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Aoki KC, Wong S, Duong JQ, Feldman SR. Adherence to Psoriasis Therapies. Dermatol Clin 2024; 42:495-506. [PMID: 38796278 DOI: 10.1016/j.det.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Understanding the underlying causes of nonadherence among patients with psoriasis and adopting strategies to address these issues may allow providers to share responsibility and work alongside patients to overcome these barriers. The review explores patient adherence to different types of psoriasis treatment, suggestions for interventions to overcome barriers, and methods to promote adherence that have been published in the literature.
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Affiliation(s)
- Kawaiola C Aoki
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Summer Wong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Jessica Q Duong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
| | - Steven R Feldman
- Department of Dermatology, Pathology, and Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
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Potestio L, Tommasino N, Lauletta G, Feo F, Ruggiero A, Martora F, Portarapillo A, Guerriero L, Megna M. Efficacy and safety of deucravacitinib for the management of psoriasis: a drug safety evaluation. Expert Opin Drug Saf 2024; 23:677-685. [PMID: 38699874 DOI: 10.1080/14740338.2024.2351462] [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: 12/11/2023] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Nowadays, despite the wide availability of biological drugs and apremilast for psoriasis management, there is always a need for new therapies to customize the therapeutic approach on the basis of the patient's clinical features and comorbidities, especially in order to achieve a prolonged therapeutic response. Thus, new treatment strategies are required to offer patients a personalized approach. In this scenario, major knowledge on psoriasis pathogenesis led to the development of deucravacitinib, an orally administered selective TYK2 inhibitor. AREAS COVERED The aim of this manuscript is to review the current literature on the effectiveness and safety of deucravacitinib in psoriasis to offer readers a wide perspective. The current English literature was analyzed using the PubMed, Google Scholar, Embase, Cochrane Skin, and clinicaltrials.gov databases, selecting the most relevant manuscripts. EXPERT OPINION Deucravacitinib appears to be an innovative weapon for the management of moderate to severe psoriasis. Despite its efficacy and safety profiles have been revealed by RCTs, real-life data are still scant. Certainly, deucravacitinib broadens the range of therapeutic alternatives for psoriasis patients, thus enhancing the holistic and personalized approaches required for the treatment of this disease.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nello Tommasino
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Lauletta
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Federica Feo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Portarapillo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Guerriero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Teixeira A, Teixeira M, Gaio R, Torres T, Magina S, Dinis MAP, Sousa-Lobo J, Almeida I, Peixoto M, Almeida V. Influence of Clinical and Psychosocial Factors on the Adherence to Topical Treatment in Psoriasis. Healthcare (Basel) 2024; 12:822. [PMID: 38667584 PMCID: PMC11050139 DOI: 10.3390/healthcare12080822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Psoriasis is a common chronic inflammatory skin disease with different manifestations, affecting the quality of life at social, emotional, and professional dimensions and requiring long-term treatment. This study aimed to investigate the effect of psychosocial and clinical factors on adherence to topical treatment in psoriasis. (2) Methods: Self-reported measures and weighing the medicines were used to assess adherence. Psychopathological symptoms were measured using the Brief Symptoms Inventory (BSI). Social and clinical factors were assessed by a sociodemographic and clinical questionnaire. Adherence to treatment with topical medication was assessed using a sample of 102 psoriasis patients. (3) Results: The explanatory models of adherence to topical treatment in psoriasis translated into positive associations between adherence and the education level (higher education) (p = 0.03; φ = 0.23), the single-family household (p = 0.01; φ = 0.44), active employment status (p = 0.05; φ = -0.19), familiar history of psoriasis (p = 0.04; φ = -0.21), and the presence of obsessive-compulsive symptoms (p = 0.01; d = 0.29). (4) Conclusions: In patients who present the characteristics identified that influence non-adherence, instructions should be reinforced to increase adherence. The experimental mortality (39.6%) reduced the sample size, representing a limitation of the study.
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Affiliation(s)
- Ana Teixeira
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, University Institute of Health Sciences—CESPU, 4585-116 Gandra, Portugal;
- UCIBIO—Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Maribel Teixeira
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, University Institute of Health Sciences—CESPU, 4585-116 Gandra, Portugal;
- UCIBIO—Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Rita Gaio
- Centro de Matemática da Universidade do Porto, Departamento de Matemática, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal;
| | - Tiago Torres
- Serviço de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001 Porto, Portugal;
| | - Sofia Magina
- Serviço de Dermatologia, Centro Hospitalar de São João, Departamento de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal;
| | - Maria Alzira Pimenta Dinis
- Fernando Pessoa Research, Innovation and Development Institute (FP-I3ID), University Fernando Pessoa (UFP), Praça 9 de Abril 349, 4249-004 Porto, Portugal;
| | - José Sousa-Lobo
- UCIBIO—Applied Molecular Biosciences Unit, MedTech, Applied Biomolecular Biosciences Unit, Medicines and Healthcare Products, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (J.S.-L.); (V.A.)
| | - Isabel Almeida
- UCIBIO—Applied Molecular Biosciences Unit, MedTech, Applied Biomolecular Biosciences Unit, Medicines and Healthcare Products, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (J.S.-L.); (V.A.)
| | - Miguel Peixoto
- Instituto Universitário de Ciências da Saúde (IUCS), CESPU—Cooperativa de Ensino Superior Politécnico e Universitário, 4585-116 Gandra, Portugal;
- Psychosocial Rehabilitation Laboratory, Rehabilitation Investigation Center, School of Health, Polytechnic University of Porto, 4200-465 Porto, Portugal
| | - Vera Almeida
- UCIBIO—Applied Molecular Biosciences Unit, MedTech, Applied Biomolecular Biosciences Unit, Medicines and Healthcare Products, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (J.S.-L.); (V.A.)
- UNIPRO—Unidade de Investigação em Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde (IUCS), CESPU—Cooperativa de Ensino Superior Politécnico e Universitário, 4585-116 Gandra, Portugal
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4
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Huo Y, Huang Y, Lee T, Lin M, Chun W. An observational study on treatment regimens and effectiveness for psoriasis in real-world settings among 407 patients in Southeast China. Front Med (Lausanne) 2024; 11:1328750. [PMID: 38348339 PMCID: PMC10860679 DOI: 10.3389/fmed.2024.1328750] [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: 10/27/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction While new targeted therapies have advanced psoriasis treatment, real-world data on comparative effectiveness is lacking. This study analyzed treatment regimens and response in an observational cohort, examining potential disparities between clinical trials and routine practice. Methods Data from the Psoriasis Standardized Diagnosis and Treatment Center registry were analyzed. Patients with ≥1 follow-up were included. Treatment response was assessed using PASI 50/90 criteria. Factors associated with response were analyzed. Results 407 patients were included (46 first-time diagnosed, 361 previously diagnosed). A higher proportion of first-time diagnosed patients achieved treatment response than previously diagnosed (76.1% vs. 62.6%). Multivariable analysis identified factors associated with reduced response in previously treated patients. Conclusion This real-world study found lower treatment response rates compared to clinical trials, especially in previously treated patients. Disparities highlight remaining unmet needs for psoriasis management. Combination and rotational strategies may improve outcomes in patients unresponsive to available therapies. Ongoing research on novel targets and pathways is warranted to address treatment gaps.
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Affiliation(s)
- Yuping Huo
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Yike Huang
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Tungchun Lee
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Maoying Lin
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Wenhung Chun
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
- Department of Dermatology, Linkou Chang-Gung Memorial Hospital, Taiwan, China
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Svendsen MT, Andersen KE, Feldman SR, Mejldal A, Möller S, Kongstad LP. An effective patient-supporting intervention for topical treatment of psoriasis is also cost-effective. Clin Exp Dermatol 2023; 48:1247-1254. [PMID: 37585448 DOI: 10.1093/ced/llad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND A randomized controlled trial (RCT) of topical treatment combined with regular patient support provided by dermatological nurses in structured consultations of 20-min duration every fourth week improved psoriasis severity, quality of life and treatment adherence compared with topical treatment combined with standard patient support, which is seeing a dermatologist every third month. OBJECTIVES To examine the economic impact of the patient support from a healthcare-sector perspective in the RCT. METHODS Costs for primary care, secondary healthcare services and costs of prescription medication were compared for the intervention and nonintervention groups over 48 weeks. Health benefits were expressed in terms of quality-adjusted life-years (QALYs) measured by the EuroQoL five-dimension three-level questionnaire. Regression analyses were used to estimate incremental cost and QALYs. RESULTS The incremental cost was estimated at £462, with an average increase of 0.08 QALYs per patients for participants receiving the intervention compared with those receiving standard care. The incremental cost-effectiveness ratio for patients was £5999/QALY. The intervention had an almost 100% probability of being cost-effective at a willingness-to-pay threshold of £30 000 per QALY. CONCLUSIONS Addressing adherence issues is critical to improving outcomes for patients with psoriasis who use topical treatment. The personal support intervention was effective with an acceptable increase in costs.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Klaus Ejner Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steven R Feldman
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna Mejldal
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Line Planck Kongstad
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
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6
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Yao Q, Zhai YY, He Z, Wang Q, Sun L, Sun T, Lv L, Li Y, Yang J, Lv D, Chen R, Zhang H, Luo X, Kou L. Water-responsive gel extends drug retention and facilitates skin penetration for curcumin topical delivery against psoriasis. Asian J Pharm Sci 2023; 18:100782. [PMID: 36845839 PMCID: PMC9950530 DOI: 10.1016/j.ajps.2023.100782] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by erythema, scaling, and skin thickening. Topical drug application is recommended as the first-line treatment. Many formulation strategies have been developed and explored for enhanced topical psoriasis treatment. However, these preparations usually have low viscosity and limited retention on the skin surface, resulting in low drug delivery efficiency and poor patient satisfaction. In this study, we developed the first water-responsive gel (WRG), which has a distinct water-triggered liquid-to-gel phase transition property. Specifically, WRG was kept in a solution state in the absence of water, and the addition of water induced an immediate phase transition and resulted in a high viscosity gel. Curcumin was used as a model drug to investigate the potential of WRG in topical drug delivery against psoriasis. In vitro and in vivo data showed that WRG formulation could not only extend skin retention but also facilitate the drug permeating across the skin. In a mouse model of psoriasis, curcumin loaded WRG (CUR-WRG) effectively ameliorated the symptoms of psoriasis and exerted a potent anti-psoriasis effect by extending drug retention and facilitating drug penetration. Further mechanism study demonstrated that the anti-hyperplasia, anti-inflammation, anti-angiogenesis, anti-oxidation, and immunomodulation properties of curcumin were amplified by enhanced topical drug delivery efficiency. Notably, neglectable local or systemic toxicity was observed for CUR-WRG application. This study suggests that WRG is a promising formulation for topically psoriasis treatment.
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Affiliation(s)
- Qing Yao
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Yuan-Yuan Zhai
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Zhimin He
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Qian Wang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Lining Sun
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou 325027, China
| | - Tuyue Sun
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Leyao Lv
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yingtao Li
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Jiyong Yang
- Beijing Baoyi Technology Co., Ltd, Beijing 101115, China
| | - Donghui Lv
- Beijing Baoyi Technology Co., Ltd, Beijing 101115, China
| | - Ruijie Chen
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou 325027, China
| | - Hailin Zhang
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,Corresponding authors.
| | - Xiang Luo
- Institute of Pharmaceutics, Shaoxing University, Shaoxing 312000, China,Corresponding authors.
| | - Longfa Kou
- Wenzhou Municipal Key Laboratory of Pediatric Pharmacy, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China,Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou 325027, China,Wenzhou key Laboratory of basic science and translational research of radiation oncology, Wenzhou 325027, China,Corresponding authors.
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Svendsen MT, Feldman SR, Mejldal A, Möller S, Kongstad LP, Andersen KE. Regular support provided by dermatological nurses improves outcomes in patients with psoriasis treated with topical drugs: a randomized controlled trial. Clin Exp Dermatol 2022; 47:2208-2221. [PMID: 35973788 PMCID: PMC10092433 DOI: 10.1111/ced.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long-term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome. AIM To evaluate whether regular support from dermatological nurses improves outcome and treatment adherence in patients with psoriasis receiving topical medications. METHODS We conducted a randomized controlled trial (RCT) (clinicaltrials.gov registration NCT04220554), in which patients received once-daily topical medications (containing corticosteroids and/or calcipotriol) for as long as their psoriasis was visible. The patients were randomly allocated to standard care by the dermatologist either with (n = 51) or without (n = 52) support from dermatological nurses. The nurse support intervention consisted of a structured dermatological consultation at baseline and Week 1, followed by contact with a nurse each month (in the outpatient clinic or by telephone). The primary outcome was severity of psoriasis, which was measured by the Lattice System Physician's Global Assessment (LS-PGA) and assessed by intention-to-treat analyses using linear mixed regression models for longitudinal data. Secondary outcomes were quality of life (measured by the Dermatology Life Quality Index; DLQI) and good adherence (defined as use of ≥ 80% of recommended doses). RESULTS In total, 92 patients (89%) completed the 48-week trial period. The intervention group improved more than the nonintervention group from baseline to Week 24 in LS-PGA (2.21 vs. 1.28, P = 0.001) and in DLQI at Week 12 (6.50 vs. 1.55, P < 0.001). Differences between the two groups in favour of the intervention were observed throughout the study period. More participants in the intervention group had good adherence compared with the nonintervention group (36% vs. 14%, P < 0.001). CONCLUSION Regular, continued patient support from dermatological nurses increased the efficacy of psoriasis treatment, improved quality of life and enhanced long-term adherence to topical antipsoriatic drugs. However, there is still room for more improvement.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Steven R Feldman
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.,Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna Mejldal
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Line Planck Kongstad
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Klaus E Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Nasimi M, Abedini R, Ghandi N, Hajinamaki H, Tabatabaei MSHZ, Ansari MS. Topical treatment adherence and associated factors in patients with psoriasis: a single centre, cross-sectional study. Dermatol Ther 2022; 35:e15547. [PMID: 35502491 DOI: 10.1111/dth.15547] [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: 02/04/2022] [Revised: 03/26/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Topical medications are one of the main treatments for psoriasis. Adherence to treatment is an important factor in achieving successful control of disease. The aim of this study was to evaluate adherence to topical drugs and identify possible associated factors in in patients with psoriasis. METHOD Ninety-three patients were evaluated by a two-part questionnaire; The first part examined demographic, socioeconomic and disease-related factors while the second part, the ECOB questionnaire (Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux), examined adherence to topical drugs. RESULTS The mean self-reported adherence to topical treatment in this study, was 50.5%. Severe disease, involvement of lower extremity, and positive family history of psoriasis were associated with poor adherence to treatment. Patients with a history of diabetes mellitus had better adherence to treatment. CONCLUSION In this study adherence to topical treatment was low and had no significant relationship with most of the studied demographic and socioeconomic factors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maryam Nasimi
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadis Hajinamaki
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahshid Sadat Ansari
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lu ST, Kelly KA, Feldman SR. An overview of benvitimod for the treatment of psoriasis: a narrative review. Expert Opin Pharmacother 2021; 23:327-333. [DOI: 10.1080/14656566.2021.2016699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah T Lu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Katherine A Kelly
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, Nc USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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10
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Svendsen MT, Feldman SR, Möller S, Kongstad LP, Andersen KE. Long-term improvement of psoriasis patients' adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals. Trials 2021; 22:742. [PMID: 34696820 PMCID: PMC8543428 DOI: 10.1186/s13063-021-05707-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Psoriasis affects 2-4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure. METHODS The intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure. The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18-85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol. The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician's Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants' total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out. DISCUSSION If the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics. TRIAL REGISTRATION Clinicaltrials.gov NCT04220554 . Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov . Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Dermatology and Allergy Centre, Odense University Hospital, Kløvervænget 15, 5000, Odense C, Denmark.
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.
| | - Steven R Feldman
- Department of Dermatology and Allergy Centre, Odense University Hospital, Kløvervænget 15, 5000, Odense C, Denmark
- Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Line Planck Kongstad
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Klaus Ejner Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Svendsen MT, Tiedemann SN, Andersen KE. Pros and cons of eHealth: A systematic review of the literature and observations in Denmark. SAGE Open Med 2021; 9:20503121211016179. [PMID: 34046178 PMCID: PMC8135209 DOI: 10.1177/20503121211016179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/16/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: The main objectives of this article are to systematically review the recent literature on patient safety in relation to the use of eHealth and to investigate how the Danish authorities supervise private eHealth clinics with regard to patient safety. Methods: Original studies reporting the association between patient safety and the use of eHealth as a means of communication between patients and healthcare providers were included. Four literature databases were searched for English-language articles reporting results from cohort studies and clinical trials, published from 2015 until March 2021. Moreover, registered private eHealth clinics in Denmark were evaluated with reference to a recent national audit of patient safety issues in eHealth. Results: The literature search retrieved four intervention studies. The studies did not identify any particular patient safety risks associated with the use of eHealth. Many different authorized healthcare providers (preferably, doctors) apply eHealth in various contexts. eHealth is being used as the only form of contact between the healthcare provider and the patient, as a supplement to patient visitations in an outpatient clinic, or as a tool for communicating between two or more healthcare providers. The regulation of eHealth involves patient safety issues but also has interfaces to marketing, IT systems, and infrastructure. Supervision of eHealth includes the organization of clinics, handling patient charts, prescription medicine, patient legal rights, and patient transition. However, there are many interfaces in the division of responsibilities among the various governmental players. Conclusion: eHealth is being used increasingly and in many settings, although recently published intervention studies investigating patient safety issues by the use of eHealth are limited. A structured and continuous governmental control and regulation of patient safety in relation to the use of eHealth is warranted.
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Affiliation(s)
- Mathias T Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Sylvia N Tiedemann
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Ejner Andersen
- Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
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Svendsen MT, Feldman SR, Tiedemann SN, Stochholm Sørensen AS, Rivas CMR, Andersen KE. Dermatology nurses view on factors related to Danish psoriasis patients' adherence to topical drugs: a focus group study. J DERMATOL TREAT 2019; 32:497-502. [PMID: 31664863 DOI: 10.1080/09546634.2019.1687817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Topical medications are first-line treatment for mild-to-moderate psoriasis, but adherence is low, which negatively affects patients' outcomes and quality of life. Nurses can play a central role in patient care, particularly in improving adherence. OBJECTIVES To explore the experience of dermatology nurses with psoriasis patients' adherence to topical drugs. METHODS We conducted a semi-structured focus group study with 6 dermatology nurses and 2 dermatology nursing students. Participants were recruited from a dermatology hospital outpatient clinic. Data were analyzed by a systematic text condensation method with a phenomenological-hermeneutic approach. RESULTS Nurses experienced that factors such as social inequality, patient-centered nursing, and patients' quality of life can have an influence on adherence. CONCLUSION Optimal adherence to topical treatments is a complex exercise and is influenced by many different factors. Involving nurses when prescribing topical treatments may be beneficial since they are one of the most trustworthy professions and have a holistic view on psoriasis severity, patient preferences, health care resources available and socioeconomic factors.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark
| | - Steven R Feldman
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark.,Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Klaus Ejner Andersen
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark
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13
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Svendsen MT, Feldman SR, Tiedemann SN, Sørensen ASS, Rivas CMR, Andersen KE. Psoriasis patient preferences for topical drugs: a systematic review. J DERMATOL TREAT 2019; 32:478-483. [PMID: 31610687 DOI: 10.1080/09546634.2019.1675855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Topical drugs are recommended first-line treatment for mild-to-moderate psoriasis. However, patient preferences for the topical drugs differ, since a wide variety of topical drugs and topical drug formulations are available. OBJECTIVES The aim of this study was to investigate psoriasis patient preferences for topical drugs. METHODS A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library. RESULTS Four surveys, six randomized controlled trials, and two prospective studies of mainly good quality were included. Seven of the studies investigated patient preferences for topical drug formulations, while five studies investigated their preferences for different topical drugs. Overall, patients preferred drugs that are easy to apply, less messy, and have a pleasant scent. CONCLUSION Psoriasis patient preferences for topical drugs differ. There is no one topical drug or topical drug formulation that suits everyone, which shows the importance of individualized prescriptions for topical drugs that are based on shared decision-making between the prescriber and patient.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark
| | - Steven R Feldman
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark.,Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Klaus Ejner Andersen
- Research Unit of the Dermato-Venerology and Allergy Center, University of Southern Denmark, Odense, Denmark
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