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Balak D, Perez-Chada LM, Guo LN, Mita C, Armstrong AW, Bell SJ, Gondo GC, Liao W, Merola JF. Definitions of Remission in Psoriasis: A Systematic Literature Review from the National Psoriasis Foundation. J Eur Acad Dermatol Venereol 2022; 36:2291-2300. [PMID: 35924437 DOI: 10.1111/jdv.18477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
Psoriasis studies increasingly employ outcomes that indicate complete disease resolution, yet remission and cure are poorly defined for psoriasis. We conducted a systematic literature review to identify definitions of psoriasis remission and cure reported in the literature. Medline, EMBASE, and The Cochrane Central Register of Controlled Trials databases were searched on July 22, 2020 for full-text studies providing definitions for psoriasis remission/cure. Definitions were analyzed descriptively for endpoint, time-frame, on/off treatment, patient-reported outcomes, and disease domains. We identified 106 studies that provided 41 unique remission definitions. Most definitions included endpoints based on Psoriasis Area and Severity Index (PASI), such as PASI75 (n=16 studies), PASI90 (n=10), PASI100 (n=10), and PASI of 0 (n=3), and descriptive endpoints related to 'skin clearance' (n=18). Few definitions specified time-frame, on/off treatment or other psoriasis-related disease domains. One small consensus-initiative defined drug-free remission for plaque psoriasis by BSA of 0 without any therapy for at least 12 months. While there is no cure for psoriasis, seven studies defined psoriasis cure using similar endpoints to those used to define remission. We identified a variety of definitions of psoriasis remission. These results will inform the development of consensus-based definitions for psoriasis remission to support efforts to improve research and clinical outcomes.
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Affiliation(s)
- Dmw Balak
- Department of Dermatology, LangeLand Hospital, Zoetermeer, the Netherlands.,Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L N Guo
- Harvard Medical School, Boston, MA, USA
| | - C Mita
- Countway Library of Medicine, Harvard University, Boston, Massachusetts, USA
| | - A W Armstrong
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - S J Bell
- National Psoriasis Foundation, Portland, OR, USA
| | - G C Gondo
- National Psoriasis Foundation, Portland, OR, USA
| | - W Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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3
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Satake K, Amano T, Okamoto T. Calcipotriol and betamethasone dipropionate synergistically enhances the balance between regulatory and proinflammatory T cells in a murine psoriasis model. Sci Rep 2019; 9:16322. [PMID: 31705000 PMCID: PMC6841938 DOI: 10.1038/s41598-019-52892-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/21/2019] [Indexed: 01/16/2023] Open
Abstract
A topical medication combining calcipotriol (Cal) and betamethasone dipropionate (BDP) has proven effective in a number of randomized controlled trials performed in patients with psoriasis, but its mechanism of action has not been fully elucidated. We investigated whether the combination of Cal and BDP (Cal/BDP) in this topical medication had a synergistic effect on psoriasis-like dermatitis and explored the underlying immunological mechanisms in a murine psoriasis model induced by application of imiquimod. Cal/BDP synergistically inhibited ear thickening induced by imiquimod compared to monotherapy with either Cal or BDP. In addition, Cal/BDP significantly suppressed the interleukin (IL)-23/IL-17-producing T (T17) pathogenic axis, including expression of IL-17a, IL-23a, IL-22 and TNF-α mRNA in skin lesions and expansion of CCR6+ γδ T17 cells in the draining lymph nodes. Notably, Cal/BDP synergistically induced regulatory CD8+ T cells and also improved the balance between regulatory CD8+ or CD4+ T cells and proinflammatory CCR6+ γδ T17 cells in the draining lymph nodes. These results suggest synergistic anti-psoriatic activity of Cal/BDP with normalization of the imbalance between regulatory CD8+ or CD4+ T cells and proinflammatory CCR6+ γδ T17 cells, which contributes to successful control of psoriasis by Cal-BDP combination therapy.
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Affiliation(s)
- Kyosuke Satake
- R&D division, Kyowa Kirin Co., Ltd, 1188 Shimotogari, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8731, Japan.
| | - Toru Amano
- R&D division, Kyowa Kirin Co., Ltd, 1188 Shimotogari, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8731, Japan
| | - Tadao Okamoto
- Medical Affairs Department, LEO Pharma K.K., 1-105, Kanda Jimbocho, Chiyoda-ku, Tokyo, 101-0051, Japan
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4
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Shimizu T, Kamata M, Fukaya S, Hayashi K, Fukuyasu A, Tanaka T, Ishikawa T, Ohnishi T, Tada Y. Anti-IL-17A and IL-23p19 antibodies but not anti-TNFα antibody induce expansion of regulatory T cells and restoration of their suppressive function in imiquimod-induced psoriasiform dermatitis. J Dermatol Sci 2019; 95:90-98. [PMID: 31362906 DOI: 10.1016/j.jdermsci.2019.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease. Anti-TNFα, IL-17A and IL-23p19 antibodies are effective for psoriasis. However, the contribution of regulatory T cells (Treg) in their effectiveness remains to be elucidated. OBJECTIVE We investigated the effects of TNFα, IL-17A and IL-23p19 inhibition on Tregs in imiquimod-induced psoriasiform dermatitis. METHODS Psoriasiform dermatitis was induced by imiquimod application on murine shaved back skin for six days. Mice were treated with anti-TNFα, IL-17A or IL-23p19 monoclonal antibodies every other day from one day before imiquimod application. RESULTS Administration of anti-TNFα, IL-17A or IL-23p19 antibodies improved the clinical score and downregulated Th17-related cytokines and chemokines, while IL-23p19 antibodies upregulated IL-10 mRNA expression. Anti-IL-17A or IL-23p19 antibody-treated imiquimod-applied mice showed a significant increase in the number of Foxp3+ IL-10+ Tregs. Recipient mice adoptively transferred with Tregs derived from donor mice treated with antibodies demonstrated clinical and pathological improvement in imiquimod-induced psoriasiform dermatitis. Anti-IL-17A or IL-23p19 antibody-induced Tregs significantly increased the number of Foxp3+ cells and IL-10 expression in imiquimod-induced psoriasiform dermatitis in recipient mice but anti-TNFα antibody-induced Tregs did not. CONCLUSION Anti-IL-17A or IL-23p19 antibody inhibits the IL-17/IL-23 signaling pathway, and induces expansion of Tregs and their suppressive capacity in imiquimod-induced psoriasiform dermatitis.
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Affiliation(s)
- Teruo Shimizu
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
| | - Saki Fukaya
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kotaro Hayashi
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsuko Fukuyasu
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takamitsu Tanaka
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeko Ishikawa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takamitsu Ohnishi
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
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5
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Hau CS, Shimizu T, Tada Y, Kamata M, Takeoka S, Shibata S, Mitsui A, Asano Y, Sugaya M, Kadono T, Sato S, Watanabe S. The vitamin D 3 analog, maxacalcitol, reduces psoriasiform skin inflammation by inducing regulatory T cells and downregulating IL-23 and IL-17 production. J Dermatol Sci 2018; 92:117-126. [PMID: 30166055 DOI: 10.1016/j.jdermsci.2018.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Psoriasis is a Th1/Th17-mediated inflammatory dermatosis treated with topical corticosteroids and vitamin D3 analogs (VD3 As). OBJECTIVE To compare the effects of a VD3 A maxacalcitol and betamethasone valerate (BV) steroid lotion on topical imiquimod (IMQ)-induced psoriasiform skin inflammation. METHODS Female BALB/c mice were treated with vehicle, maxacalcitol or BV lotion on the skin for 3 days, and IMQ cream for 6 days. q-PCR, H&E, immunohistochemistry and immunofluorescence studies were performed on skin samples. Additionally, mice were treated with vehicle, maxacalcitol or BV lotion for 3 days and CD4+CD25+ regulatory T cells (Tregs) and CD4+CD25- cells from each group were isolated from lymph nodes. Adoptive transfer of the cells was performed on recipient mice which were treated with IMQ cream for 6 days, and skin samples were obtained for q-PCR and H&E staining. RESULTS Maxacalcitol and BV were comparable in regards clinical improvement, although maxacalcitol reduced the MHC Class II+ inflammatory cell infiltration more than BV in IMQ skin. While both treatments downregulated IL-17 A, IL-17 F, IL-22, IL-12p40, TNF-α and IL-6 mRNA expression levels, only maxacalcitol downregulated IL-23p19 expression. Significantly increased Foxp3+ cell infiltrations and IL-10 expression were noted in maxacalcitol-treated IMQ skin. Adoptive transfer of Treg cells from maxacalcitol-treated donor mice improved IMQ-induced inflammation clinically and histopathologically more than the recipients of Treg cells from BV-treated donor groups, showing reduced levels of inflammatory cytokines and increased IL-10 expression. CONCLUSION These results indicate that maxacalcitol reduces psoriasiform skin inflammation by inducing Treg cells as well as downregulating IL-23 and IL-17 production.
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Affiliation(s)
- Carren Sy Hau
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Teruo Shimizu
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
| | - Masahiro Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
| | - Shintaro Takeoka
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Sayaka Shibata
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Aya Mitsui
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Takafumi Kadono
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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El Hayek Fares J, Weiler HA. Implications of the nutrition transition for vitamin D intake and status in Aboriginal groups in the Canadian Arctic. Nutr Rev 2017; 74:571-83. [PMID: 27534942 DOI: 10.1093/nutrit/nuw020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aboriginal Canadians have low intakes of vitamin D and are shifting away from consumption of traditional foods. Higher body mass index, skin pigmentation, and geographic latitude of residence further predispose Canadian Aboriginal populations to low vitamin D status. Low vitamin D status could compromise bone health and other health outcomes. Studies assessing vitamin D status of different Aboriginal groups are limited. The aim of this review is to examine the literature on vitamin D status and intakes of Canadian Aboriginal populations living in the Arctic. PubMed was searched for relevant articles published from 1983 to 2013. The prevalence of 25-hydroxy vitamin D deficiency ranged from 13.9% to 76.0% among children and adults in the summer. Furthermore, mean vitamin D intakes among all age groups were below the estimated average requirement. As vitamin D deficiency has been recently associated with chronic diseases, and Aboriginal populations living in the Arctic are at high risk for low vitamin D status, their vitamin D status should be assessed regularly across seasons.
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Affiliation(s)
- Jessy El Hayek Fares
- J.E.H. Fares and H.A. Weiler are with the School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada, and the Centre for Indigenous Peoples' Nutrition and Environment, Sainte-Anne-de-Bellevue, Quebec, Canada. J.E.H. Fares is with the Faculty of Nursing and Health Sciences, Notre Dame University, Zouk Mikael, Lebanon
| | - Hope A Weiler
- J.E.H. Fares and H.A. Weiler are with the School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada, and the Centre for Indigenous Peoples' Nutrition and Environment, Sainte-Anne-de-Bellevue, Quebec, Canada. J.E.H. Fares is with the Faculty of Nursing and Health Sciences, Notre Dame University, Zouk Mikael, Lebanon.
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7
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Venegas-Iribarren S, Andino R. Topical corticosteroids or vitamin D analogues for plaque psoriasis? Medwave 2017; 17:e6981. [PMID: 28665918 DOI: 10.5867/medwave.2017.6981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 06/19/2017] [Indexed: 11/27/2022] Open
Abstract
Psoriasis is a frequent chronic inflammatory disease. The plaque variant being its most common form of presentation. Although there is still no cure, treatment alternatives that induce remission and reduce lesions are available. Topical therapies, particularly corticosteroids and vitamin D analogues, are considered effective, but it is still not clear which would be the best alternative. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified eight systematic reviews including 26 studies overall, of which 22 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded there might be little or no difference in clinical response between topical corticosteroids and topical vitamin D analogues, but topical corticosteroids are less irritating at the site of application. No studies evaluating their long term adverse effects were found.
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Affiliation(s)
- Soledad Venegas-Iribarren
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. . Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago Centro, Chile
| | - Romina Andino
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Vena G, Cassano N, Alessandrini G, Fai D, Gabellone M, Ligori P, Malvindi C, Mancino A, Pellè S, Rinaldi F, Sodo M. Treatment of Mild to Moderate Plaque Psoriasis with Calcitriol Ointment Applied with or without a Dosing Device. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0700500205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Results of topical treatments can be influenced by several factors, including accurate dosing based on the affected skin area. The aim of this open-labelled multicenter study is to evaluate if correct dosing of calcitriol ointment has an impact on the clinical response of plaque psoriasis. For this purpose, patients with plaque psoriasis eligible to be treated with calcitriol ointment were randomized to treatment with a ‘standardized dose’ method, using a dosing device (N. 100), or treatment without the device (N. 101), for 12 weeks. Regardless of the use of the dosing device, calcitriol ointment caused a significant reduction of both the severity of signs and symptoms and the extent of body surface area affected after both 4 weeks and 12 weeks. Clinical response was not significantly different between the two groups. Local adverse events occurred in 12 subjects (of whom five treated with the device) and were mild and transient in most cases.
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Affiliation(s)
| | | | | | - D. Fai
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - M. Gabellone
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - P. Ligori
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - C. Malvindi
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - A. Mancino
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - S. Pellè
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - F. Rinaldi
- Collegio Salentino di Dermatologia, Lecce, Italy
| | - M.R. Sodo
- Collegio Salentino di Dermatologia, Lecce, Italy
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9
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Klebes M, Lademann J, Philipp S, Ulrich C, Patzelt A, Ulmer M, Kluschke F, Kramer A, Weltmann K, Sterry W, Lange-Asschenfeldt B. Effects of tissue-tolerable plasma on psoriasis vulgaris treatment compared to conventional local treatment: A pilot study. CLINICAL PLASMA MEDICINE 2014. [DOI: 10.1016/j.cpme.2013.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Chiricozzi A, Chimenti S. Effective topical agents and emerging perspectives in the treatment of psoriasis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Sawyer L, Samarasekera EJ, Wonderling D, Smith CH. Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis. Br J Dermatol 2013; 168:1095-105. [PMID: 23374249 DOI: 10.1111/bjd.12261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost. OBJECTIVES To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp. METHODS Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures. RESULTS For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made. CONCLUSIONS Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.
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Affiliation(s)
- L Sawyer
- Symmetron Limited, Kinetic Centre, Theobald Street, Borehamwood, Hertfordshire, WD6 4PJ, UK.
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12
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Samarasekera E, Sawyer L, Wonderling D, Tucker R, Smith C. Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. Br J Dermatol 2013; 168:954-67. [DOI: 10.1111/bjd.12276] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- E.J. Samarasekera
- National Clinical Guideline Centre; Royal College of Physicians of London; 11 St Andrews Place; London; NW1 4LE; U.K
| | - L. Sawyer
- Symmetron Ltd; Kinetic Centre; Theobald St, Borehamwood; WD6 4PJ; U.K
| | - D. Wonderling
- National Clinical Guideline Centre; Royal College of Physicians of London; 11 St Andrews Place; London; NW1 4LE; U.K
| | - R. Tucker
- Faculty of Health and Social Care; University of Hull; Hull; HU6 7RX; U.K
| | - C.H. Smith
- Division of Medicine and Molecular Genetics; St John's Institute of Dermatology; Guy's Hospital; London; SE1 9RT; U.K
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13
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Abstract
BACKGROUND Chronic plaque psoriasis is the most common type of psoriasis, and it is characterised by redness, thickness, and scaling. First-line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid, and topical retinoids. OBJECTIVES To compare the effectiveness, tolerability, and safety of topical treatments for chronic plaque psoriasis, relative to placebo, and to similarly compare vitamin D analogues (used alone or in combination) with other topical treatments. SEARCH METHODS We updated our searches of the following databases to February 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 2), MEDLINE (from 1948), EMBASE (from 1980), Science Citation Index (from 2008), Conference Proceedings Citation Index - Science (from 2008), BIOSIS (from 1993), Dissertation Abstracts via DialogClassic (all publication years), and Inside Conferences (all publication years).We identified ongoing and unpublished studies from the UK Clinical Research Network Study Portfolio and the metaRegister of Controlled Trials. We checked the bibliographies of published studies and reviews for further references to relevant trials, and we contacted trialists and companies for information about newly published studies.A separate search for adverse effects was undertaken in February 2011 using MEDLINE and EMBASE (from 2005).Final update searches for both RCTs and adverse effects were undertaken in August 2012. Although it has not been possible to incorporate RCTs and adverse effects studies identified through these final searches within this review, we will incorporate these into the next update. SELECTION CRITERIA Randomised trials comparing active topical treatments against placebo or against vitamin D analogues (used alone or in combination) in people with chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted trialists and companies for missing data. We also extracted data on withdrawals and on local and systemic adverse events. We defined long-term trials as those with a duration of at least 24 weeks. MAIN RESULTS This update added 48 trials and provided evidence on 7 new active treatments. In total, the review included 177 randomised controlled trials, with 34,808 participants, including 26 trials of scalp psoriasis and 6 trials of inverse psoriasis, facial psoriasis, or both. The number of included studies counted by Review Manager (RevMan) is higher than these figures (190) because we entered each study reporting a placebo and an active comparison into the 'Characteristics of included studies' table as 2 studies.When used on the body, most vitamin D analogues were significantly more effective than placebo, with the standardised mean difference (SMD) ranging from -0.67 (95% CI -1.04 to -0.30; 1 study, 119 participants) for twice-daily becocalcidiol to SMD -1.66 (95% CI -2.66 to -0.67; 1 study, 11 participants) for once-daily paricalcitol. On a 6-point global improvement scale, these effects translate into 0.8 and 1.9 points, respectively. Most corticosteroids also performed better than placebo; potent corticosteroids (SMD -0.89; 95% CI -1.06 to -0.72; I² statistic = 65.1%; 14 studies, 2011 participants) had smaller benefits than very potent corticosteroids (SMD -1.56; 95% CI -1.87 to -1.26); I² statistic = 81.7%; 10 studies, 1264 participants). On a 6-point improvement scale, these benefits equate to 1.0 and 1.8 points, respectively. Dithranol, combined treatment with vitamin D/corticosteroid, and tazarotene all performed significantly better than placebo.Head-to-head comparisons of vitamin D for psoriasis of the body against potent or very potent corticosteroids had mixed findings. For both body and scalp psoriasis, combined treatment with vitamin D and corticosteroid performed significantly better than vitamin D alone or corticosteroid alone. Vitamin D generally performed better than coal tar, but findings relative to dithranol were mixed. When applied to psoriasis of the scalp, vitamin D was significantly less effective than both potent corticosteroids and very potent corticosteroids. Indirect evidence from placebo-controlled trials supported these findings.For both body and scalp psoriasis, potent corticosteroids were less likely than vitamin D to cause local adverse events, such as burning or irritation. Combined treatment with vitamin D/corticosteroid on either the body or the scalp was tolerated as well as potent corticosteroids, and significantly better than vitamin D alone. Only 25 trials assessed clinical cutaneous dermal atrophy; few cases were detected, but trials reported insufficient information to determine whether assessment methods were robust. Clinical measurements of dermal atrophy are insensitive and detect only the most severe cases. No comparison of topical agents found a significant difference in systemic adverse effects. AUTHORS' CONCLUSIONS Corticosteroids perform at least as well as vitamin D analogues, and they are associated with a lower incidence of local adverse events. However, for people with chronic plaque psoriasis receiving long-term treatment with corticosteroids, there remains a lack of evidence about the risk of skin dermal atrophy. Further research is required to inform long-term maintenance treatment and provide appropriate safety data.
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Affiliation(s)
- Anne R Mason
- Centre for Health Economics, The University of York, York, UK.
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14
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Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B. S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges 2012; 10 Suppl 2:S1-95. [PMID: 22386073 DOI: 10.1111/j.1610-0387.2012.07919.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).
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Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité- Universitätsmedizin Berlin, Germany
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15
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Devaux S, Castela A, Archier E, Gallini A, Joly P, Misery L, Aractingi S, Aubin F, Bachelez H, Cribier B, Jullien D, Le Maître M, Richard MA, Ortonne JP, Paul C. Topical vitamin D analogues alone or in association with topical steroids for psoriasis: a systematic review. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:52-60. [DOI: 10.1111/j.1468-3083.2012.04524.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Paul C, Gallini A, Archier E, Castela E, Devaux S, Aractingi S, Aubin F, Bachelez H, Cribier B, Joly P, Jullien D, Le Maître M, Misery L, Richard MA, Ortonne JP. Evidence-based recommendations on topical treatment and phototherapy of psoriasis: systematic review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:1-10. [DOI: 10.1111/j.1468-3083.2012.04518.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res 2012; 304:87-113. [DOI: 10.1007/s00403-012-1214-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 01/19/2023]
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18
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JYM, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol 2011; 65:137-74. [PMID: 21306785 DOI: 10.1016/j.jaad.2010.11.055] [Citation(s) in RCA: 310] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 11/21/2010] [Accepted: 11/26/2010] [Indexed: 12/13/2022]
Abstract
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the American Academy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients' needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.
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Affiliation(s)
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- Psoriasis Research Center, Baylor University Medical Center, Dallas, Texas, USA
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19
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van de Kerkhof P, de Peuter R, Ryttov J, Jansen JP. Mixed treatment comparison of a two-compound formulation (TCF) product containing calcipotriol and betamethasone dipropionate with other topical treatments in psoriasis vulgaris. Curr Med Res Opin 2011; 27:225-38. [PMID: 21142833 DOI: 10.1185/03007995.2010.541005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The efficacy of the two-compound formulation (TCF) product containing calcipotriol and betamethasone dipropionate applied once daily in psoriasis has been demonstrated in phase III trials but no randomised clinical trial comparing all commonly used topical treatments exists. The aim of the study was to compare the efficacy of once-daily use of the TCF product relative to other commonly used topical agents in plaque psoriasis. RESEARCH DESIGN AND METHODS Data on change in Psoriasis Area and Severity Index (PASI) score from baseline and PASI 75 (percentage of patients achieving a 75% reduction in PASI score), after 4 weeks of treatment were obtained by means of a systematic literature review of randomised controlled trials and synthesised with a Bayesian mixed treatment comparison meta-analysis. RESULTS Relative to all active interventions, except for the unlicensed twice-daily application of the TCF product, the TCF once daily showed a greater efficacy based on PASI 75 response (relative risk ranging from 1.22 to 3.18) and improvement in PASI score from baseline (difference in % CFB PASI between TCF once daily and other active interventions ranged from 4.01 to 49.68). CONCLUSION Among topical therapies evaluated, TCF once daily can be considered the most efficacious treatment for plaque psoriasis.
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20
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Abstract
IMPORTANCE OF THE FIELD The majority of patients with psoriasis can be safely and effectively treated with topical therapy alone, either under the supervision of a family physician or dermatologist. For those requiring systemic agents, topical therapies can provide additional benefit. Optimal use of topical therapy requires an awareness of the range and efficacy of all products. AREAS COVERED IN THIS REVIEW The review covers the efficacy and role of topical therapies including emollients, corticosteroids, vitamin D analogs, calcineurin inhibitors, dithranol, coal tar, retinoids, keratolyics and combination therapy. The report was prepared following a PubMed and Embase literature search up to April 2010. WHAT THE READER WILL GAIN The paper provides a broad review of the relevant topical therapeutic options available in routine clinical practice for the management of psoriasis and a recommendation for selection of treatment. TAKE HOME MESSAGE Topical therapies used appropriately provide a safe and effective option for the management of psoriasis. An awareness of the available products and their efficacy is key to treatment selection and patient satisfaction.
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Affiliation(s)
- Philip M Laws
- The University of Manchester, Salford Royal Hospital (Hope), Manchester Academic Health Sciences Centre, Department of Dermatology, Salford, Manchester M6 8HD, UK
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21
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Radtke M, Herberger K, Kornek T, Augustin M. Calcipotriol plus Betamethasondipropionat-Gel in der Behandlung der Kopfhautpsoriasis. Hautarzt 2010; 61:770-5. [DOI: 10.1007/s00105-010-1974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Kowalzick L. Novel topical therapy for mild-to-moderate plaque psoriasis: focus on calcitriol. Clin Cosmet Investig Dermatol 2009; 2:153-9. [PMID: 21436978 PMCID: PMC3047927 DOI: 10.2147/ccid.s5758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The benefits of vitamin D derivatives for the treatment of chronic plaque psoriasis are well documented. Of importance is how compatible they are with, and how they compare to, other established treatments for psoriasis. This paper reviews 15 studies with calcitriol 3 μg g(-1) ointment (Silkis(®)/Vectical(™) ointment; Galderma Laboratories) applied twice daily for up to 52 weeks. The ointment was found to be effective and safe for the treatment of mild-to-moderate plaque psoriasis including sensitive skin areas. Calcitriol 3 μg g(-1) ointment was found to be as effective as, or even superior to, other established treatment modalities and more highly tolerated than other local treatment modalities in most studies' comparisons. It could be combined with other psoriasis treatment modalities such as ultraviolet B phototherapy or topical corticosteroids in order to achieve a faster response and in order to reduce the risk of adverse events.
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Affiliation(s)
- Lutz Kowalzick
- Department of Dermatology and Allergology, HELIOS Vogtland-Klinikum Plauen GmbH Plauen, Germany
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23
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Abstract
BACKGROUND Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid and topical retinoids. OBJECTIVES To compare the effectiveness, tolerability and safety of topical treatments for chronic plaque psoriasis with placebo; to compare vitamin D analogues with other topical treatments. SEARCH STRATEGY The Cochrane Skin Group's Trials Register was searched (2004/12). To update an unpublished 2002 review we also searched CENTRAL in The Cochrane Library (Issue 1,2005); MEDLINE (to 2005/02); EMBASE (to 2005/08); Science Citation Index (to 2005); Biosis (to 2005); Dissertation Abstracts (all publication years); Inside Conferences (all publication years); SIGLE (to 2005); National Research Register (all projects with a start date of 2001 to 2005); metaRegister of Current Controlled Trials. SELECTION CRITERIA Randomised trials comparing treatments against placebo or against vitamin D analogues in people with chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted triallists and companies for missing data. We extracted data on withdrawals and adverse events. MAIN RESULTS The review included 131 RCTs with 21,448 participants. Vitamin D was significantly more effective than placebo, although there was a wide variation in effect size with the standardised mean difference (SMD) ranging from -0.82 (95% CI -1.34 to -0.29) to -1.90 (95% CI -2.09 to -1.71). With one exception, all corticosteroids performed better than placebo, with potent corticosteroids (SMD: -0.95 (95% CI: -1.11 to -0.80; I(2): 61.1%; 17 studies; 2386 participants)) having smaller benefits than very potent corticosteroids (SMD: -1.29 (95% CI: -1.45 to -1.13; I(2): 53.2%; 11 studies; 1571 participants)). Dithranol and tazarotene performed better than placebo. Head-to-head comparisons of vitamin D against potent or very potent corticosteroids found no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone. Vitamin D performed better than coal tar, but findings relative to dithranol were mixed. Potent corticosteroids were less likely than vitamin D to cause local adverse events. No comparison of topical agents found a significant difference in systemic adverse effects. AUTHORS' CONCLUSIONS Corticosteroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Further research is required to inform long-term maintenance treatment.
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Affiliation(s)
- Anne R Mason
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, UK, YO10 5DD.
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24
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2009; 60:643-59. [DOI: 10.1016/j.jaad.2008.12.032] [Citation(s) in RCA: 327] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 12/16/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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25
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26
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Carrascosa J, Vanacloch F, Borrego L, Fernández-López E, Fuertes A, Rodríguez-Fernández-Freire L, Zulaica A, Tuneu A, Caballé G, Colomé E, Bordas X, Hernanz J, Brufau C, Herrera E. Update of the Topical Treatment of Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70044-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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van de Kerkhof PCM, Barker J, Griffiths CEM, Kragballe K, Mason J, Menter A, Papp K. Psoriasis: consensus on topical therapies. J Eur Acad Dermatol Venereol 2007; 22:859-70. [PMID: 18081748 DOI: 10.1111/j.1468-3083.2007.02534.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A consensus conference was convened to evaluate the topical treatment of psoriasis. PARTICIPANTS Members of the International Psoriasis Council (IPC) with broad clinical experience in the treatment of psoriasis and a specialist in meta- and pharmacoeconomic analyses were invited to participate on the consensus panel. Those accepting the invitation convened in Saariselkä, Finland. EVIDENCE An advisory group on topical treatments was nominated by the organizing panel members. All participants reported at the consensus conference on evidence based data with respect to disease severity assessment, the available data on efficacy and safety and on a comparative efficacy/safety analysis. CONSENSUS PROCESS At the consensus conference, the presentations were discussed and conclusions, which were reached by the group, were recorded. Active participants of the group wrote assigned sections of this consensus document with a majority of participants agreed on the conclusions.
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Affiliation(s)
- P C M van de Kerkhof
- Department of Dermatology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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28
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Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris. J Dtsch Dermatol Ges 2007; 5 Suppl 3:1-119. [PMID: 17615051 DOI: 10.1111/j.1610-0387.2007.06172.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.
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Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Germany
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29
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Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version). Arch Dermatol Res 2007; 299:111-38. [PMID: 17497162 PMCID: PMC1910890 DOI: 10.1007/s00403-007-0744-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 11/30/2022]
Abstract
Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).
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Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany.
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30
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Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. S3-Leitlinie zur Therapie der Psoriasis vulgaris. J Dtsch Dermatol Ges 2006; 4 Suppl 2:S1-126. [PMID: 17187649 DOI: 10.1111/j.1610-0387.2006.06172.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
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31
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Ma Y, Khalifa B, Yee YK, Lu J, Memezawa A, Savkur RS, Yamamoto Y, Chintalacharuvu SR, Yamaoka K, Stayrook KR, Bramlett KS, Zeng QQ, Chandrasekhar S, Yu XP, Linebarger JH, Iturria SJ, Burris TP, Kato S, Chin WW, Nagpal S. Identification and characterization of noncalcemic, tissue-selective, nonsecosteroidal vitamin D receptor modulators. J Clin Invest 2006; 116:892-904. [PMID: 16528410 PMCID: PMC1395481 DOI: 10.1172/jci25901] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 01/16/2006] [Indexed: 11/17/2022] Open
Abstract
Vitamin D receptor (VDR) ligands are therapeutic agents for the treatment of psoriasis, osteoporosis, and secondary hyperparathyroidism. VDR ligands also show immense potential as therapeutic agents for autoimmune diseases and cancers of skin, prostate, colon, and breast as well as leukemia. However, the major side effect of VDR ligands that limits their expanded use and clinical development is hypercalcemia that develops as a result of the action of these compounds mainly on intestine. In order to discover VDR ligands with less hypercalcemia liability, we sought to identify tissue-selective VDR modulators (VDRMs) that act as agonists in some cell types and lack activity in others. Here, we describe LY2108491 and LY2109866 as nonsecosteroidal VDRMs that function as potent agonists in keratinocytes, osteoblasts, and peripheral blood mononuclear cells but show poor activity in intestinal cells. Finally, these nonsecosteroidal VDRMs were less calcemic in vivo, and LY2108491 exhibited more than 270-fold improved therapeutic index over the naturally occurring VDR ligand 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] in an in vivo preclinical surrogate model of psoriasis.
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MESH Headings
- Acetates/chemical synthesis
- Acetates/metabolism
- Acetates/pharmacology
- Animals
- Arylsulfonates/chemical synthesis
- Arylsulfonates/metabolism
- Arylsulfonates/pharmacology
- Caco-2 Cells
- Calcitriol/metabolism
- Calcitriol/pharmacology
- Cell Proliferation
- Cells, Cultured
- Colonic Neoplasms/metabolism
- Dose-Response Relationship, Drug
- Drug Evaluation, Preclinical
- Female
- Humans
- Hypercalcemia/metabolism
- Intestines
- Keratinocytes/drug effects
- Keratinocytes/metabolism
- Ligands
- Mice
- Mice, Hairless
- Mice, Inbred C57BL
- Mice, Inbred Strains
- Models, Biological
- Osteoblasts/drug effects
- Osteoblasts/metabolism
- Psoriasis/drug therapy
- Rats
- Receptors, Calcitriol/agonists
- Receptors, Calcitriol/metabolism
- Signal Transduction
- Species Specificity
- Thiophenes/chemical synthesis
- Thiophenes/metabolism
- Thiophenes/pharmacology
- Transcription, Genetic
- Tumor Cells, Cultured
- Vitamin D/analogs & derivatives
- Vitamin D/chemical synthesis
- Vitamin D/metabolism
- Vitamin D/pharmacology
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Affiliation(s)
- Yanfei Ma
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Berket Khalifa
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Ying K. Yee
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Jianfen Lu
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Ai Memezawa
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Rajesh S. Savkur
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Yoko Yamamoto
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Subba R. Chintalacharuvu
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Kazuyoshi Yamaoka
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Keith R. Stayrook
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Kelli S. Bramlett
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Qing Q. Zeng
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Srinivasan Chandrasekhar
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Xiao-Peng Yu
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Jared H. Linebarger
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Stephen J. Iturria
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Thomas P. Burris
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Shigeaki Kato
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - William W. Chin
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Sunil Nagpal
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
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32
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Abstract
1alpha,25-Dihydroxyvitamin D(3) [1,25-(OH)(2)D(3)], the active metabolite of vitamin D(3), is known for the maintenance of mineral homeostasis and normal skeletal architecture. However, apart from these traditional calcium-related actions, 1,25-(OH)(2)D(3) and its synthetic analogs are being increasingly recognized for their potent antiproliferative, prodifferentiative, and immunomodulatory activities. These actions of 1,25-(OH)(2)D(3) are mediated through vitamin D receptor (VDR), which belongs to the superfamily of steroid/thyroid hormone nuclear receptors. Physiological and pharmacological actions of 1,25-(OH)(2)D(3) in various systems, along with the detection of VDR in target cells, have indicated potential therapeutic applications of VDR ligands in inflammation (rheumatoid arthritis, psoriatic arthritis), dermatological indications (psoriasis, actinic keratosis, seborrheic dermatitis, photoaging), osteoporosis (postmenopausal and steroid-induced osteoporosis), cancers (prostate, colon, breast, myelodysplasia, leukemia, head and neck squamous cell carcinoma, and basal cell carcinoma), secondary hyperparathyroidism, and autoimmune diseases (systemic lupus erythematosus, type I diabetes, multiple sclerosis, and organ transplantation). As a result, VDR ligands have been developed for the treatment of psoriasis, osteoporosis, and secondary hyperparathyroidism. Furthermore, encouraging results have been obtained with VDR ligands in clinical trials of prostate cancer and hepatocellular carcinoma. This review deals with the molecular aspects of noncalcemic actions of vitamin D analogs that account for the efficacy of VDR ligands in the above-mentioned indications.
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Affiliation(s)
- Sunil Nagpal
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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