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Riaz S, Emam S, Wang T, Gniadecki R. Negative impact of comorbidities on all-cause mortality of patients with psoriasis is partially alleviated by biologic treatment: A real-world case-control study. J Am Acad Dermatol 2024; 91:43-50. [PMID: 38387852 DOI: 10.1016/j.jaad.2024.01.078] [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: 07/26/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Cardiovascular comorbidities are believed to cause higher mortality in psoriasis patients. Conversely, systemic therapy may improve overall survival. OBJECTIVE To evaluate the impact of different comorbidities and therapy on mortality risk of psoriasis patients in the entire population of Alberta, Canada (population 4.37 million). METHODS Cohorts of psoriasis cases (n = 18,618) and controls (ambulatory patients matched 1:3 by age and sex) were retrieved from Alberta Health Services Data Repository of Reporting database within the period 2012 to 2019. Cases were stratified according to Charlson Comorbidity Index, and the type of therapy. RESULTS Mortality in psoriasis cohort was significantly higher than in the controls (median age of death 72.0 years vs 74.4 years, respectively). Charlson Comorbidity Index and comorbidities were strong predictors of mortality, in particular drug induced liver injury (hazard ratio 1.8, affective bipolar disease, hazard ratio 1.6, and major cardiovascular diseases. Mortality was lower in patients treated with biologics (hazard ratio 0.54). LIMITATIONS Some factors (psoriasis type and severity, response to treatment, smoking, alcohol intake) could not be measured. CONCLUSIONS Hepatic injury, psychiatric affective disorders and cardiovascular disease were major determinants of overall survival in psoriasis. Biologic therapy was associated with a reduced mortality risk.
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Affiliation(s)
- Saba Riaz
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Sepideh Emam
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Ting Wang
- Provincial Research Data Services-Alberta Health Services, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
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2
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Galajda NÁ, Meznerics FA, Mátrai P, Fehérvári P, Lengyel AS, Kolonics MV, Sipos Z, Kemény LV, Csupor D, Hegyi P, Bánvölgyi A, Holló P. Reducing cardiovascular risk in immune-mediated inflammatory diseases: Tumour necrosis factor inhibitors compared to conventional therapies-A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:1070-1088. [PMID: 38433519 DOI: 10.1111/jdv.19900] [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: 10/02/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
Immune-mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)-α-mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case-control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random-effects meta-analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non-biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta-analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58-0.95, p = 0.025; IRR = 0.77, 95% CI 0.67-0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi-treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64-0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.
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Affiliation(s)
- N Á Galajda
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - F A Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - P Mátrai
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - P Fehérvári
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | - A S Lengyel
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- HCEMM-SU Translational Dermatology Research Group, Department of Physiology, Semmelweis University, Budapest, Hungary
| | - M V Kolonics
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Z Sipos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - L V Kemény
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- HCEMM-SU Translational Dermatology Research Group, Department of Physiology, Semmelweis University, Budapest, Hungary
| | - D Csupor
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - P Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - A Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - P Holló
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Poortinga S, Sondermann W, Förster M, Yazdi AS, Bieber T, Balakirski G, Wilsmann-Theis D. [Inpatient care for psoriasis: quo vadis?-A retrospective study at the University Hospitals of Aachen, Bonn, and Essen from 2010 to 2019]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:170-175. [PMID: 37819277 DOI: 10.1007/s00105-023-05234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION A number of new, highly effective biologic drugs for psoriasis have been approved over the past few decades, which raises the question whether psoriasis is still a disease that requires inpatient treatment. METHODS We conducted a retrospective analysis of inpatient data between 2010 and 2019 (the last 10 years prior to the coronavirus disease 2019 [COVID-19] pandemic) from three German dermatology departments at university hospitals (Aachen, Bonn, and Essen). The data collected included age, gender, the primary admission diagnosis, length of stay (LOS), and number of all comorbidities recorded during hospitalization. RESULTS A total of 59,500 patients were admitted to the three dermatological departments in the defined 10-year period. Of these patients, psoriasis (L40.-) was the main diagnosis for 4322 (7.3%). An almost continuous increase was observed in all inpatient dermatological cases, which was as high as 27% in 2016 compared to 2010. For psoriasis patients, the most substantial increase in the number of admissions was reached in 2016 compared to 2010 and was as high as 45%. While there was a statistically significant reduction of the mean LOS for all dermatological inpatient cases from 6.4 ± 6.6 days in 2010 to 5.1 ± 4.6 days in 2019 (p < 0.001), the decrease in 2019 compared to 2010 (from 12.2 ± 5.5 to 8.9 ± 3.3 days) was significantly greater for the inpatient psoriasis patients compared to the inpatient population overall (p < 0.001). CONCLUSIONS Our data show a stable need for inpatient psoriasis facilities in Germany. Further analysis of hospital admissions after the end of the COVID-19 pandemic is needed to understand the ongoing influence of modern systemic treatment options on inpatient psoriasis care in Germany.
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Affiliation(s)
- Sietske Poortinga
- Abteilung für Dermatologie, Bergman Clinics, Cromhoffsbleekweg 2, 7513, Enschede, Niederlande.
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Wiebke Sondermann
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Meike Förster
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Amir S Yazdi
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Thomas Bieber
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Galina Balakirski
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
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Strober B, Coates LC, Lebwohl MG, Deodhar A, Leibowitz E, Rowland K, Kollmeier AP, Miller M, Wang Y, Li S, Chakravarty SD, Chan D, Shawi M, Yang YW, Thaҫi D, Rahman P. Long-Term Safety of Guselkumab in Patients with Psoriatic Disease: An Integrated Analysis of Eleven Phase II/III Clinical Studies in Psoriasis and Psoriatic Arthritis. Drug Saf 2024; 47:39-57. [PMID: 37906417 PMCID: PMC10764399 DOI: 10.1007/s40264-023-01361-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION The benefit/risk profiles of biologics can be affected by comorbidities, certain demographic characteristics, and concomitant medications; therefore, it is important to evaluate the long-term safety profiles of biologics across broad patient populations. Guselkumab was well tolerated and efficacious across individual pivotal clinical studies in adults with moderate-to-severe psoriasis and/or active psoriatic arthritis (PsA). OBJECTIVES The objective of the current analysis was to evaluate guselkumab safety in a large population of patients with psoriatic disease by pooling adverse event (AE) data from 11 phase II/III studies (seven in psoriasis; four in PsA). METHODS Guselkumab was generally administered as 100 mg subcutaneous injections at Week 0, Week 4, then every 8 weeks (Q8W) in psoriasis studies and at Week 0, Week 4, then every 4 weeks (Q4W) or Q8W in PsA studies. Safety data were summarized for the placebo-controlled period (Weeks 0-16 in psoriasis; Weeks 0-24 in PsA) and through the end of the reporting period (up to 5 years in psoriasis; up to 2 years in PsA). Using the integrated data, incidence rates of key AEs were determined post hoc, adjusted for duration of follow-up, and reported per 100 patient-years (PYs). AE rates were also determined in subgroups of patients defined by sex, age, body mass index (BMI), and prior biologic use. RESULTS During the placebo-controlled period, 1061 patients received placebo (395 PYs) and 2257 received guselkumab (856 PYs). Through the end of the reporting period, 4399 guselkumab-treated patients contributed 10,787 PYs of follow-up. During the placebo-controlled period, in the guselkumab and placebo groups, respectively, rates of AEs were 281 versus 272/100 PYs, and infections were 76.0 versus 72.2/100 PYs. Rates of serious AEs (5.6 vs. 7.8/100 PYs), AEs leading to discontinuation (4.9 vs. 6.6/100 PYs), serious infections (1.0 vs. 2.3/100 PYs), malignancy (0.59 vs. 0.25 patients/100 PYs), and major adverse cardiovascular events (MACE; 0.35 vs. 0.25/100 PYs) were low and comparable between guselkumab and placebo. Among guselkumab-treated patients, safety event rates through the end of the reporting period were numerically lower than or comparable with rates observed during the placebo-controlled period: AEs, 164/100 PYs; infections, 61.2/100 PYs; serious AEs, 5.4/100 PYs; AEs leading to discontinuation, 1.8/100 PYs; serious infections, 1.0/100 PYs; malignancy, 0.6/100 PYs; and MACE, 0.3/100 PYs. No AEs of Crohn's disease, ulcerative colitis, or active tuberculosis were reported among guselkumab-treated patients. In the psoriasis studies, no opportunistic infections were reported among guselkumab-treated patients. Three AEs of opportunistic infections were reported in guselkumab-treated patients with PsA (0.14/100 PYs; all after Week 52 in DISCOVER-2). AE rates were largely consistent across subgroups of guselkumab-treated patients defined by sex, age, BMI, and prior biologic use. CONCLUSIONS In this analysis of 4399 guselkumab-treated patients with psoriatic disease followed for 10,787 PYs, guselkumab had a favorable AE profile. AE rates were similar between guselkumab- and placebo-treated patients and were consistent throughout long-term guselkumab treatment and across broad subgroups of patients with psoriatic disease. CLINICAL TRIALS REGISTRATIONS Clinicaltrials.gov identifiers: NCT01483599, NCT02207231, NCT02207244, NCT02203032, NCT02905331, NCT03090100, NCT02325219, NCT02319759, NCT03162796, NCT03158285, and NCT03796858.
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Affiliation(s)
- Bruce Strober
- Yale University, New Haven, CT, USA.
- Central Connecticut Dermatology Research, Cromwell, CT, USA.
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Megan Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Yanli Wang
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Shu Li
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Daphne Chan
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - May Shawi
- Immunology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Diamant Thaҫi
- Institute and Comprehensive Center for Inflammatory Medicine, University of Luebeck, Luebeck, Germany
| | - Proton Rahman
- Division of Rheumatology, Craig L. Dobbin Genetics Research Centre, Discipline of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
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Brodell RT. JAAD Game Changer: "Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry: A nested case-control analysis". J Am Acad Dermatol 2023; 89:1140. [PMID: 37562604 DOI: 10.1016/j.jaad.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
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6
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Zhao Y, Yang XT, Bai YP, Li LF. Association of Complete Blood Cell Count-Derived Inflammatory Biomarkers with Psoriasis and Mortality. Clin Cosmet Investig Dermatol 2023; 16:3267-3278. [PMID: 38021430 PMCID: PMC10655728 DOI: 10.2147/ccid.s437936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
Background and Aim Psoriasis is a persistent inflammatory disorder that affects 3% of the population and is associated with cardiovascular diseases. Therefore, this study aimed to investigate the correlations between complete blood cell count (CBC)-derived inflammatory biomarkers, psoriasis prevalence, and all-cause mortality. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2006 and 2009-2014. Mortality data up to December 31, 2019 were obtained using the National Death Index. The following CBC-derived inflammatory biomarkers were examined: neutrophil/lymphocyte ratio (NLR), neutrophil/(white blood cells - neutrophils) ratio (dNLR), monocyte count/lymphocyte ratio (MLR), (neutrophil + monocyte)/lymphocyte ratio (NMLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI). Weighted logistic and Cox regression analyses were used to calculate odds ratios, hazard ratios, and the corresponding 95% confidence intervals. Additionally, the prognostic value of the inflammatory indicators was assessed and ranked using the random survival forest approach. Results In total, data from 21,431 participants with average age of 45.02 ± 0.27 years (49.51% male) were included in the study, among which 600 participants were positive for psoriasis (prevalence rate, 2.80%). Additionally, 79 all-cause deaths were recorded during a median follow-up period of 8.83 (6.67-11.00) years. Moreover, NLR, dNLR, NMLR, PLR, and SIRI were positively associated with the prevalence of psoriasis. Furthermore, MLR, NMLR, and SIRI were positively correlated with all-cause mortality in patients with psoriasis, with NMLR being the most valuable predictor of all-cause mortality. Conclusion CBC-derived inflammatory biomarkers were associated with psoriasis prevalence, NMLR, SIRI, and MLR values were associated with all-cause mortality in patients with psoriasis. Overall, assessment of these CBC-derived indicators may serve as a simple method for screening high-risk individuals among patients with psoriasis.
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Affiliation(s)
- Yang Zhao
- Department of Dermatology, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, People’s Republic of China
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Xu Tong Yang
- Department of Dermatology, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, People’s Republic of China
| | - Yan Ping Bai
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
| | - Lin Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
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7
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Gooderham MJ, Bissonnette R, Kalia S, Papp KA, Guenther LC, Gulliver WP, Ho V, Shear NH, Vender R, Gniadecki R, Prajapati VH, Turchin I, Langholff W, Parnell K, Simpson SD, Abbarin N, Lakhani O, Alhusayen R. Baseline Characteristics of Canadian Patients in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Cutan Med Surg 2023; 27:594-600. [PMID: 37571829 PMCID: PMC10714709 DOI: 10.1177/12034754231191509] [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: 05/07/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The Psoriasis Longitudinal Assessment and Registry (PSOLAR) is a global, prospective, longitudinal, disease-based registry. It serves as a post-marketing safety commitment with a focus on patients with moderate to severe plaque psoriasis who are candidates for systemic therapy. OBJECTIVES To describe the baseline disease demographics and clinical characteristics of a Canadian subgroup of participants enrolled in PSOLAR. METHODS Baseline demographic/disease characteristics, medical histories, and previous psoriasis treatments for Canadian patients in PSOLAR were summarized using descriptive statistics. RESULTS There were 1896 patients analyzed in the Canadian subgroup at 37 clinical sites, accounting for 15.7% of the global PSOLAR population. Baseline disease and clinical characteristics were as expected for a moderate to severe psoriasis population and were generally similar to the global PSOLAR population. Two distinctions were noted in the Canadian subgroup versus those enrolled globally: a higher proportion of patients were overweight/obese (84.7% vs. 80.4%) and male (61.4% vs. 54.7%). In addition, the Canadian subgroup had numerically higher historical peak disease activity (PGA score 3.35 vs. 3.1) and longer disease duration (22.3 years vs. 17.5 years). Canadian PSOLAR patients reported a variety of comorbidities, including psoriatic arthritis (31.5%), hypertension (34.6%), hyperlipidemia (24.3%), mental illness (24.1%), and inflammatory bowel disease (1.6%). CONCLUSION The Canadian subgroup of PSOLAR patients was generally similar to those enrolled globally with respect to baseline disease demographics and clinical characteristics. Multiple comorbidities are noted in the Canadian subgroup, underscoring the need for a holistic approach to the treatment of psoriatic patients.
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Affiliation(s)
- Melinda J. Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, ON, Canada
| | | | - Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Kim A. Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
| | | | - Wayne P. Gulliver
- Memorial University of Newfoundland and New Lab Life Sciences, St. John’s, NL, Canada
| | - Vincent Ho
- Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Neil H. Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Ron Vender
- Dermatrials Research Inc., Hamilton, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vimal H. Prajapati
- 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
- Department of Pediatrics, Section of Pediatric Rheumatology, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Irina Turchin
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
| | | | - Kim Parnell
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | | | - Raed Alhusayen
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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8
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Salahuddin T, Hebbe A, Kovach CP, Strobel A, Armstrong EJ, Waldo SW. Biologic therapy for psoriasis is associated with reduced risk of death: Insights from the VA clinical assessment, reporting and tracking program. J Eur Acad Dermatol Venereol 2023. [PMID: 36786354 DOI: 10.1111/jdv.18964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Taufiq Salahuddin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Annika Hebbe
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia, USA
| | - Christopher P Kovach
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Aaron Strobel
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Stephen W Waldo
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia, USA.,Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
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9
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Dao DPD, Pixley JN, Feldman SR. When should systemic biologic therapy for psoriasis be discontinued? J DERMATOL TREAT 2023; 34:2173516. [PMID: 36705324 DOI: 10.1080/09546634.2023.2173516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Diem-Phuong D Dao
- 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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10
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Association between psoriasis and short-term outcomes of acute myocardial infarction: A matched-pair cohort study using a nationwide inpatient database in Japan. JAAD Int 2022; 8:21-30. [PMID: 35620322 PMCID: PMC9127561 DOI: 10.1016/j.jdin.2022.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Objective Methods Results Limitations Conclusion
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11
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Augustin M, Garbe C, Neitemeier S, Steimle T, Schwarz S, Augustin J, von Kiedrowski R, Hagenström K. [Regional variations in healthcare for patients with psoriasis and atopic dermatitis in Germany]. Hautarzt 2021; 73:27-39. [PMID: 34821976 DOI: 10.1007/s00105-021-04913-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare. OBJECTIVES The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison. METHODS Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined. RESULTS In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors (< 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found. CONCLUSION Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.
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Affiliation(s)
- M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Garbe
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | | | - T Steimle
- Techniker Krankenkasse, Hamburg, Deutschland
| | - S Schwarz
- Techniker Krankenkasse, Hamburg, Deutschland
| | - J Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - R von Kiedrowski
- Dermatologische Spezial- und Schwerpunktpraxis Selters, Selters, Deutschland
| | - K Hagenström
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
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Mosca M, Hong J, Hadeler E, Hakimi M, Brownstone N, Liao W, Bhutani T. Psoriasis and Cardiometabolic Comorbidities: An Evaluation of the Impact of Systemic Treatments in Randomized Clinical Trials. Dermatol Ther (Heidelb) 2021; 11:1497-1520. [PMID: 34505985 PMCID: PMC8484473 DOI: 10.1007/s13555-021-00590-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
The association between psoriasis, metabolic syndrome, and cardiovascular disease is well established. The shared pathways between psoriasis, metabolic syndrome, and atherosclerosis suggest that treatments targeting the inflammatory pathways of psoriasis may also be beneficial in the treatment of associated cardiometabolic comorbidities. This paper reviews the most recent data regarding the impact of systemic psoriasis treatments on comorbid cardiovascular and metabolic disease. Data from randomized clinical trials with systemic and biologic agents are presented. Overall, studies demonstrate beneficial effects on several cardiometabolic markers and risk factors in psoriasis patients; however, longer randomized controlled trials to characterize the direct benefit for cardiovascular outcomes are needed.
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Affiliation(s)
- Megan Mosca
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Julie Hong
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Edward Hadeler
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
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Bissonnette R, Gottlieb AB, Langley RG, Leonardi CL, Papp KA, Pariser DM, Uy J, Lafferty KP, Langholff W, Fakharzadeh S, Berlin JA, Brouwer ES, Greenspan AJ, Strober BE. Signal Detection and Methodological Limitations in a Real-World Registry: Learnings from the Evaluation of Long-Term Safety Analyses in PSOLAR. Drug Saf 2021; 44:699-709. [PMID: 34075572 PMCID: PMC8184557 DOI: 10.1007/s40264-021-01065-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Psoriasis Longitudinal Assessment and Registry (PSOLAR) was designed in 2007 as the first disease-based registry for patients with psoriasis. OBJECTIVE The aim of this study was to discuss methodological limitations and post hoc analyses in long-term safety registries using learnings from analyses of a potential safety risk for major adverse cardiovascular events (MACE) in PSOLAR. METHODS PSOLAR is an international observational study of over 12,000 psoriasis patients that was conducted to meet postmarketing safety commitments for infliximab and ustekinumab. A recent annual review of registry data indicated a potential MACE risk for ustekinumab vs. non-biologics based on prespecified COX model regression analyses, which yielded an adjusted hazard ratio (HR) of 1.533 (95% confidence interval [CI] 1.103-2.131). Therefore, we conducted a comprehensive review of key statistical methodology and implemented post hoc analytical methods to address specific limitations. RESULTS The following limiting factors were identified: (1) inclusion of both prevalent and incident (new) users of biologics; (2) unanticipated imbalances in patient characteristics between treatment cohorts at baseline; (3) limited availability of relevant clinical data after enrollment; and (4) divergence of characteristics associated with outcomes among comparator groups over time. The analysis was modified to include only incident users, propensity scores were used to weight HRs, and adalimumab was deemed a more clinically appropriate comparator. The revised HR was 0.820 (95% CI 0.532-1.265), indicating no meaningful increase in MACE risk for ustekinumab. CONCLUSION Our results, which do not support a causal association between ustekinumab exposure and MACE risk, underscore the need for ongoing assessment of analytical methods in long-term observational studies.
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Affiliation(s)
- Robert Bissonnette
- Innovaderm Research, Inc., 3530 St-Laurent Blvd, Suite 300, Montreal, QC, H2X 2V1, Canada.
| | | | | | | | - Kim A Papp
- K. Papp Clinical Research and Probity Research Inc., Waterloo, ON, Canada
| | | | - Jonathan Uy
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | | | | | | | | | - Bruce E Strober
- Yale University, New Haven, CT, USA
- Central Connecticut Dermatology Research, Cromwell, CT, USA
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This Month in JAAD - January 2021. J Am Acad Dermatol 2020; 84:34. [PMID: 33122019 DOI: 10.1016/j.jaad.2020.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022]
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