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Jacobson ME, Rick JW, Gerbens LAA, Baghoomian W, Gould LJ, Marzano AV, Chen DM, Oakes DL, Dissemond J, Yamamoto T, Shinkai K, Nolan B, Lobato D, Thomas KS, Ortega-Loayza AG. A core domain set for pyoderma gangrenosum trial outcomes: an international eDelphi and consensus study from the UPGRADE initiative. Br J Dermatol 2024; 190:392-401. [PMID: 37952167 DOI: 10.1093/bjd/ljad420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/24/2023] [Accepted: 11/16/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare ulcerative skin condition with no current standardized outcomes or outcome measures. With a rich investigational therapeutic pipeline, standardization of outcomes and improvement of data quality and interpretability will promote the appropriate and consistent evaluation of potential new therapies. Core outcome sets (COS) are agreed, standardized sets of outcomes that represent the minimum that should be measured and reported in all clinical trials of a specific condition. OBJECTIVES To identify and reach a consensus on which domains (what to be measured) should be included in the Understanding Pyoderma Gangrenosum: Review and Analysis of Disease Effects (UPGRADE) core domain set for clinical trials in PG. METHODS Collaborative discussions between patients and PG experts, and a systematic review of the literature identified items and prospective domains. A three-round international eDelphi exercise was performed to prioritize the domains and refine the provisional items (consensus: ≥ 70% of participants rating a domain as 'extremely important' and < 15% of participants voting 'not important'), followed by an international meeting to reach consensus on the core domain set (consensus: < 30% disagreement). Item-generation discussions and consensus meetings were hosted via online videoconferences. The eDelphi exercise and consensus voting were performed using Qualtrics survey software. Participants were adults with PG, healthcare professionals, researchers and industry representatives. RESULTS Collaborative discussions and systematic reviews yielded 115 items, which were distilled into 15 prospective domains. The eDelphi exercise removed the three lowest-priority domains ('laboratory tests', 'treatment costs' and 'disease impact on family') and ranked 'pain', 'quality of life' and 'physical symptoms' as the highest-priority prospective domains. Consensus was reached on the domains of 'pain', 'quality of life' and 'clinical signs'. The domain of 'disease course/disease progression' narrowly failed to reach consensus for inclusion in the core set (32% of participants voted 'no'). Refinement of this domain definition will be required and presented for consideration at future consensus meetings. CONCLUSIONS The UPGRADE core domain set for clinical trials in PG has been agreed by international multistakeholder consensus. Future work will develop and/or select outcome measurement instruments for these domains to establish a COS.
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Affiliation(s)
- Michael E Jacobson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Jonathan W Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection, and Immunity, Amsterdam, the Netherlands
| | - Wenelia Baghoomian
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Lisa J Gould
- South Shore Health Center for Wound Healing, Weymouth, MA, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Diana M Chen
- Genentech Incorporated, South San Francisco, CA, USA
| | - Debbie L Oakes
- South Shore Health Center for Wound Healing, Weymouth, MA, USA
| | - Joachim Dissemond
- Department of Dermatology, Venerology, and Allergology, University of Essen-Duisburg, Essen, Germany
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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Mardani G, Shahidi Dadras M, Abdollahimajd F, Safari Giv T, Pourgholi E, Rakhshan A, Ghalamkarpour F. Facial pyoderma gangrenosum associated with fallopian tube carcinosarcoma. Clin Case Rep 2023; 11:e8065. [PMID: 37850059 PMCID: PMC10577160 DOI: 10.1002/ccr3.8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with underlying disorders. The association between PG and solid organ tumors (SM), including gynecologic cancers, has been previously reported. Here, we report a case of a 61-year-old woman with pyoderma gangrenosum on the posterior auricular region associated with an underlying fallopian tube carcinosarcoma: a rare and aggressive gynecologic malignancy. The patient's ulcer responded favorably to treatment, and surgical resection of the tumor was performed. The patient was then referred for further cancer management. No new lesions or recurrences were found over the 18 months of routine follow-up.
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Affiliation(s)
- Ghazal Mardani
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | | | - Toktam Safari Giv
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Elnaz Pourgholi
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Azadeh Rakhshan
- Pathology DepartmentShahid Beheshti University of Medical SciencesTehranIran
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Honigman A, Kelly RI. Pyoderma gangrenosum: A review of patient's demographics, disease and treatment in 118 patients. Australas J Dermatol 2022; 63:267-269. [PMID: 35437757 DOI: 10.1111/ajd.13840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony Honigman
- Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Robert I Kelly
- Department of Dermatology, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
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