1
|
Affandi AM, Thiruchelvam K. Patient perspective on psoriasis: Psychosocial burden of psoriasis and its management in Malaysia. PLoS One 2024; 19:e0305870. [PMID: 39024344 PMCID: PMC11257229 DOI: 10.1371/journal.pone.0305870] [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: 08/18/2023] [Accepted: 06/05/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Psoriasis is a chronic erythematous inflammatory skin disorder. The major challenge with psoriasis is delayed diagnosis, resulting in delayed treatment initiation and reduced quality of life (QoL). OBJECTIVE This patient perspective study aimed to explore the emotional and psychosocial burdens faced by patients with psoriasis in Malaysia and their attitudes toward current psoriasis treatment. METHODS Adult patients with mild or moderate-to-severe plaque psoriasis, preferably with concomitant psoriatic arthritis, participated in a patient advisory board meeting along with a senior consultant dermatologist. Patients had to describe their initial symptoms, time of diagnosis, misdiagnosis, treatment initiation delays, treatment course, flare-ups, psychosocial impact, and QoL associated with psoriasis. RESULTS The 11 participating patients had a mean age of 46 years with mean age of psoriasis diagnosis and an average year of suffering with psoriasis being 21.9 years and 24.5 years, respectively. The most common initial symptom of psoriasis was itching (62.5%), particularly of the scalp followed by itchiness and red patches on skin. Most patients (90%) reported initial misdiagnosis with other skin diseases by their primary care physicians (PCPs), which led to delayed treatment initiation. Most patients reported an emotional impact of psoriasis, including low self-esteem (18%), lack of confidence (27%), shock (18%), sadness (9%), and outrage (9%). Social discrimination/stigmatization in public places and at work (45%), and even from relatives (18%) was another reported challenge. However, 73% of patients were highly satisfied with the current treatment. Overall, the patients agreed that the lack of public awareness of psoriasis was responsible for the social stigma. CONCLUSIONS The evidence obtained from this qualitative study indicated that psoriasis has a significant emotional and psychological impact on the patients affecting their QoL. Lack of awareness of the disease among PCPs, patients, and the public is a major challenge leading to poor treatment outcomes.
Collapse
Affiliation(s)
- Azura Mohd Affandi
- Consultant Dermatologist, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Medical Advisor of Psoriasis Association of Malaysia, Selangor Darul Ehsan, Malaysia
| | - K. Thiruchelvam
- Psoriasis Association of Malaysia, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
2
|
Drozdowski R, Jain N, Gronbeck C, Feng H. Disparities in Care for Psoriasis. Dermatol Clin 2024; 42:507-512. [PMID: 38796279 DOI: 10.1016/j.det.2024.02.009] [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
Race, ethnicity, language, sex, age, income, insurance status, location, and other socioeconomic and demographic factors influence access to and quality of care for patients with psoriasis, which can potentially lead to inequitable outcomes.
Collapse
Affiliation(s)
- Roman Drozdowski
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA.
| |
Collapse
|
3
|
Truong TM, Pathak GN, Singal A, Taranto V, Rao BK. Deucravacitinib: The First FDA-Approved Oral TYK2 Inhibitor for Moderate to Severe Plaque Psoriasis. Ann Pharmacother 2024; 58:416-427. [PMID: 37341177 DOI: 10.1177/10600280231153863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE The objective of this study was to review the safety and efficacy of deucravacitinib, a tyrosine kinase 2 (TYK2) inhibitor for moderate to severe plaque psoriasis. DATA SOURCES Literature was reviewed from MEDLINE and Clinicaltrials.gov up to December 2022 using the terms "deucravacitinib" and "BMS-986165." STUDY SELECTION Relevant articles in English relating to the pharmacodynamics, pharmacokinetics, efficacy, and safety of deucravacitinib were included. A total of 6 trial results were included. STUDY SELECTION AND DATA EXTRACTION Deucravacitinib showed clinical efficacy across all the phase II and III clinical trials. Excluding the long-term extension study, there were 2248 subjects across all studies, with 63.2% of patients receiving deucravacitinib 6 mg daily. Of these subjects, the average proportion achieving a PASI 75 (a reduction of greater than 75% in the Psoriasis Area and Severity Index) at week 16 was 65.1%. Patients receiving deucravacitinib 6 mg once daily had a higher rate of achieving both PASI 75 response and a Static Physician's Global Assessment (sPGA) score of 0 or 1, compared with oral apremilast 30 mg twice daily. The safety profile of deucravacitinib includes mild adverse events (AEs), most commonly nasopharyngitis, with serious AEs reported ranging from 1.35% to 9.5%. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING MEDICATIONS While many available therapies for moderate to severe plaque psoriasis rely on an injectable dosage form or extensive monitoring, deucravacitinib can potentially reduce patient medication-related burden. This review summarizes the efficacy and safety of oral deucravacitinib for the treatment of severe plaque psoriasis. CONCLUSION Deucravacitinib shows a consistent efficacy and safety profile as the first oral TYK2 inhibitor approved for adult patients with moderate to severe plaque psoriasis who are eligible for systemic therapy or phototherapy treatment.
Collapse
Affiliation(s)
- Thu Minh Truong
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gaurav N Pathak
- School of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amit Singal
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| |
Collapse
|
4
|
Ossanai Schoenardie B, Oliveira Almeida R, Hanemann T, Ossanai Schoenardie A, Ribeiro AL, Catucci Boza J. Unmet needs in the management of psoriasis in Latin America: a systematic review. An Bras Dermatol 2024; 99:244-258. [PMID: 38061962 PMCID: PMC10943312 DOI: 10.1016/j.abd.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Psoriasis is a chronic, systemic inflammatory disease with a worldwide prevalence of approximately 2%. Currently, despite the difficulties faced every day by patients and physicians in low-resource countries, literature describing the exact needs of psoriasis treatment in Latin America remains scarce. OBJECTIVE To investigate the unmet needs in psoriasis treatment in Latin America. METHODS The authors conducted a systematic review following PRISMA statements in PubMed, Embase, and LILACS of studies published from January 2011 to March 2021 addressing challenges in psoriasis treatment in Latin America. RESULTS The search strategy identified 3,837 articles, of which 19 were included in the final analysis. Most were from Brazil (58%; n=11), all were observational, and most were cross-sectional (84%; n=16). Difficulties faced by psoriasis patients in Latin America included the high prevalence of opportunistic and endemic infections (42% of the studies addressed this matter; n=8), delay in diagnosis (5%; n=1), work productivity impairment (16%; n=3), limited access to medication/medical care (37%; n=7), poor adherence to treatment (5%; n=1) and poor adherence to guidelines (11%; n=2). STUDY LIMITATIONS Number and quality of studies currently available on this subject. CONCLUSIONS Current psoriasis guidelines do not always account for epidemiological, financial, and cultural characteristics. Most studies available are from Brazil, which might not accurately represent Latin America as a whole. In a region where neglected diseases and scarce resources remain a reality, it is imperative that dermatological training be offered to primary care providers, allowing for standardized conduct and earlier diagnosis.
Collapse
Affiliation(s)
| | | | - Thaísa Hanemann
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - André Lucas Ribeiro
- Department of Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Juliana Catucci Boza
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Mary E Horner
- Dermatology Consultants of Sacramento, 5340 Elvas Ave, Ste 600, Sacramento, CA, 95819, USA.
| | | | | | | | | |
Collapse
|
6
|
Yee D, Lee K, Huang MY, Kingston P, Korouri E, Peterson H, Armstrong AW. Assessing the Quality, Comprehensiveness, and Readability of Online Patient Health Resources About Psoriasis in Skin of Color. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:52-54. [PMID: 38125673 PMCID: PMC10729803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Danielle Yee
- Dr. Yee and Dr. Armstrong are with the Division of Dermatology, University of California in Los Angeles, Los Angeles, California
| | - Kathryn Lee
- Ms. Lee is with Saint Louis University School of Medicine in Saint Louis, Missouri
| | - Margaret Y. Huang
- Ms. Huang and Ms. Kingston are with Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paige Kingston
- Ms. Huang and Ms. Kingston are with Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Edwin Korouri
- Mr. Korouri is with Chicago Medical School in North Chicago, Illinois
| | - Hannah Peterson
- Ms. Peterson is with Loma Linda University School of Medicine in Loma Linda, California
| | - April W. Armstrong
- Dr. Yee and Dr. Armstrong are with the Division of Dermatology, University of California in Los Angeles, Los Angeles, California
| |
Collapse
|
7
|
Li C, Sunhe Y, Zhou H, Dong W. Efficacy and safety evaluations of adalimumab biosimilars in the treatment of psoriasis. J DERMATOL TREAT 2023; 34:2249145. [PMID: 37608703 DOI: 10.1080/09546634.2023.2249145] [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: 04/10/2023] [Accepted: 05/17/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE We aimed to systematically evaluate the efficacy and safety of adalimumab biosimilar agents in the treatment of moderate-to-severe plaque psoriasis, in order to provide evidence-based reference data for clinical medicine. MATERIALS AND METHODS Five databases were searched by electronic retrieval: PubMed, Embase, Cochrane Library, WanFang and CNKI (China National Knowledge Internet). The retrieval period was from the establishment of each database up to April 2022. Randomized controlled trials (RCTs) on adalimumab biosimilar agents compared with their reference agents in the treatment of moderate-to-serve plague psoriasis were included. A meta-analysis using RevMan software was applied to 8 RCTs involving 2589 patients. RESULTS After 16 weeks of medication, there was no significant difference in the response rates of adalimumab biosimilar agents and their reference agents defined as a decrease in the Psoriasis Area and Severity Index (PASI) of ≥75% (PASI 75) (p > 0.05), or in the PASI 50, PASI 90 and PASI 100 measures (p > 0.05). After 16 weeks and 24 weeks of medication, there was no significant difference in the incidence rate of serious adverse events (SAEs) between adalimumab biosimilar agents and their reference agents (p > 0.05). After 16 weeks, 24 weeks and 51 weeks of medication, there was no significant difference in withdrawal rate due to SAEs, treatment-emergent adverse events and adverse events of special interest between adalimumab biosimilar agents and their reference agents (p > 0.05). CONCLUSION These findings suggest that biosimilar agents of adalimumab have an overall efficacy and safety profile for psoriasis comparable to those of their reference agents.
Collapse
Affiliation(s)
- Changkun Li
- Department of Pharmacy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yixuan Sunhe
- School of Pharmacy, Xi'an Medical College, Xi'an, PR China
| | - Hui Zhou
- Department of Pharmacy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Weihua Dong
- Department of Pharmacy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| |
Collapse
|
8
|
Luna PC, Chu CY, Fatani M, Borlenghi C, Adora A, Llamado LQ, Wee J. Psychosocial Burden of Psoriasis: A Systematic Literature Review of Depression Among Patients with Psoriasis. Dermatol Ther (Heidelb) 2023; 13:3043-3055. [PMID: 37995052 PMCID: PMC10689612 DOI: 10.1007/s13555-023-01060-5] [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: 07/11/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
Psoriasis is associated with various comorbidities with a notable psychosocial burden. This systematic literature review explores the burden of depression in patients with psoriasis, comparing it with that experienced by patients with other chronic medical conditions. Embase via Ovid, PubMed, and Cochrane Database of Systematic Reviews via Ovid were searched for peer-reviewed studies published in English between January 1, 2016 and December 6, 2021 that reported real-world evidence or observational studies involving at least 100 adults (age ≥ 18 years) with general (unspecified) or plaque psoriasis experiencing symptoms of depression (but not restricted to patients with a clinical diagnosis). Any report of depression or suicidality was eligible for inclusion. Systematic literature reviews reporting depression/suicidality in other chronic medical conditions were also included. Statistical analysis was not performed; the study was descriptive only. A total of 1744 records were identified, and after several defined screenings by two independent reviewers for publication year, relevance, and sample size, 82 publications were included. Psoriasis was significantly associated with depression. The prevalence of depression in patients with psoriasis ranged from 0.2% to 74.6%, with incidence from 4.83 to 91.9 per 1000 person-years. The prevalence of depression was generally higher among patients with more severe psoriasis than those with less severe disease (as determined by Psoriasis Area Severity Index [PASI] scoring system) and was more prevalent among women than men with psoriasis. Depression in psoriasis significantly reduced quality of life, including factors such as sexual dysfunction, sleep difficulties, subjective well-being, and addictions. Comorbid hypertension, hyperlipidemia, psoriatic arthritis, obesity, inflammatory bowel disease, diabetes, and statin use were all associated with increased depression risk in patients with psoriasis. This systematic literature review found that the burden of depression in psoriasis is no lower than in other chronic medical conditions. Greater awareness of the psychological impact of psoriasis would improve care and management, which should incorporate psychological interventions.
Collapse
Affiliation(s)
- Paula C Luna
- Hospital Aleman, Arenales 2557 1a ZC 1425, Buenos Aires, Argentina.
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mohammad Fatani
- Dermatology Department, Hera General Hospital, Makkah, Saudi Arabia
| | | | - Anna Adora
- Department of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines
- Department of Adult Cardiology, Philippine Heart Center, Quezon City, Metro Manila, Philippines
| | | | - James Wee
- Pfizer Inc., Makati City, Philippines
| |
Collapse
|
9
|
Nguyen HT, Vu AT, Pham NTU, Tran TNA, Pham NN, Bui HTT, Pham TT, Dinh VTT, Bui YT, Vu TTP. Comorbidity Burden and Treatment Patterns of Psoriasis in Vietnam: Real-World Data from the EXPAND Study. Dermatol Ther (Heidelb) 2023; 13:3193-3208. [PMID: 37978119 PMCID: PMC10689324 DOI: 10.1007/s13555-023-01062-3] [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: 08/31/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Psoriasis is a multi-faceted, immune-mediated inflammatory disease associated with a wide range of comorbidities. Real-world data on treatment patterns, comorbidities, and economic burden in patients with psoriasis are needed for comprehensive patient care in Vietnam. METHODS A retrospective chart review study was conducted using secondary data extracted from patients' medical records of two hospitals in Vietnam, with the aim of identifying adult patients with a confirmed diagnosis of psoriasis. The index date was defined as the date of first diagnosis between 1 January 2020 and 31 October 2021. Sociodemographic factors, disease characteristics, comorbidities, medication usage, drug survival, and medication costs were analyzed. RESULTS A total of 661 patients were identified (mean ± standard deviation [SD] age 43.5 ± 14.8 years). The most prevalent comorbidity was dyslipidemia (49.6% of patients), followed by hypertension (23.4%), and psoriatic arthritis (10.4%). In total, 44% of patients received biologic therapies. Overall, 66.7% and 54.3% of patients receiving biologic and non-biologic therapies, respectively, had ≥ 1 comorbidity. Only 23.2% of patients with psoriasis-related comorbidities stopped therapy with biologics. Biologics had a longer retention time (17.0 months) than non-biologics (6.0 months) in patients with comorbidities. Patients with comorbidities had significantly higher total annual healthcare costs than those without comorbidities (in US dollars: USD901 vs. USD304; p < 0.001), mainly due to the relatively higher costs associated with the use of biologics. CONCLUSION Patients with psoriasis in Vietnam experience a high disease and economic burden due to comorbidities. Evidence from this real-world study supports the need for routine monitoring of and an appropriate treatment course for psoriasis-related comorbidities.
Collapse
Affiliation(s)
- Hao Trong Nguyen
- Ho Chi Minh City Hospital of Dermato-Venereology, 2 Nguyen Thong, Ward Vo Thi Sau, District 3, Ho Chi Minh City, Vietnam.
| | - Anh Tuan Vu
- Quy Hoa National Leprosy Dermatology Hospital, Quy Nhon City, Binh Dinh Province, Vietnam
| | - Nhi Thi Uyen Pham
- Ho Chi Minh City Hospital of Dermato-Venereology, 2 Nguyen Thong, Ward Vo Thi Sau, District 3, Ho Chi Minh City, Vietnam
| | - Tu Nguyen Anh Tran
- Ho Chi Minh City Hospital of Dermato-Venereology, 2 Nguyen Thong, Ward Vo Thi Sau, District 3, Ho Chi Minh City, Vietnam
| | - Nguyen Nhat Pham
- Ho Chi Minh City Hospital of Dermato-Venereology, 2 Nguyen Thong, Ward Vo Thi Sau, District 3, Ho Chi Minh City, Vietnam
| | - Huong Thi Thanh Bui
- Quy Hoa National Leprosy Dermatology Hospital, Quy Nhon City, Binh Dinh Province, Vietnam
| | - Thuyen Thi Pham
- Quy Hoa National Leprosy Dermatology Hospital, Quy Nhon City, Binh Dinh Province, Vietnam
| | - Vi Thi Thuy Dinh
- Quy Hoa National Leprosy Dermatology Hospital, Quy Nhon City, Binh Dinh Province, Vietnam
| | - Yen Thi Bui
- Novartis Vietnam Company Limited, Ho Chi Minh City, Vietnam
| | - Thao Thi Phuong Vu
- Ho Chi Minh City Hospital of Dermato-Venereology, 2 Nguyen Thong, Ward Vo Thi Sau, District 3, Ho Chi Minh City, Vietnam
| |
Collapse
|
10
|
Morin S, Tremblay A, Dumais E, Julien P, Flamand N, Pouliot R. Eicosapentaenoic Acid Influences the Lipid Profile of an In Vitro Psoriatic Skin Model Produced with T Cells. Biomolecules 2023; 13:1413. [PMID: 37759812 PMCID: PMC10526348 DOI: 10.3390/biom13091413] [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: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Psoriasis is a skin disease characterized by epidermal hyperplasia and an inappropriate activation of the adaptive immunity. A dysregulation of the skin's lipid mediators is reported in the disease with a predominance of the inflammatory cascade derived from n-6 polyunsaturated fatty acids (n-6 PUFAs). Bioactive lipid mediators derived from arachidonic acid (AA) are involved in the inflammatory functions of T cells in psoriasis, whereas n-3 PUFAs' derivatives are anti-inflammatory metabolites. Here, we sought to evaluate the influence of a supplementation of the culture media with eicosapentaenoic acid (EPA) on the lipid profile of a psoriatic skin model produced with polarized T cells. Healthy and psoriatic skin substitutes were produced following the auto-assembly technique. Psoriatic skin substitutes produced with or without T cells presented increased epidermal and dermal linolenic acid (LA) and AA levels. N-6 PUFA lipid mediators were strongly measured in psoriatic substitutes, namely, 13-hydroxyoctadecadienoic acid (13-HODE), prostaglandin E2 (PGE2) and 12-hydroxyeicosatetraenoic acid (12-HETE). The added EPA elevated the amounts of EPA, n-3 docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in the epidermal and dermal phospholipids. The EPA supplementation balanced the production of epidermal lipid mediators, with an increase in prostaglandin E3 (PGE3), 12-hydroxyeicosapentaenoic acid (12-HEPE) and N-eicosapentaenoyl-ethanolamine (EPEA) levels. These findings show that EPA modulates the lipid composition of psoriatic skin substitutes by encouraging the return to a cutaneous homeostatic state.
Collapse
Affiliation(s)
- Sophie Morin
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec, QC G1J 2Z4, Canada; (S.M.); (A.T.)
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
| | - Andréa Tremblay
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec, QC G1J 2Z4, Canada; (S.M.); (A.T.)
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
| | - Elizabeth Dumais
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (E.D.); (N.F.)
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec, QC G1V 0A6, Canada
| | - Pierre Julien
- Centre de Recherche du CHU de Québec-Université Laval, Axe Endocrinologie et Néphrologie, Université Laval, Québec, QC G1V 4G2, Canada;
- Département de Médecine, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Nicolas Flamand
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (E.D.); (N.F.)
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec, QC G1V 0A6, Canada
- Département de Médecine, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Roxane Pouliot
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec, QC G1J 2Z4, Canada; (S.M.); (A.T.)
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
| |
Collapse
|
11
|
Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic. Dermatol Ther (Heidelb) 2023; 13:1973-1984. [PMID: 37392261 PMCID: PMC10442297 DOI: 10.1007/s13555-023-00967-3] [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: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION Limited access to healthcare during the COVID-19 pandemic prompted patients to seek care using telehealth. In this study, we assessed whether treatment patterns differed for patients with psoriasis (PsO) or psoriatic arthritis (PsA) initiating apremilast by either a telehealth or an in-person visit. METHODS We estimated adherence and persistence among US patients in the Merative© MarketScan© Commercial and Supplemental Medicare Databases who newly initiated apremilast between April and June 2020, categorized by the type of visit (telehealth or in-person) when apremilast was first prescribed. Adherence was defined as the proportion of days covered (PDC), with PDC ≥ 0.80 considered to indicate high adherence. Persistence was defined as having apremilast available to take without a 60-day gap during follow-up. Factors associated with high adherence and persistence were estimated with logistic and Cox regression. RESULTS Among apremilast initiators (n = 505), the mean age was 47.6 years, 57.8% were female, and the majority had PsO (79.6%). Telehealth index visits were more likely among patients residing in Northeast USA (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.63-6.71) and Western USA (OR 2.52, 95% CI 1.07-5.93]), those with a prescribing rheumatologist (OR 2.27, 95% CI 1.10-4.68), and those with any baseline telehealth visit (OR 1.91, 85% CI 1.20-3.04). Those initiating apremilast with a telehealth visit (n = 141) had similar mean PDC to those initiating apremilast with an in-person visit (n = 364) (0.695 vs. 0.728; p = 0.272). At the end of the 6-month follow-up, 54.3% of the overall population had high adherence (PDC ≥ 0.80) and 65.1% were persistent. After adjusting for potential confounders, patients initiating apremilast via telehealth had similar full adherence (OR 0.80, 95% CI 0.52-1.21) and persistence as those initiating apremilast in-person. CONCLUSION Patients with PsO and patients with PsA initiating apremilast via telehealth or in-person during the COVID-19 pandemic had similar medication adherence and persistence during the 6-month follow-up period. These data suggest that patients initiating apremilast can be as effectively managed with telehealth visits as with in-person visits.
Collapse
Affiliation(s)
- Ashis K. Das
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Caleb Paydar
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Michael S. Broder
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | | | | |
Collapse
|
12
|
Sivesind TE, Oganesyan A, Bosma G, Hochheimer C, Schilling LM, Dellavalle R. Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study. JMIR DERMATOLOGY 2023; 6:e41194. [PMID: 37647114 PMCID: PMC10500357 DOI: 10.2196/41194] [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: 07/18/2022] [Revised: 06/28/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory disease caused by a type 2 T helper cell-mediated immune response to environmental antigens. Approximately 1 in 5 patients with AD presents with moderate to severe disease, and treatments approved by the Food and Drug Administration include emollients, topical glucocorticoids, and calcineurin inhibitors. Dupilumab, a fully human monoclonal antibody, improves AD via inhibition of interleukin-4 and interleukin-13. OBJECTIVE Our aim was to characterize the prescribing patterns of dupilumab for AD in adults at a large university-affiliated health system. METHODS A retrospective, observational cohort study was conducted using electronic data from the Observational Health Data Sciences and Informatics database, assessing data from the University of Colorado Medical Campus and its affiliates. The outcome measured was the prevalence of dupilumab prescribed for adults with AD (n=6421), between March 28, 2013, and March 28, 2021. We assessed whether the characteristics of patients who received dupilumab were different from those who did not. Each patient characteristic was assessed using a univariate logistic regression with the binary outcome of receiving or not receiving dupilumab. RESULTS We found a population prevalence of 5.6% (6421/114,476) for AD. In our cohort, Black patients with AD were more than twice as likely to have received dupilumab compared to White patients (odds ratio 2.352, 95% CI 1.58-3.39). Patients with a diagnosis of atopic neurodermatitis were approximately twice as likely to have received dupilumab compared to those with other diagnostic variants of AD (odds ratio 1.87, 95% CI 1.01-3.22). CONCLUSIONS Our results demonstrate that both patient racial characteristics and specific AD diagnoses were associated with variations in dupilumab prescription patterns.
Collapse
Affiliation(s)
- Torunn E Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ani Oganesyan
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Grace Bosma
- Center for Innovative Design and Analysis, The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Camille Hochheimer
- Center for Innovative Design and Analysis, The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lisa M Schilling
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert Dellavalle
- The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Denver, CO, United States
| |
Collapse
|
13
|
Kovalchin CE, Kaffenberger J, Trinidad J, Gilkey TW, Minta A, Gudjonsson J, Kaffenberger BH. Characterizing risk factors for hospitalization for psoriasis patients. Arch Dermatol Res 2023; 315:1541-1546. [PMID: 36662322 DOI: 10.1007/s00403-023-02533-5] [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: 06/01/2022] [Revised: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
Psoriasis is a chronic autoimmune disease with a large economic impact. Inpatient care is a significant expense, and about one-third of patients admitted for psoriasis are readmitted. Reducing hospitalizations and readmissions is an important goal for improving outcomes for psoriasis patients. The objective of this study is to characterize patients who are hospitalized for psoriasis, and differentiate features for patients with a single hospitalization from those who were hospitalized multiple times during the study period. Hospitalized psoriasis patients were identified from an in-patient database at a single academic institution. Differences between psoriasis patients with one hospitalization and those with multiple hospitalizations were characterized, as were differences between patients who were hospitalized primarily for psoriasis and those who were admitted primarily for other reasons. Patients who were primarily hospitalized for psoriasis had fewer comorbidities, shorter hospitalizations, and a lower death rate than those hospitalized for other reasons. Patients with multiple hospitalizations had more comorbidities and worse outcomes than patients with a single hospitalization. Patients who are hospitalized primarily for psoriasis are more likely to be pustular, and tend to have fewer comorbidities and better outcomes than patients with psoriasis who are hospitalized with psoriasis as a secondary diagnosis. One limitation of this study is the lack of data available to consistently quantify disease severity, such as percent of body surface area affected by psoriasis or Physician's Global Assessment score.
Collapse
Affiliation(s)
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA
| | - John Trinidad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA
| | - Ty W Gilkey
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abena Minta
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Johann Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA.
| |
Collapse
|
14
|
Khanna R, Khanna R, Desai SR. Diagnosing Psoriasis in Skin of Color Patients. Dermatol Clin 2023; 41:431-434. [PMID: 37236712 DOI: 10.1016/j.det.2023.02.002] [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: 03/29/2023]
Abstract
Diagnosing psoriasis in patients of color can pose both diagnostic and treatment challenges. It is important to keep psoriasis on the differential diagnosis with conditions such as lichen planus, tinea corporis, and subcutaneous lupus for patients of color. Biopsy can help delineate the causes and guide treatment. Although there is no documented difference in efficacy of certain treatments for psoriasis based on racial group, cultural norms, hair washing practices, health literacy, and attitudes toward certain treatment options should be elicited in all patients.
Collapse
Affiliation(s)
- Rayva Khanna
- Department of Internal Medicine, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Ramona Khanna
- Georgetown University School of Medicine, 3900 Reservoir Road Northwest, Washington, DC 20007, USA
| | - Seemal R Desai
- Innovative Dermatology, PA, 5655 West Spring Creek Parkway, Suite 105, Plano, TX 75024, USA; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
15
|
Akuffo-Addo E, Udounwa T, Chan J, Cauchi L. Exploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review. J Racial Ethn Health Disparities 2023; 10:942-951. [PMID: 35476223 PMCID: PMC9045033 DOI: 10.1007/s40615-022-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient's decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient-physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.
Collapse
Affiliation(s)
- Edgar Akuffo-Addo
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.
| | - Theodora Udounwa
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Chan
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Laura Cauchi
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada
| |
Collapse
|
16
|
Zhao H, Zhong Z, Chen M, Sun B, Wang J, Jin C. Investigation on the synthesis of 24-(R)-hydroxycholesterol. Steroids 2023; 195:109227. [PMID: 36966967 DOI: 10.1016/j.steroids.2023.109227] [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: 02/15/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
A facile and novel strategy has been developed for synthesis of 24-(R)-hydroxycholesterol, a key intermediate of tacalcitol, starting from 24-dehydrocholesterol in seven steps with 48.2% overall yield and high diastereomer ratio. Photocatalytic oxidation of olefins by employing inexpensive Rose Bengal as photosensitizer and air as the sole oxidant for the preparation of Δ5,25-3β-Hydroxycholestadiene-24-one-3-acetate is the key step in this synthetic route. This developed strategy features mild conditions, satisfied total yield and excellent stereoselectivity (24-R/S = 97.7:2.3), providing a novel access to the 24-(R)-hydroxycholesterol.
Collapse
Affiliation(s)
- Haiyun Zhao
- College of Pharmaceutical Sciences, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Zhicheng Zhong
- College of Pharmaceutical Sciences, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Maojie Chen
- College of Pharmaceutical Sciences, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Bin Sun
- College of Pharmaceutical Sciences, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China; Key Laboratory of Pharmaceutical Engineering of Zhejiang Province, Hangzhou 310014, PR China.
| | - Jiayang Wang
- School of Life Sciences, Huzhou University, Huzhou, Zhejiang, PR China
| | - Can Jin
- College of Pharmaceutical Sciences, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China; Key Laboratory of Pharmaceutical Engineering of Zhejiang Province, Hangzhou 310014, PR China.
| |
Collapse
|
17
|
Bosma AL, Ouwerkerk W, Heidema MJ, Prieto-Merino D, Ardern-Jones MR, Beattie P, Brown SJ, Ingram JR, Irvine AD, Ogg G, Patel P, Reynolds NJ, Hearn RR, Wan M, Warren RB, Woolf RT, Hyseni AM, Gerbens LA, Spuls PI, Flohr C, Middelkamp-Hup MA. Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types. JAAD Int 2023; 10:14-24. [PMID: 36387062 PMCID: PMC9661502 DOI: 10.1016/j.jdin.2022.09.006] [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] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types. Objective To investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type. Methods In an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated. Results A total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05). Limitations Unblinded, non-randomized. Conclusion Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.
Collapse
Key Words
- AD, atopic dermatitis
- AE, adverse event
- DLQI, Dermatology Life Quality Index
- DST, Dark Skin Type(s)
- EASI, Eczema Area and Severity Index
- IQR, interquartile range
- LST, Light Skin Type(s)
- NRS, Numerical Rating Scale
- POEM, Patient-Oriented Eczema Measure
- SD, Standard Deviation
- atopic dermatitis
- atopic eczema
- ciclosporin
- daily practice
- dupilumab
- effectiveness
- ethnicity
- methotrexate
- morphology
- race
- registry
- routine clinical care
- safety
- skin type
- systemic treatment
Collapse
Affiliation(s)
- Angela L. Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- NHRIS, National Heart Centre Singapore, Singapore
| | - Madeline J. Heidema
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - David Prieto-Merino
- Faculty of Medicine, Universidad de Alcalá, Madrid, Spain
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Michael R. Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Dermatology, University Hospitals NHS Foundation Trust, Southampton, UK
| | - Paula Beattie
- Department of Dermatology, Royal Hospital for Children NHS Trust, Glasgow, UK
| | - Sara J. Brown
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - John R. Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Alan D. Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Graham Ogg
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Prakash Patel
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Nick J. Reynolds
- Department of Dermatology, Institute of Cellular Medicine, Medical School, Newcastle University, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - R.M. Ross Hearn
- Department of Dermatology & Photobiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Mandy Wan
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Richard B. Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical 17 Research Centre, University of Manchester, Manchester, UK
| | - Richard T. Woolf
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ariënna M. Hyseni
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Louise A.A. Gerbens
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Maritza A. Middelkamp-Hup
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - TREAT NL registry and UK-Irish A-STAR Study Groups
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- NHRIS, National Heart Centre Singapore, Singapore
- Faculty of Medicine, Universidad de Alcalá, Madrid, Spain
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Dermatology, University Hospitals NHS Foundation Trust, Southampton, UK
- Department of Dermatology, Royal Hospital for Children NHS Trust, Glasgow, UK
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Dermatology, Institute of Cellular Medicine, Medical School, Newcastle University, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Dermatology & Photobiology, Ninewells Hospital and Medical School, Dundee, UK
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical 17 Research Centre, University of Manchester, Manchester, UK
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Dermatology Life Quality Index in Patients with Psoriasis Treated with Biologic Versus Non-biologic Treatment in Malaysia: A Retrospective Cross-Sectional Study. Drugs Real World Outcomes 2023:10.1007/s40801-023-00359-1. [PMID: 36840826 DOI: 10.1007/s40801-023-00359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Psoriasis imposes a substantial burden on patients' social, emotional, physical, and family life. Although psoriasis has no complete cure, various treatments are available to control its symptoms and improve a patients' quality of life. OBJECTIVE We aimed to compare the effectiveness of biologic versus non-biologic treatments on health-related quality of life among patients with psoriasis in Malaysia. METHODS This retrospective cross-sectional study evaluated data of adult patients diagnosed with psoriasis during 2007-18 from the Malaysian Psoriasis Registry. Baseline demographics, disease, and treatment characteristics were described. For a subset of patients treated with biologics and non-biologics who had baseline and 6-month follow-up data available, changes in the mean Dermatology Life Quality Index scores and the proportion of patients with a clinically relevant improvement (≥ 4 points) post-treatment were assessed. RESULTS Overall, 15,238 adult patients with psoriasis from the Malaysian Psoriasis Registry were included in the analysis. Patients receiving biologics showed a statistically significant reduction in the mean Dermatology Life Quality Index scores after 6 months compared with those receiving non-biologic treatment (- 5.7 vs - 0.8%; p < 0.001). The proportion of patients who achieved a ≥ 4-point improvement in Dermatology Life Quality Index scores was approximately two times greater in the biologic-treated group versus the non-biologic-treated group (56.4 vs 27.7%). CONCLUSIONS Biologic treatment showed a greater reduction in the Dermatology Life Quality Index scores of patients with psoriasis versus non-biologic treatment. These results highlight the importance of early treatment with more efficacious treatment options, such as biologic therapies, to improve the overall health-related quality of life of patients with psoriasis.
Collapse
|
19
|
Cheraghlou S. In defence of the machines: How artificial intelligence may help to improve dermatologic outcomes and diminish barriers and disparities in care. Australas J Dermatol 2023; 64:e106-e107. [PMID: 36409207 DOI: 10.1111/ajd.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Shayan Cheraghlou
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
20
|
Narla S, Heath CR, Alexis A, Silverberg JI. Racial disparities in dermatology. Arch Dermatol Res 2022; 315:1215-1223. [PMID: 36508020 PMCID: PMC9743121 DOI: 10.1007/s00403-022-02507-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Significant racial/ethnic disparities in dermatologic care and their subsequent impact on dermatologic conditions were recently reported. Contributing factors include socioeconomic factors, gaps in educational exposure, and underrepresentation of minority groups in the dermatologic workforce. In 2021, the American Academy of Dermatology (AAD) announced its three-year plan to expand diversity, equity, and inclusion in dermatology. One way to reduce disparities in dermatology is for every dermatologist, regardless of race or ethnicity, to receive adequate education in diseases, treatments, health equity, and tailored approaches to delivering dermatologic care with cultural humility. In addition, a diverse dermatologic workforce-especially at the level of residency program educators and organizational leaders-will contribute to improved cross-cultural understanding, more inclusive research efforts, and improved treatment approaches for conditions that are more prevalent or nuanced in certain racial/ethnic populations. Finally, the dermatology and broader healthcare community needs to acknowledge and educate ourselves on the health impacts of racism.
Collapse
Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA 18045 USA
| | - Candrice R. Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA 19140 USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10075 USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037 USA
| |
Collapse
|
21
|
Smith B, Oulee A, Devjani S, Collier MR, Egeberg A, Wu JJ. Annual trends in Medicare part D prescription claims for calcipotriene/betamethasone dipropionate foam for psoriasis 2016–2020. Int J Dermatol 2022. [DOI: 10.1111/ijd.16545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Brandon Smith
- Drexel University College of Medicine Philadelphia PA USA
| | - Aislyn Oulee
- University of California Riverside School of Medicine Riverside CA USA
| | | | | | | | - Jashin J. Wu
- University of Miami Miller School of Medicine Miami FL USA
| |
Collapse
|
22
|
Do regional geography and race influence management of chronic spontaneous urticaria? J Allergy Clin Immunol 2022; 150:1260-1264.e7. [PMID: 36481046 DOI: 10.1016/j.jaci.2022.10.017] [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: 07/11/2022] [Revised: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 12/07/2022]
Abstract
Chronic spontaneous urticaria is defined as migratory evanescent pruritic blanching wheals that occur with variable frequency for 6 weeks or more, with or without accompanying angioedema. This condition affects approximately 0.1% to 1.4% of persons worldwide. Second-generation H1 antihistamines are the mainstay of management, with refractory cases often managed with an array of options, including H2 antihistamines, leukotriene receptor antagonists, glucocorticosteroids, immunosuppressive agents, and omalizumab. However, the degree of practice variation as to what treatments are prescribed is poorly understood, given that clinical care could be driven by patient preferences or lack of clarity as to best practices for refractory cases. We conducted a small, exploratory study of the role of race, ethnicity, and regional geographic distance to specialist care on chronic spontaneous urticaria prescribing practices. A small-area geographic variation in chronic spontaneous urticaria management in a large Chicago-area health care system was identified. Rates of omalizumab use varied by patient zip code, with more omalizumab prescriptions being associated with zip codes closer to the main office of an academic medical center-affiliated allergist-immunologist practice. Higher rates of omalizumab use were associated with White race in regional and patient-level analyses, though the reasons for this race-based finding are not clear.
Collapse
|
23
|
Wu JJ, Liu J, Thatiparthi A, Martin A, Egeberg A. The risk of COVID-19 in patients with psoriasis: A retrospective cohort study. J Am Acad Dermatol 2022; 87:1395-1398. [PMID: 36305697 PMCID: PMC9484859 DOI: 10.1016/j.jaad.2022.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Jashin J. Wu
- University of Miami Miller School of Medicine, Miami, Florida,Correspondence and reprint requests to: Jashin J. Wu, MD, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A, Miami, FL 33136
| | - Jeffrey Liu
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Amylee Martin
- School of Medicine, University of California Riverside, Riverside, California
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
24
|
Petersen J, Garbe C, Wolf S, Stephan B, Augustin M, Hagenström K. Medicinal Treatment of Elderly Psoriasis Patients before and after Entering a Nursing Home. Healthcare (Basel) 2022; 10:1730. [PMID: 36141342 PMCID: PMC9498407 DOI: 10.3390/healthcare10091730] [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: 08/12/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022] Open
Abstract
Psoriasis (PS) is a chronic inflammatory skin disease, and it increasingly appears also in the elderly population. There is a rising interest in drug therapy for PS, especially for people receiving care in nursing homes (NH). Which PS-related drugs are prescribed in the time before nursing home admission (NHA), and to what extent does the supply of drugs change after NHA? Which specialties prescribe PS-related drugs? Statutory health insurance data were examined for people with PS, aged ≥ 65 years, who were newly admitted to a NH in the period 2011-2014 and observed for one year before and after NHA. Changes in prescription prevalence (pre-post comparison) were examined for significant differences. Prescriptions of PS-relevant drugs were measured by defined daily dose and stratified according to the prescribing specialist group. The analysis included 718 insured persons with PS (76.2% female, mean age 83.3 years). Systemic therapeutics played a minor role (pre: 2.6% vs. post: 2.1%) in drug therapy. Topical steroids had a high share of about 40% in the pre-post comparison. Overall, the proportion of people with PS who received treatment remained at a comparable level before and after NHA. A structured assessment of the skin is crucial, specifically in people with cognitive impairment.
Collapse
Affiliation(s)
- Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
25
|
Sariahmed K, Kurian J, Singh AK, Leyton C, Minuti A, Jerschow E, Arora S, Jariwala SP. Social, political, and economic determinants of access to biologics: A scoping review of structural determinants in the clinical disparities literature. Res Social Adm Pharm 2022; 18:4038-4047. [DOI: 10.1016/j.sapharm.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
|
26
|
da Silva JB, de Carvalho AEV, Schneider C, Corbellini VA. Saliva may predict quality of life in psoriasis as measured by Fourier transform infrared spectroscopy (FTIR) and chemometrics. Photodiagnosis Photodyn Ther 2022; 39:103017. [PMID: 35843561 DOI: 10.1016/j.pdpdt.2022.103017] [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: 05/22/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin disease, with several comorbidities, such as psoriatic arthritis, inflammatory bowel disease, metabolic syndrome, and impaired quality of life and work activity. The Dermatology Life Quality Index (DLQI) is the most commonly used quality of life index in psoriatic patients, as it is a marker of severe disease. This study evaluated the association between salivary Fourier transform Infrared Spectroscopy (FTIR) metabolic fingerprints and severity of psoriasis as measured by DLQI, using chemometric algorithms. MATERIALS AND METHODS Saliva was collected from 56 (27 with DLQI ≤ 10 [GI]; 29 with DLQI > 10 [GII]) psoriatic patients diagnosed and assessed by DLQI for disease severity by a dermatologist and analyzed by the transflectance technique in mid-infrared. Hierarchic cluster analysis (HCA), principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA) and orthogonal partial least squares (OPLS) algorithms were used to associate salivary FTIR spectra with the respective DLQI scores. RESULTS Second derivative (2D) discriminated GI and GII at 2522 cm-1 (p < 0.0001). HCA and PCA partially discriminated GI from GII at 4000-450 cm-1 (p = 0.042 and 0.00821, respectively). Data processing with 1st derivative (1D), 3 latent variables (LV) and 1 orthogonal signal correction (OSC) component at 2550-1801 cm-1 generated an FTIR/OPLS-DA model with 100% accuracy to classify the severity of psoriasis, and an FTIR/OPLS model to quantify DLQI (range 0-28) with high performance: root mean square error of prediction (RMSEP) < 0.01 and coefficient of determination (R2) > 0.9999. CONCLUSIONS Salivary FTIR combined with chemometric algorithms such as OPLS-DA and OPLS can be used as a clinical tool to classify or predict the severity of psoriasis according to DLQI in patients with confirmed psoriasis.
Collapse
Affiliation(s)
- Jaquelini Barboza da Silva
- Postgraduate Program in Health Promotion, Universidade de Santa Cruz do Sul, RS, Brazil; Department of Life Sciences, Universidade de Santa Cruz do Sul, RS, Brazil.
| | | | - Carolina Schneider
- Postgraduate Program in Health Promotion, Universidade de Santa Cruz do Sul, RS, Brazil; Department of Life Sciences, Universidade de Santa Cruz do Sul, RS, Brazil
| | - Valeriano Antonio Corbellini
- Postgraduate Program in Health Promotion, Universidade de Santa Cruz do Sul, RS, Brazil; Postgraduate Program in Environmental Technology, Universidade de Santa Cruz do Sul, RS, Brazil; Department of Life Sciences, Universidade de Santa Cruz do Sul, RS, Brazil; Department of Sciences, Humanities and Education, Universidade de Santa Cruz do Sul, RS, Brazil
| |
Collapse
|
27
|
Husni ME, Chang E, Broder MS, Paydar C, Bognar K, Desai P, Klyachkin Y, Khilfeh I. Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims Database. Open Access Rheumatol 2022; 14:123-132. [PMID: 35734243 PMCID: PMC9207121 DOI: 10.2147/oarrr.s342123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the rate of biologic initiation after commencing treatment with apremilast (APR) vs methotrexate (MTX), in systemic-naïve patients with psoriatic arthritis (PsA). Patients and Methods Systemic-naïve patients with PsA who started treatment with either APR or MTX between 01/01/2015 and 12/31/2018 were analyzed using claims data from the IBM® MarketScan® Commercial and Medicare Supplemental databases (2014-2019). PsA patients were identified via diagnosis codes; the first prescription date for APR or MTX was the index date. Patient demographics, clinical characteristics, healthcare utilization during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported descriptively. The rates and risk of biologic initiation during follow-up were compared between APR and MTX users by logistic and Cox regressions, respectively. Models were adjusted for demographics, clinical and utilization measures during the baseline period. Results A total of 2116 patients with PsA newly treated with APR (n = 534) or MTX (n = 1582) were identified. Mean age was similar (50.5 vs 50.4; P = 0.938), and proportion of females was higher for APR vs MTX users (59.4% vs 54.0%; P = 0.031). Mean time to biologic initiation among patients who initiated during follow-up was 194.1 vs 138.7 days between APR vs MTX users (P < 0.001). After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32-0.54]; P < 0.001) with APR, with a significantly lower predicted rate of biologic initiation among APR users when compared to MTX users during follow-up (20.0% [95% CI, 16.6-23.9%] vs 37.5% [95% CI, 35.0-40.1%]). Additionally, APR users had a lower risk of biologic initiation than MTX users (HR, 0.46 [95% CI, 0.37-0.57]; P < 0.001) during the 1-year follow-up. Conclusion Systemic-naïve patients with PsA have a lower rate of, and longer time to, biologic initiation over one-year following APR initiation, compared to those initiating MTX.
Collapse
Affiliation(s)
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Caleb Paydar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Katalin Bognar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | | | | | | |
Collapse
|
28
|
Chat VS, Hekmatjah J, Sierro TJ, Kassardjian AA, Read C, Armstrong AW. Language proficiency and biologics access: a population study of psoriasis patients in the United States. J DERMATOL TREAT 2022; 33:1413-1417. [DOI: 10.1080/09546634.2020.1820936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vipawee S. Chat
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joshua Hekmatjah
- Homer Stryker M.D. Schoolof Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Tiffany J. Sierro
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Ari A. Kassardjian
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Charlotte Read
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
- Department of Medicine, Imperial College London, London, UK
| | - April W. Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| |
Collapse
|
29
|
Takeshita J, Augustin M, de Jong EMGJ, Lafferty KP, Langholff W, Langley RG, Menter A, Alexis AF. Health-related quality of life differs by race/ethnicity in North American patients with psoriasis: results from PSOLAR. J Invest Dermatol 2022; 142:2528-2531.e3. [PMID: 35304247 DOI: 10.1016/j.jid.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Junko Takeshita
- Departments of Dermatology and Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
30
|
Nazir Z, Strunk A, Garg A. Age- and sex-adjusted prevalence estimates among adults with psoriasis in the United States. J Am Acad Dermatol 2022; 86:703-705. [PMID: 33705815 DOI: 10.1016/j.jaad.2021.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/09/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Zaeem Nazir
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
| |
Collapse
|
31
|
Characteristics of New Biologic Users Among the Moderate-to-Severe Psoriasis Population-Retrospective Cohort Study Leveraging the Modernizing Medicine Data Services Database. Dermatol Ther (Heidelb) 2022; 12:741-752. [PMID: 35212934 PMCID: PMC8941060 DOI: 10.1007/s13555-022-00691-4] [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: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Biologics have expanded the treatment options in the management of patients with moderate-to-severe psoriasis. The objective of this study was to describe patient characteristics and previous treatments in psoriasis patients newly treated with guselkumab, secukinumab, or ixekizumab. Methods This retrospective study included patients ≥ 18 years old with psoriasis in the USA who were newly treated with guselkumab, secukinumab, or ixekizumab between 1 July 2017 and 31 March 2019 in the Modernizing Medicine Data Services database (MMDS). Patients were indexed on their first prescription or injection record of guselkumab, secukinumab, or ixekizumab, and three mutually exclusive cohorts were created. Patients were required to have evidence of moderate-to-severe psoriasis, defined as Physician Global Assessment (PGA) score of 3 or 4, or body surface area (BSA) ≥ 10% on index date or within 12 months before index. Baseline characteristics, including treatment history, were reported for each cohort. Results The study population included 461 guselkumab, 619 secukinumab, and 375 ixekizumab patients. The median age across cohorts was 51–52 years. Median baseline BSA ranged from 15% to 20%; 16.1–29.3% of patients had a PGA of 4 and over half of patients were obese prior to index. Approximately 40% of patients had comorbid cardiovascular disease and 20.8–24.2% of patients had a psychiatric disorder. About half of patients in each cohort had prior biologic use, of which adalimumab was most common (28.2–34.9%) across the cohorts. Conclusion This real-world study describes the characteristics of patients with moderate-to-severe psoriasis receiving biologic treatments.
Collapse
|
32
|
Shao K, Hooper J, Feng H. Racial/Ethnic Health Disparities in Dermatology in the United States Part 2: Disease-specific Epidemiology, Characteristics, Management, and Outcomes. J Am Acad Dermatol 2022; 87:733-744. [PMID: 35143915 DOI: 10.1016/j.jaad.2021.12.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Racial and ethnic disparities in dermatology negatively affect outcomes such as mortality and quality of life. Dermatologists and dermatologic surgeons should be familiar with disease-specific inequities that may influence their practice. The second article in this two-part continuing medical education series highlights gaps in frequency, clinical presentation, management, and outcomes by race and ethnicity. We review cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous T cell lymphoma, and inflammatory disorders including atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, and rosacea.
Collapse
Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
| |
Collapse
|
33
|
INDICATORS OF THE LEVEL OF SUBJECTIVE CONTROL IN MALE PATIENTS WITH MILD OR SEVERE PSORIASIS WITHOUT TAKING INTO ACCOUNT SOMATOTYPE AND WITH TAKING INTO ACCOUNT SOMATOTYPE. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-1-79-126-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Khatoon F, Husain N, Jabeen A, Uddin Q, Azahar M, Qureshi A, Khan AA. Psoriasis with special reference to Unani medicine – A review. OPEN HEALTH 2022; 3:124-140. [DOI: 10.1515/openhe-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Abstract
Background. Psoriasis is a chronic and recurrent inflammatory skin disorder that affects about 125 million people worldwide. Patients with psoriasis are more likely to develop inflammatory arthritis, cardiometabolic disease, and mental health issues. Psoriasis remains incurable and recurrent despite the availability of contemporary treatments. Unani (Greco-Arabic) medicine has its unique concept of psoriasis; numerous treatments and formulations are prescribed by renowned Unani scholars.
Objective. This study sought to provide an understanding of psoriasis in conventional medicine, as well as clinically equivalent conditions documented by ancient Unani academics in their writings, such as Rūfas, Jālinūs, Rāzī, Ibn Sīna, Majūsi, Ibn-i Zuhr, Ibn al- Quf, and Ibn-i Hubal Baghdādi.
Methods. The Unani classical literature was researched manually and online for this purpose. PubMed, Science Direct, and Google Scholar were utilized to assemble all the classic and contemporary psoriasis disease-related literature.
Results. Since antiquity, Unani scholars have advocated ‘Ilāj bi’l Ghiḍhā (diet therapy), ‘Ilāj bi’l- Tadbīr (regimenal therapy), ‘Ilāj bi’l Dawā (drug therapy) to treat disorders clinically comparable to psoriasis.
Conclusion. This study provided a comprehensive evaluation of existing psoriasis knowledge, with an emphasis on Unani medicine, which may be valuable for generating integrated hypotheses to treat the psoriasis challenge.
Collapse
Affiliation(s)
- Faiza Khatoon
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Nazim Husain
- Department of Moalajat (Medicine) , Luqman Unani Medical College Hospital and Research Center , Bijapur, Karnataka- 586101 , India
| | - Arzeena Jabeen
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Qamar Uddin
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Mohd Azahar
- Rajasthan Unani Medical College and Hospital , Jaipur , Rajasthan , , India
| | - Arshad Qureshi
- Department of Ilmul Advia (Pharmacology) National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Asif Ahmad Khan
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| |
Collapse
|
35
|
Sangha AM. Special Considerations in the Diagnosis and Treatment of Psoriasis. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:S24-S25. [PMID: 35291258 PMCID: PMC8903223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Archana M Sangha
- Ms. Sangha is a medical science liaison for Incyte in Wilmington, Delaware. Prior to that, she spent over a decade as a dermatology PA specializing in general, surgical, and cosmetic dermatology. She is a fellow of the American Academy of Physician Assistants in Alexandria, Virginia. She is also Immediate Past President of the Society of Dermatology Physician Assistants
| |
Collapse
|
36
|
Kauhl W, Pototschnig H, Paasch U. Can Platelet-Rich Plasma Reduce the Burden of Inflammatory Skin Diseases Such as Psoriasis and Atopic Dermatitis? Cureus 2021; 13:e18472. [PMID: 34754637 PMCID: PMC8565102 DOI: 10.7759/cureus.18472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/05/2022] Open
Abstract
Objective In this study, our aim was to investigate the clinical effects of platelet-rich plasma (PRP) on the skin of patients suffering from plaque psoriasis or atopic dermatitis. Methods Over a period of 53 months, we treated a total of 40 patients for inflammatory skin diseases with PRP. All of these patients were included in this study; 5-6 ml of PRP were prepared with the autologous-conditioned plasma (ACP) double syringe and injected subdermally. Follow-ups were conducted at three, six, nine, and 12 weeks after treatment. Besides the lesion size, Psoriasis Area and Severity Index (PASI) and Eczema Area and Severity Index (EASI) were also calculated. Data were evaluated statistically at a significance level of p≤0.05. Results A total of 30 patients were treated for plaque psoriasis. The elbow area represented the most common area of treatment (17 cases). The average lesion size decreased from 8.2 cm² to 0.3 cm² (p<0.00001). Of note, 80% of all patients achieved complete remission (PASI100) at the last follow-up. The remaining 20% reached at least PASI70. Ten patients were treated for atopic dermatitis. In six cases, efflorescences on patients' arms were treated, and in four cases, patients' legs were treated. The average lesion size decreased from 8 cm² to 0.155 cm² (p<0.00001). Notably, 50% of all patients achieved complete remission (EASI100) at the last follow-up. The other half reached at least EASI70. In all cases, the lesion size decreased progressively. No adverse events were reported. Conclusion Our study revealed encouraging results for both psoriasis and atopic dermatitis. The autologous treatment was safe and effective in all patients. Further studies are required to validate these initial findings.
Collapse
Affiliation(s)
- Winfried Kauhl
- Plastic and Reconstructive Surgery, Gemeinschaftspraxis Dr. med. Kauhl Dr. med. Cymorek, Moenchengladbach, DEU
| | | | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergology, University of Leipzig Medical Center, Leipzig, DEU
| |
Collapse
|
37
|
Skinner R, Breck A, Esposito D. An economic evaluation of teledermatology care delivery for chronic skin diseases. J Comp Eff Res 2021; 11:67-77. [PMID: 34747638 DOI: 10.2217/cer-2021-0062] [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: 11/21/2022] Open
Abstract
Aim: Analyze the impact of nationwide implementation of teledermatological care for psoriasis. Methods: Develop a Markov model that estimates the impact of telehealth technology for treatment of moderate-to-severe psoriasis on health and healthcare expenditures compared with in-person clinical care. Results: Lower medical costs by US$1.5 billion and total social costs of US$4.3 billion over 5 years. Patients save more than 67 million hours in work absenteeism and travel time, valued at US$598 million. Employers save US$1.2 billion over 5 years due to decreased employee absenteeism. Conclusion: National implementation of telehealth for psoriasis care has the potential to substantially reduce both formal healthcare costs and informal costs for families and patients, while maintaining equivalent clinical outcomes as traditional in-person care.
Collapse
Affiliation(s)
| | - Andrew Breck
- Insight Policy Research, Inc., Arlington, VA 22209, USA
| | | |
Collapse
|
38
|
Fagni F, Simon D, Tascilar K, Schoenau V, Sticherling M, Neurath MF, Schett G. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. THE LANCET. RHEUMATOLOGY 2021; 3:e724-e736. [PMID: 34485930 PMCID: PMC8397302 DOI: 10.1016/s2665-9913(21)00247-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase risk for SARS-CoV-2 infection or severe COVID-19 compared with people without these diseases. Furthermore, substantial data suggest that certain medications frequently used in patients with immune-mediated inflammatory diseases, in particular cytokine inhibitors, might even lower the risk for severe COVID-19. Conversely, glucocorticoids and potentially B-cell-depleting treatments seem to worsen COVID-19 outcomes. Additionally, the first data on SARS-CoV-2 vaccination in patients with these diseases suggest that tolerability of vaccination in patients with immune-mediated inflammatory diseases is good, although the immune response to vaccination can be somewhat reduced in this patient group, particularly those taking methotrexate or CD20-targeted treatment.
Collapse
Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Verena Schoenau
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Markus F Neurath
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| |
Collapse
|
39
|
Hadeler E, Mosca M, Hong J, Brownstone N, Liao W, Bhutani T, Shinkai K. Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Lin IC, Heck JE, Chen L, Feldman SR. Psoriasis Severity and Cardiometabolic Risk Factors in a Representative US National Study. Am J Clin Dermatol 2021; 22:719-730. [PMID: 33913115 DOI: 10.1007/s40257-021-00600-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psoriasis is associated with metabolic syndrome; however, the relationship of psoriasis severity with individual cardiometabolic risk factors is not clear. There is a reporting gap between the cardiometabolic risks among patients with psoriasis and what has been reported in the literature using US samples. OBJECTIVES The objective of this study was to examine the disease burden of psoriasis and assess the associations of psoriasis severity and cardiometabolic risk factors in a nationally representative sample. METHODS We conducted a cross-sectional study using the weighted pooled data from the National Ambulatory Medical Care Survey (NAMCS) 2007 through 2016. The NAMCS data were collected from US office-based physicians. Each physician was randomly assigned a specific week to report a sample of their cases. Patients were categorized as severe psoriasis if they were prescribed at least one systemic therapy. We used logistic regression models adjusting for potential confounders to estimate the associations of psoriasis severity with individual cardiometabolic factors. RESULTS There were about 3.3 million office-based psoriasis visits per year with a mean age of 50 years, a female-to-male ratio of 1:1, and severe disease in 23%. We observed greater values of blood pressure, lipid profiles, and higher body mass index among patients with psoriasis, compared with patients without psoriasis. A higher proportion of the psoriasis patient group were overweight and obese (73.6% vs 62.9% in the non-psoriasis patient group). Compared to mild case groups, severe case groups tended to have a higher proportion of overweight/obese with a body mass index ≥ 25 kg/m2 (77% vs 73%). Obesity was weakly associated with psoriasis severity (adjusted odds ratio = 1.37, 95% confidence interval 0.98-1.91 for mild disease and adjusted odds ratio = 1.42, 95% confidence interval 0.80-2.52 for severe cases). CONCLUSIONS Cardiometabolic factors are related health issues in psoriasis, and obesity is associated with greater psoriasis severity.
Collapse
Affiliation(s)
- I-Chun Lin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Julia E Heck
- College of Health and Public Service, University of North Texas, Denton, TX, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Steven R Feldman
- Department of Dermatology, Social Sciences and Health Policy, and Pathology, School of Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA.
| |
Collapse
|
41
|
Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol 2021; 157:940-946. [PMID: 34190957 PMCID: PMC8246333 DOI: 10.1001/jamadermatol.2021.2007] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Determining psoriasis prevalence is fundamental to understanding the burden of the disease, the populations most affected, and health policies to address the disease. OBJECTIVE (1) To determine the prevalence of psoriasis among adults in the US and (2) to evaluate the change in psoriasis prevalence over time since the 2003-2004 National Health and Nutrition Examination Survey (NHANES) data. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used 2011-2014 NHANES data (collected from January 1, 2011, to December 31, 2014) with sampling from a general, noninstitutionalized US civilian population. Participants were 20 years or older and were selected via a multistage probability sampling design to ensure that surveys were nationally representative. Eligible participants had an in-person interview followed by a medical examination by medical professionals. Data were analyzed from July 15, 2019, to December 23, 2020. EXPOSURES None. MAIN OUTCOMES AND MEASURES Psoriasis prevalence in the US, as measured by the percentage of people in the representative sample with psoriasis, and trend statistics comparing prevalence estimates from the 2003-2004, 2009-2010, and 2011-2014 NHANES cycles. RESULTS A total of 12 625 participants (mean [SD] age, 32.8 [24.1] years; 6492 women [51.4%]; and 4828 non-Hispanic White participants [38.2%]) answered the question of whether they were given the diagnosis of psoriasis by a physician or another health care professional. Psoriasis prevalence among US adults 20 years or older was 3.0% (95% CI, 2.6%-3.4%). Based on the 2020 US census data, this outcome translates to an estimated 7.55 million US adults with psoriasis. Psoriasis prevalence was similar between women and men, with 3.2% (95% CI, 2.6%-3.8%) in women and 2.8% (95% CI, 2.4%-3.3%) in men. Psoriasis prevalence was highest in White individuals at 3.6% (95% CI, 2.9%-4.2%), followed by other racial/ethnic groups (non-Hispanic, including multiracial) at 3.1% (95% CI, 1.2%-5.1%), Asian individuals at 2.5% (95% CI, 1.6%-3.3%), Hispanic individuals (including Mexican American and other Hispanic individuals) at 1.9% (95% CI, 1.3%-2.5%), and Black individuals at 1.5% (95% CI, 1.0%-2.0%). Psoriasis prevalence was not different based on patients' marital status, education, income, or medical insurance status. The prevalence of psoriasis among US adults did not differ significantly since 2003. CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that psoriasis remains a common, immune-mediated disease that affects 3.0% of the US adult population, or more than 7.5 million adults. Its prevalence has not differed since evaluation in 2003. These prevalence data are foundational to determining the burden of psoriasis and for supporting efforts in research, education, and health policy.
Collapse
Affiliation(s)
- April W. Armstrong
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles
| | - Manan D. Mehta
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles
| | | | | | | | - Christopher E. M. Griffiths
- Dermatology Centre, Salford Royal Hospital, National Institute for Health Research, Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
42
|
Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 TO 2020. Clin Rheumatol 2021; 40:4933-4942. [PMID: 34287723 PMCID: PMC8599387 DOI: 10.1007/s10067-021-05839-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. METHODS Adults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated. RESULTS 4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001). CONCLUSION Annual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease. Key points • Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA. • Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.
Collapse
|
43
|
Visser MJE, Tarr G, Pretorius E. Thrombosis in Psoriasis: Cutaneous Cytokine Production as a Potential Driving Force of Haemostatic Dysregulation and Subsequent Cardiovascular Risk. Front Immunol 2021; 12:688861. [PMID: 34335591 PMCID: PMC8324086 DOI: 10.3389/fimmu.2021.688861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022] Open
Abstract
Psoriasis (PsO) is a common T cell-mediated inflammatory disorder of the skin with an estimated prevalence of 2%. The condition manifests most commonly as erythematous plaques covered with scales. The aetiology of PsO is multifactorial and disease initiation involves interactions between environmental factors, susceptibility genes, and innate and adaptive immune responses. The underlying pathology is mainly driven by interleukin-17. In addition, various inflammatory mediators from specific T helper (TH) cell subsets, namely TH1, TH17, and TH22, are overexpressed in cutaneous lesions and may also be detected in the peripheral blood of psoriatic patients. Moreover, these individuals are also at greater risk, compared to the general population, of developing multiple comorbid conditions. Cardiovascular disease (CVD) has been recognised as a prominent comorbidity of PsO. A potential mechanism contributing to this association may be the presence of a hypercoagulable state in these individuals. Inflammation and coagulation are closely related. The presence of chronic, low-grade systemic inflammation may promote thrombosis – one of the major determinants of CVD. A pro-inflammatory milieu may induce the expression of tissue factor, augment platelet activity, and perturb the vascular endothelium. Altogether, these changes will result in a prothrombotic state. In this review, we describe the aetiology of PsO, as well as the pathophysiology of the condition. We also consider its relationship to CVD. Given the systemic inflammatory nature of PsO, we evaluate the potential contribution of prominent inflammatory mediators (implicated in PsO pathogenesis) to establishing a prothrombotic state in psoriatic patients.
Collapse
Affiliation(s)
- Maria J E Visser
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Gareth Tarr
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa.,Division of Rheumatology, Institute of Orthopaedics and Rheumatology, Winelands Mediclinic Orthopaedic Hospital, Stellenbosch, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
44
|
Healthcare utilization and costs among patients with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 to 2020. Clin Rheumatol 2021; 40:4061-4070. [PMID: 33934270 DOI: 10.1007/s10067-021-05713-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 03/21/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare healthcare resource utilization and costs among patients with psoriasis, psoriatic arthritis (PsA), and a control group of patients without psoriasis and PsA in the USA. METHODS The IBM® MarketScan® Commercial Database was used to identify three adult patient groups from 1/1/2009 through 4/30/2020: (1) Psoriasis: ≥ 2 diagnoses ≥ 30 days apart for psoriasis (no PsA diagnoses); (2) PsA: ≥ 2 diagnoses for PsA; (3) Control: no psoriasis or PsA diagnoses in their entire claims records. Patients with comorbid rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, or ulcerative colitis were excluded from the analyses. Controls were matched 1:1 to psoriasis and PsA patients based on age, gender, index year, and number of non-rheumatological comorbidities. Healthcare resource utilization and costs (in 2019 USD) were evaluated descriptively and through mixed models for five years of follow-up. RESULTS A total of 142,531 psoriasis and 21,428 PsA patients were matched to the control group (N = 163,959). Annual all-cause healthcare costs per patient were $7,470, $11,062, and $29,742 for the control, psoriasis, and PsA groups, respectively. All-cause healthcare costs increased over time and were significantly greater among PsA vs. psoriasis (p < 0.0001) and the control groups (p < 0.0001). Across all categories of healthcare resources, utilization was greatest among patients with PsA and lowest in the control group. CONCLUSION Annual healthcare costs and resource utilization were significantly higher with PsA compared with psoriasis and the control group, confirming the substantial economic burden of PsA. The cost disparity between these patient groups highlights a continued unmet medical need. Key Points • Patients with PsA incurred significantly greater healthcare resource utilization and costs than patients with psoriasis and patients without psoriasis and PsA. • Significantly greater costs and healthcare resource utilization were also observed among patients with psoriasis compared with patients without psoriasis and PsA.
Collapse
|
45
|
Jung R, Wild J, Ringen J, Karbach S, Wenzel P. Innate Immune Mechanisms of Arterial Hypertension and Autoimmune Disease. Am J Hypertens 2021; 34:143-153. [PMID: 32930786 DOI: 10.1093/ajh/hpaa145] [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] [Received: 06/15/2020] [Revised: 08/15/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
The immune system is indispensable in the development of vascular dysfunction and hypertension. The interplay between immune cells and the vasculature, kidneys, heart, and blood pressure regulating nuclei in the central nervous system results in a complex and closely interwoven relationship of the immune system with arterial hypertension. A better understanding of this interplay is necessary for optimized and individualized antihypertensive therapy. Our review article focuses on innate cells in hypertension and to what extent they impact on development and preservation of elevated blood pressure. Moreover, we address the association of hypertension with chronic autoimmune diseases. The latter are ideally suited to learn about immune-mediated mechanisms in cardiovascular disease leading to high blood pressure.
Collapse
Affiliation(s)
- Rebecca Jung
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Julia Ringen
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Susanne Karbach
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| |
Collapse
|
46
|
Castaldo G, Pagano I, Grimaldi M, Marino C, Molettieri P, Santoro A, Stillitano I, Romano R, Montoro P, D’Ursi AM, Rastrelli L. Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A Nuclear Magnetic Resonance-Based Metabolomic Study. J Proteome Res 2021; 20:1509-1521. [PMID: 33164516 PMCID: PMC8016365 DOI: 10.1021/acs.jproteome.0c00646] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 12/15/2022]
Abstract
Psoriasis is an inflammatory disease of the epidermis based on an immunological mechanism involving Langerhans cells and T lymphocytes that produce pro-inflammatory cytokines. Genetic factors, environmental factors, and improper nutrition are considered triggers of the disease. Numerous studies have reported that in a high number of patients, psoriasis is associated with obesity. Excess adipose tissue, typical of obesity, causes a systemic inflammatory status coming from the inflammatory active adipose tissue; therefore, weight reduction is a strategy to fight this pro-inflammatory state. This study aimed to evaluate how a nutritional regimen based on a ketogenic diet influenced the clinical parameters, metabolic profile, and inflammatory state of psoriasis patients. To this end, 30 psoriasis patients were subjected to a ketogenic nutritional regimen and monitored for 4 weeks by evaluating the clinical data, biochemical and clinical parameters, NMR metabolomic profile, and IL-2, IL-1β, TNF-α, IFN-γ, and IL-4 concentrations before and after the nutritional regimen. Our data show that a low-calorie ketogenic diet can be considered a successful strategy and therapeutic option to gain an improvement in psoriasis-related dysmetabolism, with significant correction of the full metabolic and inflammatory status.
Collapse
Affiliation(s)
- Giuseppe Castaldo
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
| | - Imma Pagano
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Manuela Grimaldi
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Carmen Marino
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Paola Molettieri
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
| | - Angelo Santoro
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Ilaria Stillitano
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Rocco Romano
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Paola Montoro
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Anna Maria D’Ursi
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Luca Rastrelli
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| |
Collapse
|
47
|
Neema S, Dabbas D, Radhakrishnan S, Yadav AK. Pattern of use of biologics in psoriasis among Indian dermatologists - A cross sectional survey. Indian J Dermatol Venereol Leprol 2021; 88:515-518. [PMID: 33666030 DOI: 10.25259/ijdvl_1006_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Biologics are a relatively new class of highly effective drugs in the management of psoriasis. They act on specific immune processes, achieve rapid and sustained clearance and do not cause target organ damage unlike conventional systemic therapy. It appears that their use in our country is not as widespread as in developed nations despite these benefits ; their prohibitive cost may be a major factor for the limited usage. This survey aimed to find out the extent of use and factors hindering usage of biologics for the management of psoriasis by Indian dermatologists. METHODS It was a cross-sectional questionnaire based study. The questionnaire was designed after a focussed group discussion, followed by validation. The survey was sent in the form of a link to Indian dermatologists. The responses were recorded in excel-sheet and the data was analyzed by SPSS ver 25. RESULTS Of the 310 participants who took part, 287 completed the survey. Two hundred (70%) were users of biologics, while 87 (30%) had never used them. Cost was the major factor which prevented biologic use. Majority of the respondents used biologics in less than 2 cases per month. Secukinumab was the most common biologic used followed by etanercept. The factors which determined choice of biologics were convenience, cost, previous experience, co-morbid conditions and recommendations by an expert. LIMITATIONS A small sample size was the limitation of the study. Dermatologists who do not use biologics may be under-represented in the study. CONCLUSIONS Biologics are not used optimally by Indian dermatologists for management of psoriasis. The cost, fear of adverse effects, lack of awareness and inadequate felt need are major factors which prevent their regular use.
Collapse
Affiliation(s)
- Shekhar Neema
- Departments of Dermatology and Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Disha Dabbas
- Department of Dermatology, Command Hospital, Chandi Mandir, Haryana, India
| | - S Radhakrishnan
- Departments of Dermatology and Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Arun Kumar Yadav
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
48
|
Hecht B, Frye C, Holland W, Holland CR, Rhodes LA, Marciniak MW. Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy. J Am Pharm Assoc (2003) 2021; 61:S173-S177. [PMID: 33618986 DOI: 10.1016/j.japh.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specialty medications may require a prior authorization (PA) before a patient can access the medication. Providers often identify PA approval as a burden for the practice. Pharmacists can facilitate the completion of the PA process. OBJECTIVE The primary objective was to evaluate the time to first PA decision (approval or denial) for dermatologic medications dispensed by a community-based specialty pharmacy. A secondary objective was to compare PA timeliness (time to PA approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology provider office. PRACTICE DESCRIPTION Realo Specialty Care is a community-based independent specialty pharmacy that provides comprehensive care to patients with complex and chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and atopic dermatitis. Pharmacy services include PA assistance, comprehensive medication management, patient education, and adherence monitoring. PRACTICE INNOVATION Pharmacy dispensing system data were used to conduct a retrospective analysis of the effectiveness at resolving PA requests. PAs are traditionally completed by a provider's practice, and data are documented within the pharmacy system as a PA task. EVALUATION METHODS Data included PA tasks for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019. Initial receipt of the prescription, PA decision, and PA decision date were noted in the PA task and confirmed via fax documentation. The date of first fill was confirmed by prescription data. RESULTS The pharmacy completed 677 PA tasks with a mean time to PA decision of 1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the provider's office averaged 16.2 days (P < 0.001). CONCLUSION Pharmacies can effectively complete PAs to expedite the filling process for patients and increase medication access. Provider practices could benefit from delegating these tasks to a partnered pharmacy.
Collapse
|
49
|
Hodges WT, Bhat T, Raval NS, Herbosa C, Ugwu-Dike P, Kwatra SG, Musiek A, Mann C, Semenov YR. Biologics utilization for psoriasis is lower in black compared with white patients. Br J Dermatol 2021; 185:207-209. [PMID: 33567102 DOI: 10.1111/bjd.19876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- W T Hodges
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - T Bhat
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - N S Raval
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - C Herbosa
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - P Ugwu-Dike
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - S G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - C Mann
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Y R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
50
|
Barbieri JS, Shin DB, Syed MN, Takeshita J, Gelfand JM. Evaluation of the Frequency of "Not Relevant" Responses on the Dermatology Life Quality Index by Sociodemographic Characteristics of Patients With Psoriasis. JAMA Dermatol 2020; 156:446-450. [PMID: 32101261 DOI: 10.1001/jamadermatol.2019.4659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance "Not relevant" responses (NRRs) on the Dermatology Life Quality Index (DLQI) are common among patients with psoriasis and may be associated with an underestimation of disease severity. Objective To evaluate the associations between (1) patient sociodemographic characteristics and the frequency of NRRs on the DLQI and (2) NRR frequency and treatment satisfaction. Design, Setting, and Participants This cross-sectional study using data from the Dermatology Clinical Effectiveness Research Network from February 2010 to June 2011 assessed the responses on the DLQI of 1733 patients with psoriasis. Main Outcomes and Measures Differences in the frequency of NRRs by sex, race/ethnicity, insurance type, income, educational attainment, marital status, and employment status were evaluated using the 2-tailed χ2 test. Multivariable logistic regression analysis was used to evaluate the associations between sociodemographic characteristics and having at least 1 NRR. Multivariable linear regression analysis was used to evaluate the association between having a DLQI score reclassified from 10 or less to more than 10 using the DLQI-Relevant scoring modification and the scores on the Treatment Satisfaction Questionnaire for Medication. Data were analyzed between July 2019 and November 2019. Results Of 1733 patients with psoriasis, 879 (50.7%) were female, and 1470 (84.8%) were non-Hispanic white individuals. The DLQI items 6 (sport, 223 patients [12.9%]), 9 (sexual difficulties, 214 patients [12.3%]), and 7 (work or study, 126 patients [7.3%]) had the greatest frequency of NRRs. In multivariable logistic regression analysis, male sex (odds ratio [OR], 0.63; 95% CI, 0.48-0.82) and income of more than $100 000 (OR, 0.45; 95% CI, 0.26-0.79) were associated with decreased odds of NRRs. By contrast, single (OR, 1.85; 95% CI, 1.31-2.61) or widowed or divorced (OR, 2.60; 95% CI, 1.80-3.74) marital status and unemployed or disabled employment status (OR, 1.98; 95% CI, 1.35-2.89) were associated with increased odds of NRRs. Having a DLQI score that would be reclassified from 10 or less to more than 10 using the DLQI-Relevant scoring modification was associated with lower global satisfaction scores on the Treatment Satisfaction Questionnaire for Medication (coefficient, -9.8; 95% CI, -16.3 to -3.4). Conclusions and Relevance There were sociodemographic differences in the frequency of NRRs on the DLQI among this cohort of patients with psoriasis. These differences may be associated with an underestimation of disease burden and treatment disparities owing to subsequent undertreatment among certain sociodemographic groups. Further study is needed to optimize the quality-of-life assessment among patients with psoriasis or other inflammatory skin diseases in diverse settings.
Collapse
Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Maha N Syed
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| |
Collapse
|