiliation(s)
| | - Jamie L McConaha
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
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Dai Q, Zhang Y, Liu Q, Zhang C. Efficacy and safety of vitamin D supplementation on psoriasis: A systematic review and meta-analysis. PLoS One 2023; 18:e0294239. [PMID: 37967075 PMCID: PMC10650996 DOI: 10.1371/journal.pone.0294239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Our aim was to analyze the results of published randomized controlled trials (RCTs) on vitamin D supplementation for psoriasis in order to explore its effectiveness and safety. PATIENTS AND METHODS As of July 7 2023, we conducted a systematic literature search in PubMed, Cochrane, Embase, and Web of Science Core Collection databases. The study outcomes included change values in Psoriasis Area and Severity Index (PASI) (at 3 months, 6 months, and end of follow-up)/Dermatology Life Quality Index (DLQI)/Psoriasis disability index (PDI)/C-reactive protein (CRP), and adverse events. RESULTS 333 patients from 4 studies were evaluated. Pooled analyses showed no significant effect of DLQI/PDI/CRP change value (P > 0.05) or PASI change value (3 months, end of follow-up; P > 0.05). Sensitivity analyses and statistical tests did not support the results of the PASI change values (6 months, P = 0.05). However, the results of subgroup analyses should not be ignored(supplementation with vitamin D2 or Asia would be more effective; P = 0.03). There were no serious adverse effects, and only a few individuals experienced nausea. CONCLUSIONS The efficacy and safety of vitamin D supplementation in the treatment of psoriasis remains unremarkable. The search for a new prognostic index that combines clinical and laboratory factors is needed to compensate for the shortcomings of existing measures and provide stronger evidence of validity.
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Affiliation(s)
- Qianqian Dai
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Dermatology, Shushan TCM Clinic, Anhui Xin’an TCM Medical Service Co., LTD., Hefei, China
| | - Yanfeng Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Dermatology, Tangshan Fengnan Hospital of Traditional Chinese Medicine, Tangshan, China
| | - Qian Liu
- Department of Dermatology, Shushan TCM Clinic, Anhui Xin’an TCM Medical Service Co., LTD., Hefei, China
- Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Chijin Zhang
- Department of Dermatology, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Nicolas SE, Bear MD, Kanaan AO, Coman OA, Dima L. Roflumilast 0.3% Cream: a Phosphodiesterase 4 Inhibitor for the Treatment of Chronic Plaque Psoriasis. Am J Ther 2023; 30:e535-e542. [PMID: 37921681 DOI: 10.1097/mjt.0000000000001678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Plaque psoriasis is a chronic dermatologic autoimmune disease that affects adults and children. Roflumilast 0.3% cream is currently the only topical phosphodiesterase 4 inhibitor indicated for the treatment of plaque psoriasis in patients 12 years or older. PHARMACODYNAMICS AND PHARMACOKINETICS Roflumilast inhibits phosphodiesterase 4 inhibitor enzyme leading to the accumulation of cyclic adenosine monophosphate, which suppresses the inflammatory mediators interferon-γ and tumor necrosis factor-α. Roflumilast, applied once daily, reaches steady state by day 15 and has a half life of approximately 4 days in adults. Roflumilast undergoes extensive hepatic metabolism by cytochrome P450 enzymes and conjugation. Roflumilast is 99% bound to plasma proteins. CLINICAL TRIALS Roflumilast efficacy and safety were evaluated in the DERMIS-1 and DERMIS-2 clinical trials. These identically designed, double-blind, vehicle-controlled phase 3 trials randomized 881 patients to roflumilast 0.3% cream or vehicle, applied once daily for 8 weeks. In DERMIS-1, the Investigator Global Assessment success rate was 42.4% with roflumilast 0.3% cream compared with 6.1% with the vehicle (32.3%-46.9%; P <0.001). Similarly, in DERMIS-2, the Investigator Global Assessment success rate was 37.5% with roflumilast 0.3% cream compared with 6.9% with the vehicle (20.8%-36.9%; P <0.001). Of 881 participants, 1% discontinued treatment with roflumilast cream due to adverse reactions compared with 1.3% treated with vehicle. Urticaria at the application site (0.3%) was the most common adverse reaction that led to discontinuation of roflumilast. THERAPEUTIC ADVANCE To date, topical corticosteroids are the most commonly used agents to treat mild plaque psoriasis. Sensitive areas are often challenging to treat with existing topical therapy, including corticosteroids. Topical roflumilast has shown to be effective in treating sensitive areas, including skin folds, and may be an alternative to systemic therapy for some patients. The Food and Drug Administration approved topical roflumilast for the treatment of plaque psoriasis, including intertriginous areas, for patients 12 years or older.
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Affiliation(s)
- Samar E Nicolas
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Michael D Bear
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Abir O Kanaan
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Oana Andreia Coman
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; and
| | - Lorena Dima
- Transilvania University of Brasov, Romania, Faculty of Medicine, Department of Fundamental Disciplines and Clinical Prevention, Brasov, Romania
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Bagel J, Gold LS, Del Rosso J, Johnson S, Yamauchi P, Brown PM, Bhatia N, Moore AY, Tallman AM. Tapinarof cream 1% once daily for the treatment of plaque psoriasis: Patient-reported outcomes from the PSOARING 3 trial. J Am Acad Dermatol 2023; 89:936-944. [PMID: 37172733 DOI: 10.1016/j.jaad.2023.04.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Tapinarof cream 1% once daily demonstrated significant efficacy versus vehicle and was well tolerated in two 12-week, phase 3 pivotal trials in adults with mild-to-severe plaque psoriasis. OBJECTIVE To assess long-term, health-related quality of life and patient satisfaction with tapinarof. METHODS Patients completing the 12-week trials were eligible for 40 weeks of open-label tapinarof based on Physician Global Assessment score in PSOARING 3, with a 4-week follow-up. Dermatology Life Quality Index was assessed at every visit; Patient Satisfaction Questionnaire responses were assessed at week 40 or early termination. RESULTS Seven hundred sixty-three (91.6%) eligible patients enrolled; 78.5% completed the Patient Satisfaction Questionnaire. DLQI scores improved and were maintained. By week 40, 68.0% of patients had a DLQI of 0 or 1, indicating no impact of psoriasis on health-related quality of life. Most patients strongly agreed or agreed with all Patient Satisfaction Questionnaire questions assessing confidence in tapinarof and satisfaction with efficacy (62.9%-85.8%), application ease and cosmetic elegance (79.9%-96.3%), and preference for tapinarof versus prior psoriasis therapies (55.3%-81.7%). LIMITATIONS Open-label; no control; may not be generalizable to all forms of psoriasis. CONCLUSIONS Continued and durable improvements in health-related quality of life, high rates of patient satisfaction, and positive perceptions of tapinarof cream were demonstrated.
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Affiliation(s)
- Jerry Bagel
- Psoriasis Treatment Center of New Jersey, East Windsor, New Jersey.
| | - Linda Stein Gold
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - James Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, Nevada
| | | | - Paul Yamauchi
- Dermatology Institute & Skin Care Center, Santa Monica, California
| | | | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, California
| | - Angela Yen Moore
- Arlington Center for Dermatology, Arlington Research Center, Arlington, Texas; Baylor University Medical Center, Dallas, Texas
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Arifin ANF, Hengky A, Widjaja M, Wijaya L. New-Onset and Exacerbation of Psoriasis following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series. Indian J Dermatol 2023; 68:724. [PMID: 38371588 PMCID: PMC10868966 DOI: 10.4103/ijd.ijd_833_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Introduction Although uncommon, several cases of new-onset and exacerbation of psoriasis have been reported after coronavirus disease 2019 (COVID-19) vaccination. This study aims to systematically review reports regarding new-onset and exacerbation of psoriasis to identify features related to that condition following COVID-19 vaccination. Materials and Methods Three databases were utilised, namely, PubMed, Google Scholar, and EBSCOHost to search for literature published until June 2022. We used the following MeSH terms: "psoriasis," "exacerbation," "induced psoriasis," and "COVID-19 vaccination." The included literature must report the case/(s) of psoriasis exacerbation in previously-in-remission or induced psoriasis in individuals receiving any dose of COVID-19 vaccines regardless of the type. Results Among 33 selected studies, an overall mean age was 57.52 ± 15.92 years. Female (n = 40; 54.8%) was more frequently reported than male (n = 33; 45.2%). In terms of vaccine types, Pfizer is the most commonly reported (49 cases; 67.1%), followed by Astra-Zeneca (13 cases; 17.8%), Moderna (10 cases; 13.7%), and CoronaVac (1 case; 1.4%). The onset of psoriasis after receiving the COVID-19 Vaccines was varied, ranging from 1 to 90 days (Mean ± SD: 15.75 ± 18.22). Plaque psoriasis was most commonly reported, followed by pustular, guttate and other types of psoriasis. Reported cases were frequently treated with topical steroids and monoclonal antibodies monotherapy. Conclusions Although the cases of new-onset and exacerbation of psoriasis after COVID-19 vaccination is quite scarce, the possibility of occurrence should be acknowledged and managed properly; and patients should be informed, particularly ones with history of psoriasis without discouraging patients to take vaccine.
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Affiliation(s)
- Aisyah N. F. Arifin
- From the Department of Dermatology and Venereology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Antoninus Hengky
- From the Department of Dermatology and Venereology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Maureen Widjaja
- From the Department of Dermatology and Venereology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Lorettha Wijaya
- From the Department of Dermatology and Venereology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Pinter A, Reich A, Arenberger P, Gold LS, Armstrong A, Iversen L, Praestegaard M, Augustin M. Randomized Phase 3 trial demonstrating high efficacy, favourable safety and convenience of a novel calcipotriol and betamethasone dipropionate cream for the treatment of psoriasis. J Eur Acad Dermatol Venereol 2023; 37:2327-2335. [PMID: 37432045 DOI: 10.1111/jdv.19330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The fixed dose combination of calcipotriene (CAL) and betamethasone dipropionate (BDP) is a well-established topical treatment option for psoriasis based on strong scientific rationale for the single agents having complementary efficacy and safety. CAL/BDP PAD-cream is an easily spreadable cream based on PAD Technology™, an innovative formulation and drug delivery system. OBJECTIVES AND METHODS A Phase 3, multicentre, randomized, investigator-blind, active and vehicle-controlled trial enrolling 490 patients with mild to moderate psoriasis according to the Physician Global Assessment (PGA) scale was conducted in three European countries. Products were applied once daily for 8 weeks. The aim of the trial was to evaluate the efficacy and safety of CAL/BDP PAD-cream as well as treatment acceptability compared to CAL/BDP gel and PAD-cream vehicle. Primary endpoint was percentage change in modified Psoriasis Area and Severity Index (mPASI) from baseline to Week 8. RESULTS The percentage mean change from baseline to Week 8 in mPASI for CAL/BDP PAD-cream (67.5%) was superior compared to PAD-cream vehicle (11.7%; p < 0.0001) and non-inferior to CAL/BDP gel (63.5%). The proportion of patients achieving PGA treatment success (at least two-step improvement to clear or almost clear) after 8 weeks was superior for CAL/BDP PAD-cream (50.7%) compared to PAD-cream vehicle (6.1%, p < 0.0001) and statistically significantly greater than CAL/BDP gel (42.7%, p = 0.0442). Patient-reported psoriasis treatment convenience score (PTCS) for CAL/BDP PAD-cream was rated superior to CAL/BDP gel at Week 8 (p < 0.0001) and the mean change in DLQI from baseline to Week 8 improved statistically significantly more in the CAL/BDP PAD-cream group compared to both PAD-cream vehicle (p < 0.0001) and CAL/BDP gel (p = 0.0110). Safety assessments during the trial demonstrated that CAL/BDP PAD-cream was well-tolerated. CONCLUSION CAL/BDP PAD-cream is a novel topical treatment of psoriasis that has a high efficacy and a favourable safety profile combined with a superior patient-reported treatment convenience.
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Affiliation(s)
- A Pinter
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - A Reich
- Department of Dermatology, University of Rzeszow, Rzeszów, Poland
| | | | - L S Gold
- Dermatology Clinical Research, Henry Ford Health System, Detroit, Michigan, USA
| | - A Armstrong
- University of Southern California, Los Angeles, California, USA
| | | | | | - M Augustin
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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