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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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Fargnoli MC, De Simone C, Gisondi P, Pellacani G, Calzavara-Pinton P. Topical Treatment for the Management of Mild-to-Moderate Psoriasis: A Critical Appraisal of the Current Literature. Dermatol Ther (Heidelb) 2023; 13:2527-2547. [PMID: 37737941 PMCID: PMC10613180 DOI: 10.1007/s13555-023-01024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
Several comprehensive and updated guidelines are available on the management of psoriasis with systemic treatments. However, there is a lack of updates in recommendations and guidelines on topical treatments, particularly regarding the latest evidence and developments in treatment formulations. Consequently, a comprehensive literature review on this topic, considering the continuous evolution of knowledge and evaluation of the relevance of the available literature evidence, represents a current need to improve the topical management of psoriasis. This study critically appraises the available literature on all topical treatments of psoriasis from the past 20 years to address some relevant issues, such as the vehicle associated with the highest effectiveness, the best vehicle for improving patient adherence, and the best strategy in terms of efficacy and safety for long-term treatment. The greater effectiveness of the foam formulation was demonstrated for calcipotriene/betamethasone dipropionate (Cal/BD) administration compared with the gel and ointment. Without a direct comparison, matching-adjusted indirect comparison analyses support the superiority of the foam versus the cream overall. In addition, the reduced treatment period required by the Cal/BD foam (4 weeks) may favor this formulation over cream (8 weeks). The literature evidence, supported by a broad clinical experience, reported high rates of acceptability and adherence for the foam vehicle. A growing consensus is shared among dermatologists sustaining the proactive approach as the best option for the long-term topical treatment of psoriasis in adults. The Cal/BD foam is the only treatment for which the approved label allows biweekly maintenance use (proactive management), thus representing the first option for long-term topical treatment.
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Affiliation(s)
- Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Dermatology Unit, Ospedale San Salvatore, L'Aquila, Italy.
| | - Clara De Simone
- Section of Dermatology, Department of Translational Medicine and Surgery, Catholic University of the S. Heart, Rome, Italy
- Dermatology Unit, Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Giovanni Pellacani
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Dermatology Clinic, Sapienza Medical School, Sapienza University of Rome, Rome, Italy
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Perry R, Beveridge AJ, Sears AJ, Rasmussen ER. Expert Consensus on Real-World Use and Consumption Patterns of a Fixed-Dose Combination Foam for Psoriasis as a Reactive Management (RM) and Proactive Management (PAM) Regimen. Adv Ther 2023; 40:1062-1073. [PMID: 36627543 PMCID: PMC9988791 DOI: 10.1007/s12325-022-02417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Plaque psoriasis is a chronic skin disease characterised by periods of remission and relapse and associated with considerable burden to patients and healthcare systems. For most patients, standard-of-care is reactive management (RM) with topical therapies, but, more recently, the benefits of proactive management (PAM) have been recognised. This study aimed to gain consensus on real-world use and consumption in RM versus PAM regimens, based on fixed-dose combination calcipotriol and betamethasone dipropionate (Cal/BD) foam which, following a recent update, is currently the only topical therapy for psoriasis with a long-term maintenance regimen in its label. METHODS The modified-Delphi approach was used to gain insights and consensus on real-world views, use and consumption in RM versus PAM from a panel of dermatologists with experience prescribing Cal/BD foam as PAM. The panel included 16 dermatologists, 4 each from France, Germany, Italy, and Spain, and included two questionnaire rounds and a meeting to obtain final consensus. RESULTS The panel agreed that topicals are burdensome to apply in clinical practice and that poor patient adherence, particularly long-term, is a barrier to effective psoriasis management. The panel advised that, as they prescribe a similar number of cans for RM and PAM over a given period, consumption is not a key driver influencing future decisions to prescribe PAM, even in instances where prescribing differences could be observed. Instead, the panel agreed that patient- and disease-related factors better determine patient suitability for PAM. CONCLUSION This modified-Delphi study confirms that prescription of RM or PAM, with Cal/BD foam, is largely driven by patient-related factors and patient involvement is key to optimise outcomes. Real-world experiences captured in this study suggest that a PAM regimen does not increase overall consumption, and thus costs per patient for payers and prescribers, in comparison to RM.
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Affiliation(s)
| | | | - Amy J Sears
- Adelphi Values PROVE, Bollington, Cheshire, UK
| | - Elisabeth R Rasmussen
- LEO Pharma, Global Post Launch Brands, Industriparken 51, Building S3, 2750, Ballerup, Denmark.
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Wang J, Chen Y, Li T, Ren Y, Wang Y, Zhang Y, Hu L, Zhang J, Zhao Y, Li Z, Yan C. Phellodendri Chinensis Cortex-Based Nanoparticles Integrated in Dissolvable Microneedles for Ameliorating Psoriasis-Like Inflammation. J Biomed Nanotechnol 2022. [DOI: 10.1166/jbn.2022.3422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Psoriasis is a common and highly relapsing skin disease, for which topical treatments are used by approximately 88% of people with psoriasis as their primary therapy. However, in practice, the low convenience and side effects such as skin irritation of current topical treatments limit
the application of the therapy. To address these issues, we calcined Phellodendri Chinensis Cortex (PCC) to prepare Phellodendri Chinensis Cortex Nanoparticles (PCC-NPs) which were packed into dissolvable microneedles (MNs) for the treatment of psoriasis. In this study, we revealed that the
trace amounts of PCCNPs delivered by MNs could exert therapeutic effects therapeutic effects in the affected skin comparable to those of standard drugs, accompanied with the suppressed psoriasis-like inflammation without significant hepatic or renal toxicity or allergic reactions. These results
indicate that dissolvable PCC-NPs MNs may serve as an innovative topical therapy for the inhibition of psoriatic inflammation.
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Affiliation(s)
- Jing Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yiwen Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tingyu Li
- School of Integrated Circuits, Peking University, Beijing 100871, China
| | - Yingjie Ren
- School of Integrated Circuits, Peking University, Beijing 100871, China
| | - Yifan Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yue Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Li Hu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jie Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yan Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhihong Li
- School of Integrated Circuits, Peking University, Beijing 100871, China
| | - Cong Yan
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
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Vejjabhinanta V, Muangsiri W, Werawatganone P. Fluocinolone Acetonide Microemulsion in Combination with a Fractional Laser for the Treatment of Scalp Psoriasis. AAPS PharmSciTech 2022; 23:122. [PMID: 35460022 DOI: 10.1208/s12249-022-02249-1] [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: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
This study introduces fluocinolone acetonide (FA) microemulsion in combination with ablative fractional lasering as a new effective treatment for scalp psoriasis. A pseudo-ternary phase diagram was constructed using the aqueous titration method. The suitable ratio of surfactant mixture (Smix):oil mixture (Omix):water was chosen from the microemulsion region of the diagram. FA was loaded into the selected ratio to prepare FA microemulsion. Ex vivo skin permeation study of the FA microemulsion with fractional laser assistance was performed to determine a proper ablative depth. A pilot clinical study was conducted to evaluate the efficacy of FA microemulsion and FA microemulsion combination with lasering at the optimum ablation depth. The selected microemulsion base contained (in wt%) 77% water, 20% Smix (Tween 80:ethanol, 2:1), 3% Omix (10% benzyl benzoate and 1% benzyl alcohol in bergamot oil), and 0.2% sodium carboxymethylcellulose. FA was loaded into this base at a concentration of 0.1%. The skin lasered at an ablation depth of 50 µm was conducted in the pilot clinical study. Scalp psoriasis responded well to the FA microemulsion. Psoriasis scalp severity index (PSSI) scores indicated that the FA microemulsion plus laser treatment provides higher efficacy than the FA microemulsion alone without any topical and systemic side effects. The efficacy of the treatments could be maintained for at least 1 week after treatment discontinuation. FA microemulsion was properly formulated and evaluated. The microemulsion demonstrating the greatest benefits was used in combination with ablative fractional lasering to treat scalp psoriasis.
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Guenther L, Takhar A, Megna M, Sebastian M, Nyholm N, Thoning H, Levin LÅ. Impact of fixed-dose combination Cal/BD foam on the work productivity of patients with psoriasis: Results from the 52-week randomized, double-blind, PSO-LONG trial. J Eur Acad Dermatol Venereol 2022; 36:1054-1063. [PMID: 35297108 DOI: 10.1111/jdv.18053] [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: 10/12/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis contributes to unemployment, work impairment, missed workdays, and substantial indirect costs due to lost productivity. Combination Cal/BD foam is the only topical that is approved for long-term maintenance treatment of plaque psoriasis for 52 weeks. This is the first known investigation of the effect of a topical psoriasis therapy on productivity. OBJECTIVE To examine the change in work productivity and activity impairment after four weeks of treatment with fixed-dose combination calcipotriol 50 µg/g / betamethasone dipropionate 0.5 mg/g (Cal/BD) foam and observe long-term changes after 52 weeks of long-term management (proactive or reactive treatment). METHODS This is a post-hoc analysis of the PSO-LONG trial - a phase 3, randomized, double-blind, vehicle-controlled, parallel group, international multi-center trial of treatment with combination Cal/BD foam. Work and activity impairment due to psoriasis were assessed by the Dermatology Life Quality Index (DLQI) and the Work Productivity and Activity Impairment Psoriasis (WPAI:PSO) questionnaire at baseline, week 4, week 28 and week 56. The improvement in hours of work productivity was translated into monthly and annual indirect cost savings estimates for patients in Italy, Sweden, UK, Canada, and Germany. RESULTS Using fixed-dose combination Cal/BD foam for four weeks significantly reduced psoriasis-related work presenteeism, total work productivity impairment (TWPI) and total activity impairment (TAI) over 56 weeks, with significant improvements observed as early as four weeks after the baseline visit. The proportion of patients reporting impact on work productivity (as measured by presenteeism and TWPI) and activity impairment (as measured by both DLQI-Q7b and TAI) also decreased. CONCLUSION Fixed-dose combination Cal/BD foam used for long-term management of psoriasis significantly reduces psoriasis-related work productivity and activity impairment which may result in substantial indirect cost savings.
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Affiliation(s)
- L Guenther
- Guenther Research Inc, London, ON, Canada.,Western University, London, ON, Canada
| | - A Takhar
- Wansford and Kings Cliffe Practice, Wansford, Cambridgeshire, United Kingdom
| | - M Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - M Sebastian
- Center for Dermatology and Clinical Trials, Mahlow, D-15831, Germany
| | - N Nyholm
- LEO Pharma A/S, Industriparken 55, 2750, Ballerup, Denmark
| | - H Thoning
- LEO Pharma A/S, Industriparken 55, 2750, Ballerup, Denmark
| | - L-Å Levin
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, 581 83, Linköping, Sweden
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Application of benvitimod on psoriasis: A systematic review and meta-analysis of randomized controlled trials. A systematic review of benvitimod on psoriasis. Therapie 2021; 77:339-347. [PMID: 34689959 DOI: 10.1016/j.therap.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/04/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We conducted this systematic review to clarify the efficacy and safety of benvitimod on psoriasis. METHODS We searched the databases of PubMed, China National Knowledge infrastructure, Cochrane Library, Embase, Web of science to identify randomized controlled trials (RCTs) of benvitimod on psoriasis up to April 2021. RESULTS Five RCTs of benvitimod on psoriasis were included. A total of 1237 patients were included. 0.5% or 1.0% benvitimod was applied topically once or twice a day. More patients in benvitimod group achieved PASI 90, PASI 75, PASI 50 and BSA reduction than placebo at Week 12. More patients in benvitimod group achieved PGA 0 or 1 than placebo since Week 6. There were no statistical significances in efficacies of benvitimod at different concentrations and frequencies. CONCLUSIONS Benvitimod was effective and safe for psoriasis. More RCTs with high qualities are needed to further verify the current conclusion.
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Harvima RJ, Gooderham M, Tyring S, Thoning H, Nyholm N, Stein Gold L. Clinical, patient and estimated cost benefits of proactive management versus reactive management with calcipotriol/betamethasone dipropionate foam for the treatment of plaque psoriasis in Finland. J DERMATOL TREAT 2021; 33:2234-2240. [PMID: 34130573 DOI: 10.1080/09546634.2021.1942419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Proactive management of plaque psoriasis with twice-weekly topical calcipotriol/betamethasone dipropionate (Cal/BD) foam has a demonstrated clinical benefit in preventing disease relapse compared to reactive management, where Cal/BD foam is only given as rescue therapy once-daily for four weeks after relapse. The impact of proactive management with Cal/BD foam on a wider range of clinical responses is not yet known, nor is its potential cost-effectiveness in the healthcare system of Finland. METHODS This study involved a post-hoc analysis exploring the clinical and patient-reported benefits of proactive versus reactive management with Cal/BD foam observed in the PSO-LONG trial (NCT02899962). A range of response criteria based on modified psoriasis area and severity index (mPASI) and dermatology life quality index (DLQI) were analyzed, and the cost-effectiveness of proactive versus reactive management was estimated in a Finnish healthcare setting. RESULTS AND CONCLUSION The analysis found a consistent clinical benefit of proactive management compared to reactive management on all response criteria, and a markedly lower cost-per-responder for the response criteria of mPASI 75, mPASI ≤ 2 and DLQ1 ≤ 1. The analysis was robust to sensitivity analyses on key inputs and demonstrates the cost and clinical benefits of proactive over reactive management of plaque psoriasis with Cal/BD foam in the Finnish healthcare setting.
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Affiliation(s)
- Rauno J Harvima
- Department of Dermatology, Kuopio University Hospital, Kuopio, Finland.,Department of Dermatology, University of Eastern Finland, Kuopio, Finland
| | - Melinda Gooderham
- Skin Centre for Dermatology, Peterborough, Canada.,Probity Medical Research, Waterloo, Canada.,Department of Medicine, Queen's University, Kingston, Canada
| | - Stephen Tyring
- University of Texas Health Science Center, Houston, TX, USA.,Center for Clinical Studies, Houston, TX, USA
| | | | | | - Linda Stein Gold
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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