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Yang X, Liao L, Liang Z, Yu S, Guo Z. Correlation Analysis of IL-17, IL-21, IL-23 with Non-Alcoholic Liver Fibrosis and Cirrhosis. J Inflamm Res 2024; 17:2327-2335. [PMID: 38651006 PMCID: PMC11033842 DOI: 10.2147/jir.s452061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Objective This research aimed to explore the involvement of interleukins (IL) - IL-6, IL-17, IL-21, and IL-23 - in the evolution and diagnosis of non-alcoholic liver fibrosis and cirrhosis. Methods The study subjects were selected from the patients who visited the Department of Hepatology of X Hospital in Y City from August 2021 to April 2023. Peripheral blood samples were collected. All participants were divided into liver fibrosis, cirrhosis, hepatitis, and healthy subjects four groups. IL-21, IL-17, IL23, IL-6 were detected by double antibody sandwich. Results The results showed that there was a significant difference in the levels of IL-17, IL-21, and IL-23 among the 4 groups (P<0.0001). ROC curve analysis showed that the AUC values of IL-17, IL-21 and liver fiber 4 items were >0.70, suggesting that the diagnostic efficacy of IL-17, IL-21 was similar to that of liver fiber 4 items. Spearman correlation analysis showed that IL-17 had a positive correlation with collagen type III N-peptide, type IV collagen, and Laminin (P < 0.05), and no correlation with Hyaluronic acid (P > 0.05). Conclusion IL-17, IL-21, and IL-23 play a pivotal role in the inflammatory pathways associated with liver injuries, establishing themselves as potent auxiliary diagnostic markers in identifying liver fibrosis and cirrhosis.
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Affiliation(s)
- Xiaoyan Yang
- Department of Laboratory Medicine, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, 511400, People’s Republic of China
| | - Liyin Liao
- Department of Laboratory Medicine, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, 511400, People’s Republic of China
| | - Zizhen Liang
- Department of Laboratory Medicine, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, 511400, People’s Republic of China
| | - Shenglong Yu
- Institute of Cardiovascular Medicine, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, 511400, People’s Republic of China
| | - Zhonghui Guo
- Department of Laboratory Medicine, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, 511400, People’s Republic of China
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2
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Tiucă OM, Morariu SH, Mariean CR, Tiucă RA, Nicolescu AC, Cotoi OS. Predictive Performances of Blood-Count-Derived Inflammatory Markers for Liver Fibrosis Severity in Psoriasis Vulgaris. Int J Mol Sci 2023; 24:16898. [PMID: 38069218 PMCID: PMC10707279 DOI: 10.3390/ijms242316898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
Psoriasis is an immune-mediated, chronic disorder that significantly alters patients' quality of life and predisposes them to a higher risk of comorbidities, including liver fibrosis. Various non-invasive tests (NITs) have been validated to assess liver fibrosis severity, while blood-count-derived inflammatory markers have been proven to be reliable in reflecting inflammatory status in psoriatic disease. The fibrosis-4 (FIB-4) index became part of the newest guideline for monitoring psoriasis patients undergoing systemic treatment. Patients with psoriasis vulgaris and fulfilling inclusion criteria were enrolled in this study, aiming to assess for the first time in the literature whether such inflammatory markers are useful in predicting liver fibrosis. Based on internationally validated FIB-4 index values, patients were divided into two study groups: a low risk of significant fibrosis (LR-SF) and a high risk of significant fibrosis (HR-SF). Patients from HR-SF were significantly older and had higher values of the monocyte-to-lymphocyte ratio (MLR) (p < 0.001), which further significantly correlated with fibrosis severity (p < 0.001). Platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), platelet-to-white blood cell ratio (PWR), and aggregate index of systemic inflammations (AISI) significantly correlated negatively with liver fibrosis (p < 0.001). PWR proved to be the most reliable inflammatory predictor of fibrosis severity (AUC = 0.657). MLR, PWR, and AISI were independent inflammatory markers in multivariate analysis (p < 0.001), while the AST to platelet ratio index (APRI) and AST to ALT ratio (AAR) can be used as additional NITs for significant liver fibrosis (p < 0.001). In limited-resources settings, blood-count-derived inflammatory markers such as MLR, PWR, and AISI, respectively, and hepatic indexes APRI and AAR prove to be of particular help in predicting significant liver fibrosis.
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Affiliation(s)
- Oana Mirela Tiucă
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Dermatology Clinic, Mures Clinical County Hospital, 540342 Targu Mures, Romania
| | - Silviu Horia Morariu
- Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Dermatology Clinic, Mures Clinical County Hospital, 540342 Targu Mures, Romania
| | - Claudia Raluca Mariean
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Robert Aurelian Tiucă
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Endocrinology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Endocrinology Department, Mures Clinical County Hospital, 540139 Targu Mures, Romania
| | | | - Ovidiu Simion Cotoi
- Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
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Taylor DR, Stone C. Current issues with procollagen III N-terminal peptide assay performance relevant to 2016 British Association for Dermatologist methotrexate-monitoring guidance. Clin Exp Dermatol 2023; 48:1378-1379. [PMID: 37616532 DOI: 10.1093/ced/llad287] [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: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
Procollagen III N-terminal peptide (P3NP) testing is routinely used to detect possible liver fibrosis according to the cutoffs in the British Association of Dermatologists (BAD) 2016 guidelines for the safe and effective prescribing of methotrexate in skin disease. We report significant changes to P3NP test performance that will potentially change patient management according to the BAD 2016 guidelines.
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Affiliation(s)
- David R Taylor
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Colin Stone
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
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4
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Raahimi MM, Livesey A, Hamilton J, Shipman AR, Aspinall RJ. Liver fibrosis for the dermatologist: a review. Clin Exp Dermatol 2023; 48:303-309. [PMID: 36763770 DOI: 10.1093/ced/llac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023]
Abstract
Methotrexate-induced liver fibrosis is not a well-defined pathology, and many of the reported cases can instead be classified as nonalcoholic fatty liver disease by current diagnostic criteria, which is particularly common in the psoriasis cohort. Liver fibrosis usually takes many years to progress; therefore, screening for liver fibrosis should be done no more regularly than annually at the very most in dermatology practice. An algorithm is presented about how to investigate abnormal liver blood tests and screening tools for liver fibrosis are compared.
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Affiliation(s)
- Mina M Raahimi
- Departments of Dermatology, Portsmouth Hospitals University NHS Trust, UK
| | - Amy Livesey
- Departments of Dermatology, Portsmouth Hospitals University NHS Trust, UK
| | - Jessica Hamilton
- Departments of Dermatology, Portsmouth Hospitals University NHS Trust, UK
| | - Alexa R Shipman
- Departments of Dermatology, Portsmouth Hospitals University NHS Trust, UK
| | - Richard J Aspinall
- Departments of Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, UK
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Abstract
Methotrexate is a key component of the treatment of inflammatory rheumatic diseases and the mainstay of therapy in rheumatoid arthritis. Hepatotoxicity has long been a concern for prescribers envisaging long-term treatment with methotrexate for their patients. However, the putative liver toxicity of methotrexate should be evaluated in the context of advances in our knowledge of the pathogenesis and natural history of liver disease, especially non-alcoholic fatty liver disease (NAFLD). Notably, patients with NAFLD are at increased risk for methotrexate hepatotoxicity, and methotrexate can worsen the course of NAFLD. Understanding the mechanisms of acute hepatotoxicity can facilitate the interpretation of elevated concentrations of liver enzymes in this context. Liver fibrosis and the mechanisms of fibrogenesis also need to be considered in relation to chronic exposure to methotrexate. A number of non-invasive tests for liver fibrosis are available for use in patients with rheumatic disease, in addition to liver biopsy, which can be appropriate for particular individuals. On the basis of the available evidence, practical suggestions for pretreatment screening and long-term monitoring of methotrexate therapy can be made for patients who have (or are at risk for) chronic liver disease.
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6
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Yongpisarn T, Namasondhi A, Iamsumang W, Rattanakaemakorn P, Suchonwanit P. Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1068157. [PMID: 36590962 PMCID: PMC9797863 DOI: 10.3389/fmed.2022.1068157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Patients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients. Objective To evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis. Methods Electronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included. Results Patients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92-12.75%, I 2 = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23-82.05%, I 2 = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17-9.22%, I 2 = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02-20.08%, I 2 = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42-3.40, I 2 = 0%), 3.67 (95% CI: 2.37-5.68, I 2 = 48.8%), 6.23 (95% CI: 4.39-8.84, I 2 = 42.4%), 2.82 (95% CI: 1.68-4.74, I 2 = 0%), 3.08 (95% CI: 1.90-4.98, I 2 = 0%), and 5.98 (95% CI: 3.63-9.83, I 2 = 17%), respectively. Conclusion Approximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].
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Lee JHM, Loo CH, Tan WC, Lee CK, Jamil A, Khor YH. Comparison of noninvasive screening tools for hepatic fibrosis, association with methotrexate cumulative dose, and risk factors in psoriasis patients. Dermatol Ther 2021; 35:e15203. [PMID: 34779102 DOI: 10.1111/dth.15203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
Methotrexate (MTX) is a first-line systemic psoriasis therapy with risk of liver fibrosis. Noninvasive tools for liver fibrosis screening are Fibroscan®, Fibrosis-4 (FIB-4) index, and aspartate aminotransferase-to-platelet ratio (APRI) index. To compare Fibroscan®, FIB-4, and APRI in detecting fibrosis, determine association of fibrosis with MTX cumulative dose, and explore risk factors for fibrosis. A case-control study involving psoriasis patients aged ≥18 years with MTX cumulative dose ≥1 g, with age and sex-matched MTX naïve psoriasis patients was performed. Noninvasive tools were used to assess liver fibrosis. Sixty-one patients on MTX and 54 controls participated. Fibroscan® detected fibrosis in 22 (36.1%) patients on MTX compared to 11 (19.6%) controls (p = 0.05). FIB-4 predicted fibrosis in 13 (21.3%) patients on MTX and in 10 (17.9%) controls (p = 0.64) while APRI diagnosed 7 (11.5%) versus 7 (12.5%), p = 0.65. No significant correlation between Fibroscan® assessed liver stiffness and MTX cumulative dose (p = 0.47). Independent risk factors for liver fibrosis were MTX use with raised alanine aminotransferase (OR = 68.56, 95% CI 8.26; 568.86, p < 0.001), diabetes mellitus (OR = 30.35, 95% CI 7.52; 122.42, p < 0.001), and raised BMI (obese patients OR = 8.26, 95% CI 1.73-39.43, p = 0.02; overweight patients OR = 6.29, 95% CI 1.28-30.99, p = 0.01). Liver fibrosis occurred in both MTX naïve and MTX-treated psoriasis patients. Fibroscan® detected higher prevalence of liver fibrosis compared to FIB-4 and APRI. Cumulative MTX does not correlate with fibrosis severity. Fibroscan® is recommended prior to MTX therapy and at regular intervals especially among patients with diabetes and increased BMI.
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Affiliation(s)
- Janet H M Lee
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia.,Department of Medicine, Dermatology Unit, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Chai Har Loo
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
| | - Wooi Chiang Tan
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
| | - Choon Kin Lee
- Department of Medicine, Gastroenterology Unit, Loh Guan Lye Specialists Centre, Penang, Malaysia
| | - Adawiyah Jamil
- Department of Medicine, Dermatology Unit, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Yek Huan Khor
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
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8
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Pourani MR, Abdollahimajd F, Zargari O, Shahidi Dadras M. Soluble biomarkers for diagnosis, monitoring, and therapeutic response assessment in psoriasis. J DERMATOL TREAT 2021; 33:1967-1974. [PMID: 34369253 DOI: 10.1080/09546634.2021.1966357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is an inflammatory disease associated with multiple comorbidities. Biomarkers for the assessment of psoriasis, its associated comorbidities, and the therapeutic response are not well characterized. A number of possible biomarkers for the diagnosis and monitoring of psoriasis have been proposed. PURPOSE To assess potential biomarkers for diagnosis of psoriasis, its associated comorbidities and response to treatment. METHODS We investigated medical databases from 2000 to 2021 and assessed relevant research. In this review, we evaluated the important biomarkers to help predict potential risk of psoriasis and disease activity (Beta-defensin-2, VEGF, Lipocalin-2, and YKL-40) and its possible inflammatory-related comorbidities like cardiovascular diseases (hs-CRP, GlycA, Psoriasin, IL-18, NT-proBNP, and Adipokines). In addition, we described the potential biomarkers for psoriatic arthritis (CXCL10, S100A8 and S100A9, and MicroRNA) and related manifestations such as enthesitis. Finally, we discussed novel markers for monitoring the response to specific treatments (HLA-C 06, PLC, TARC, NLR, and PLR) as well as potentially useful biomarkers for evaluation of therapy-associated adverse events (liver fibrosis-related markers). CONCLUSION A wide range of genetic, tissue and serum markers have been investigated in psoriasis; however, most of them are not used in routine clinical practice; and thorough physical examination along with the appropriate application of clinical scoring systems like Psoriasis Area and Severity Index (PASI) score are still of particular importance.
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Affiliation(s)
| | - Fahimeh Abdollahimajd
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Zargari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Azzam A, Jiyad Z, O'Beirne J. Is methotrexate hepatotoxicity associated with cumulative dose? A systematic review and meta-analysis. Australas J Dermatol 2021; 62:130-140. [PMID: 33769558 DOI: 10.1111/ajd.13546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVE Methotrexate (MTX) is widely used in various medical specialties. However, hepatotoxicity is an ongoing concern and this is thought to be directly associated with cumulative dose. We sought to synthesise the published literature to evaluate the association between methotrexate hepatotoxicity and cumulative dose. METHODS A systematic review of Medline (PubMed) EMBASE, CINAHL and The Cochrane Library was performed. Full texts of articles were examined, and excluded articles were recorded with reasons for exclusion. A meta-analysis of correlation coefficients was performed using Fisher's z-transformation and a random effects model. Cochran's Q-test and the I2 statistic were calculated to assess heterogeneity. RESULTS A total of 35 studies met inclusion criteria. Measures of hepatotoxicity were highly varied and included liver biopsy, elastography, FibroTest, biochemical tests and scoring systems (Fib-4, APRI, AST:ALT). Some studies analysed for the association with MTX cumulative dose using more than one modality. Overall, 38 analyses found no significant association between MTX cumulative dose and hepatoxicity vs eight that identified a significant association. The pooled correlation coefficient from five studies which utilised elastography was 0.18 (95% CI, -0.09 to 0.42), with significant heterogeneity between studies (P < 0.0001), I2 = 92%). CONCLUSIONS Our synthesis of a large volume of studies in this review found no significant association between MTX cumulative dose and hepatotoxicity, both in terms of vote counting and with regard to the meta-analysis of correlation coefficients from studies that utilised elastography. This challenges the long-held belief that liver injury is a direct result of drug accumulation.
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Affiliation(s)
- Ali Azzam
- Department of Hepatology, Addenbrooke's Hospital, Cambridge, UK.,Griffith University, Brisbane, Queensland, Australia
| | - Zainab Jiyad
- Dermatology Unit, St. George's University of London, London, UK.,Department of Dermatology, King's College Hospital, London, UK
| | - James O'Beirne
- University of the Sunshine Coast, Maroochydore, Queensland, Australia.,Department of Gastroenterology, Sunshine Coast University Hospital, Maroochydore, Queensland, Australia
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10
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Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Prater EF, Rahimi RS, Rupani RN, Siegel M, Stoff B, Strober BE, Tapper EB, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol 2020; 82:1445-1486. [PMID: 32119894 DOI: 10.1016/j.jaad.2020.02.044] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).
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Affiliation(s)
| | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Diego, California
| | | | | | | | - 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
| | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - 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
- 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
| | | | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- Central Connecticut Dermatology, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Elliot B Tapper
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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12
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13
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Cheng HS, Rademaker M. Monitoring methotrexate-induced liver fibrosis in patients with psoriasis: utility of transient elastography. PSORIASIS-TARGETS AND THERAPY 2018; 8:21-29. [PMID: 29785393 PMCID: PMC5953305 DOI: 10.2147/ptt.s141629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasingly, existing evidence indicates that methotrexate-associated liver injury is related to comorbid risk factors such as diabetes, alcoholism, and obesity, rather than to methotrexate itself. Despite this fact, significant effort continues to be expended in the monitoring of low-dose methotrexate in patients with psoriasis. The gold standard investigation has been liver biopsy, but this is associated with significant morbidity and mortality. As methotrexate-induced liver injury is uncommon, the risk/benefit ratio of liver biopsy has been questioned. Fortunately, a number of new technologies have been developed for the diagnosis of chronic liver disease, including transient elastography (TE). TE is a type of shear wave ultrasound elastography, which measures the speed of shear waves used to estimate hepatic tissue stiffness. Several meta-analyses show very high pooled sensitivity and specificity for the diagnosis of hepatic cirrhosis (87% and 91%, respectively) in a variety of chronic liver disorders. It has a negative predictive value for cirrhosis of >90% and a positive predictive value of 75%. Recent European guidelines now advocate the use of TE as the first-line test for the assessment of fibrosis in alcohol- or hepatitis-related liver disease, including nonalcoholic fatty liver disease (NAFLD). As the prevalence of obesity and metabolic syndrome, including NAFLD, is significantly elevated in patients with psoriasis, TE may be worth considering as a routine investigation for any patient with psoriasis. Although high-quality studies comparing TE with standard liver biopsy in the monitoring of psoriatics on low-dose methotrexate are lacking, the evidence from multiple small cohort studies and case series demonstrates its effectiveness. A recent Australasian position statement recommends that TE should be considered as a routine investigation for monitoring methotrexate therapy, repeated every 3 years if kPa <7.5 and yearly if kPa >7.5. Liver biopsy should be considered for patients with a kPa >9.5.
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Affiliation(s)
- Harriet S Cheng
- Dermatology Service, Auckland City Hospital, Auckland, New Zealand
| | - Marius Rademaker
- Waikato Clinical Campus, Auckland University Medical School, Hamilton, New Zealand
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14
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Leis-Dosil V, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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15
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Leis-Dosil VM, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:24-34. [PMID: 28964393 DOI: 10.1016/j.ad.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 12/17/2022] Open
Abstract
The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential. Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.
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Affiliation(s)
- V M Leis-Dosil
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - I Prats-Caelles
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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16
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Bauer B, Chyou PH, Stratman EJ, Green C. Noninvasive Testing for Nonalcoholic Steatohepatitis and Hepatic Fibrosis in Patients With Psoriasis Receiving Long-term Methotrexate Sodium Therapy. JAMA Dermatol 2017; 153:977-982. [PMID: 28832872 DOI: 10.1001/jamadermatol.2017.2083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance The long-term implications of hepatotoxic effects in patients with psoriasis remains uncharacterized, and a method is needed for the noninvasive monitoring of the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term methotrexate therapy. Objective To evaluate if NASH FibroSure, a noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis, can be used for patients with psoriasis to aid in determining eligibility for methotrexate sodium (MTX) therapy, monitor for the development of MTX-induced hepatotoxic effects, and monitor for worsening of hepatic fibrosis scores during MTX therapy. Design, Setting, and Participants A retrospective descriptive analysis was conducted among a cohort of patients with psoriasis treated with MTX who underwent NASH FibroSure testing between January 1, 2007, and December 31, 2013, at a dermatology referral center at a single institution. Data analysis was performed from January 1 to December 31, 2014. Main Outcomes and Measures NASH FibroSure risk scores suggesting the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term MTX therapy. Results Included in the institutional experience portion of the study were 129 patients with psoriasis undergoing treatment with MTX, while 107 patients (57 women and 50 men; mean [SD] age, 83.3 [13.5] years) underwent NASH FibroSure testing during MTX therapy and were eligible for correlation analysis. Of the 129 patients with psoriasis undergoing treatment with MTX, 69 (53.5%) underwent NASH FibroSure testing prior to starting MTX; 19 of those patients (27.5%) had elevated fibrosis scores, and 54 (78.3%) had elevated steatosis scores. Among the 107 patients who underwent NASH FibroSure testing during MTX therapy, the cumulative MTX dose corresponded to a statistically significant association of a higher NASH FibroSure hepatic fibrosis score in women (Spearman ρ = 0.21; P = .02) but not in men (Spearman ρ = 0.17; P = .11). All patients in the cohort except 1 were managed without a liver biopsy. Conclusions and Relevance The patients with psoriasis in this study had a high prevalence of elevated hepatic steatosis scores. The NASH FibroSure test can be used to monitor changes in fibrosis score in patients with psoriasis receiving MTX. In a single-institution cohort, these results suggest that NASH FibroSure may be used, especially among female patients, to help monitor for risk of worsening fibrosis during MTX therapy.
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Affiliation(s)
- Bruce Bauer
- Pariser Dermatology Specialists, Norfolk, Virginia
| | - Po-Huang Chyou
- Bioinformatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Erik J Stratman
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
| | - Clayton Green
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
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17
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van den Reek JMPA, Menting SP, Janssen WWL, Dhaliwal R, Heijboer AC, van Herwaarden AE, Sweep FCGJ, de Jong LM, Tjwa ET, Otero ME, Spuls PI, de Jong EMGJ. Procollagen-3 N-terminal peptide measurements for the detection of liver fibrosis in methotrexate-treated patients with psoriasis: daily practice use and clinical implications. Br J Dermatol 2017; 177:1454-1457. [PMID: 28112796 DOI: 10.1111/bjd.15313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- J M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S P Menting
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - W W L Janssen
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R Dhaliwal
- Department of Allergology, University Medical Center, Groningen, the Netherlands
| | - A C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, the Netherlands
| | - A E van Herwaarden
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - L M de Jong
- Department of Dermatology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | - E T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M E Otero
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
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18
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19
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Potts J, Maybury C, Salam A, Barker J, Agarwal K, Smith C. Diagnosing liver fibrosis: a narrative review of current literature for dermatologists. Br J Dermatol 2017; 177:637-644. [DOI: 10.1111/bjd.15246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/14/2022]
Affiliation(s)
- J.R. Potts
- Institute of Liver Studies King's College Hospital NHS Foundation Trust London U.K
| | - C.M. Maybury
- St John's Institute of Dermatology Division of Genetics and Molecular Medicine Faculty of Life Sciences and Medicine King's College London London U.K
| | - A. Salam
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London U.K
| | - J.N. Barker
- St John's Institute of Dermatology Division of Genetics and Molecular Medicine Faculty of Life Sciences and Medicine King's College London London U.K
| | - K. Agarwal
- Institute of Liver Studies King's College Hospital NHS Foundation Trust London U.K
| | - C.H. Smith
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London U.K
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20
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Warren RB, Weatherhead SC, Smith CH, Exton LS, Mohd Mustapa MF, Kirby B, Yesudian PD. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease 2016. Br J Dermatol 2017; 175:23-44. [PMID: 27484275 DOI: 10.1111/bjd.14816] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K
| | - S C Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - B Kirby
- St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - P D Yesudian
- Glan Clwyd Hospital, Sarn Lane, Rhyl, LL18 5UJ, U.K
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21
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Chong JH, Koh MJA. Non-topical management of recalcitrant paediatric atopic dermatitis. Arch Dis Child 2017; 102:681-686. [PMID: 28209661 DOI: 10.1136/archdischild-2016-312106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/22/2017] [Accepted: 01/24/2017] [Indexed: 01/14/2023]
Abstract
Atopic dermatitis (AD) is a common chronic, pruritic skin disease in children. As the incidence of AD increases, especially in high-income countries, paediatricians may see an increasing number of recalcitrant AD cases in their practice. Although these cases are principally managed by paediatric dermatologists, it is important for paediatricians to be aware of the use and side effects of non-topical treatment like phototherapy and systemic agents as well as the evidence for alternative treatment, which caregivers may ask about. This review presents paediatric evidence for the practical use of phototherapy and certain oral immunosuppressants for paediatric AD including doses, duration of use and monitoring of adverse effects. The use of alternative therapy including traditional medicine, probiotics and the role of nutrition are also discussed. Narrow band ultraviolet B phototherapy is effective in recalcitrant paediatric AD. When phototherapy is ineffective or contraindicated, systemic drugs may be administered cautiously with close surveillance of side effects. The use of azathioprine, ciclosporin, methotrexate and mycophenolate mofetil is generally safe in the short term under close monitoring and can be effective alongside compliance to topical treatment. Alternative complementary treatment is not known to be effective. Holistic management including therapeutic patient education is important. Good quality paediatric studies for non-topical AD treatment are needed for definitive guidelines.
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Affiliation(s)
- Jin Ho Chong
- Dermatology service, KK Women's and Children's Hospital, Singapore.,Department of General Paediatrics, KK Women's and Children's Hospital, Singapore
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22
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Rongngern P, Chularojanamontri L, Wongpraparut C, Silpa-Archa N, Chotiyaputta W, Pongpaibul A, Charatcharoenwitthaya P. Diagnostic performance of transient elastography for detection of methotrexate-induced liver injury using Roenigk classification in Asian patients with psoriasis: a retrospective study. Arch Dermatol Res 2017; 309:403-408. [DOI: 10.1007/s00403-017-1733-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/24/2017] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
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23
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Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, Gelfand JM. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017; 76:393-403. [PMID: 28212760 PMCID: PMC5839668 DOI: 10.1016/j.jaad.2016.07.065] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/13/2022]
Abstract
As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sungat Grewal
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Alexis Ogdie
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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24
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Kolios AG, Yawalkar N, Anliker M, Boehncke WH, Borradori L, Conrad C, Gilliet M, Häusermann P, Itin P, Laffitte E, Mainetti C, French LE, Navarini AA. Swiss S1 Guidelines on the Systemic Treatment of Psoriasis Vulgaris. Dermatology 2016; 232:385-406. [DOI: 10.1159/000445681] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/20/2016] [Indexed: 11/19/2022] Open
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25
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Burden-Teh E, Lam ML, Taibjee SM, Taylor A, Webster S, Dolman S, Jury C, Caruana D, Darne S, Carmichael A, Natarajan S, McPherson T, Moore A, Katugampola R, Kalavala M, Al-Ismail D, Richards L, Jones V, Batul Syed S, Glover M, Hughes J, Anderson E, Hughes B, Helbling I, Murphy R. How are we using systemic drugs to treat psoriasis in children? An insight into current clinical U.K. practice. Br J Dermatol 2015; 173:614-8. [PMID: 25601323 DOI: 10.1111/bjd.13671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Burden-Teh
- Department of Dermatology, Nottingham University Hospitals Trust, Nottingham, U.K. .,Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.
| | - M L Lam
- Department of Dermatology, Nottingham University Hospitals Trust, Nottingham, U.K
| | - S M Taibjee
- Department of Dermatology, Dorset County Hospital, Dorset, U.K
| | - A Taylor
- Department of Dermatology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - S Webster
- Department of Dermatology, Alder Hey Children's Hospital, West Derby, U.K
| | - S Dolman
- Department of Dermatology, Alder Hey Children's Hospital, West Derby, U.K
| | - C Jury
- Department of Dermatology, Royal Hospital for Sick Children, Glasgow, U.K
| | - D Caruana
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, U.K
| | - S Darne
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, U.K
| | - A Carmichael
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, U.K
| | - S Natarajan
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, U.K
| | - T McPherson
- Department of Dermatology, Churchill Hospital, Oxford, U.K
| | - A Moore
- Department of Dermatology, Churchill Hospital, Oxford, U.K
| | - R Katugampola
- Department of Dermatology, University Hospital Wales, Cardiff, U.K
| | - M Kalavala
- Department of Dermatology, University Hospital Wales, Cardiff, U.K
| | - D Al-Ismail
- Department of Dermatology, University Hospital Wales, Cardiff, U.K
| | - L Richards
- Department of Dermatology, University Hospital Wales, Cardiff, U.K
| | - V Jones
- Department of Dermatology, Royal Cornwall Hospital NHS Trust, Cornwall, U.K
| | - S Batul Syed
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - M Glover
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - J Hughes
- Department of Dermatology, Princess of Wales Hospital, Bridgend, U.K
| | - E Anderson
- Department of Dermatology, Princess of Wales Hospital, Bridgend, U.K
| | - B Hughes
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, U.K.,Department of Dermatology, St Richards Hospital, Chichester, U.K
| | - I Helbling
- Department of Dermatology, University Hospitals of Leicester, Leicester, UK
| | - R Murphy
- Department of Dermatology, Nottingham University Hospitals Trust, Nottingham, U.K
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26
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The quest for an evidence-based approach to surveillance for methotrexate-related hepatotoxicity: promise and perils. Br J Dermatol 2015; 172:1684-1685. [DOI: 10.1111/bjd.13620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Abstract
In the era of biologic therapies, methotrexate (MTX), a classic immunomodulator, is still the cornerstone of systemic treatment of psoriasis. MTX has been used for many years, achieving good responses with a good safety profile. However, only a few randomized clinical trials have been performed involving MTX, and most of the current evidence comes from pivotal studies of biologic drugs. The aim of this article is to make an extensive review of the MTX mechanism of action, pharmacokinetics, efficacy, safety and tolerability, especially focusing on the future perspective of this old drug and recent advances in the field of pharmacogenetics.
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Affiliation(s)
- Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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28
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Parkins G, Wylie G. Guideline vs. practice in procollagen-3-aminopeptide monitoring. Br J Dermatol 2014; 171:1599-600. [DOI: 10.1111/bjd.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Parkins
- Alan Lyell Centre for Dermatology; Department of Dermatology; Southern General Hospital; 1345 Govan Road Glasgow G51 4TF U.K
| | - G. Wylie
- Alan Lyell Centre for Dermatology; Department of Dermatology; Southern General Hospital; 1345 Govan Road Glasgow G51 4TF U.K
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29
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Gomollón F, Rubio S, Charro M, García-López S, Muñoz F, Gisbert JP, Domènech E. [Reccomendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of methotrexate in inflammatory bowel disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 38:24-30. [PMID: 25454602 DOI: 10.1016/j.gastrohep.2014.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022]
Abstract
Methotrexate is an immunosuppressant that may be useful in several clinical scenarios in inflammatory bowel disease. In this article, we review the available evidence in Crohn's disease and ulcerative colitis and establish general recommendations for its use in clinical practice. Although the available data are limited, it is very likely that methotrexate is underused because its effectiveness is underestimated and its toxicity is overestimated. Both in induction therapy and in maintenance of remission, methotrexate is useful in Crohn's disease. When prescribed in combination with biologic agents, immunogenicity is less frequent and consequently long-term response could potentially be improved. There are few published studies, but several data suggest that methotrexate could also be useful in ulcerative colitis. Although myelotoxicity and liver toxicity are well known risks, methotrexate is a drug that is well tolerated in many patients, even in the long term.
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Affiliation(s)
- Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, IIS Aragón, España Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD).
| | - Saioa Rubio
- Servicio de Aparato Digestivo, Hospital de Navarra, PamplonaEspaña
| | - Mara Charro
- Servicio de Aparato Digestivo, Hospital Royo Villanova, Zaragoza España
| | - Santiago García-López
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Fernando Muñoz
- Servicio de Aparato Digestivo, Hospital de León, León España
| | - Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid España, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
| | - Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Germans Trías i Pujol, Badalona España, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
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30
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Maybury C, Samarasekera E, Douiri A, Barker J, Smith C. Diagnostic accuracy of noninvasive markers of liver fibrosis in patients with psoriasis taking methotrexate: a systematic review and meta-analysis. Br J Dermatol 2014; 170:1237-47. [DOI: 10.1111/bjd.12905] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 01/06/2023]
Affiliation(s)
- C.M. Maybury
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - E. Samarasekera
- National Clinical Guideline Centre; Royal College of Physicians of London; 11 St Andrews Place London NW1 4LE U.K
| | - A. Douiri
- Department of Public Health Sciences; School of Medicine; King's College London; Capitol House; 42 Weston St London SE1 3QD U.K
| | - J.N. Barker
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - C.H. Smith
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
- St John's Institute of Dermatology; Guys and St Thomas' NHS Foundation Trust; London U.K
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