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Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190:315-339. [PMID: 36971254 DOI: 10.1093/bjd/ljad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. OBJECTIVES To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. METHODS The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. RESULTS Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. CONCLUSIONS This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.
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Affiliation(s)
| | - Jeffrey R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ravinder K Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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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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Quiles-Tsimaratos N, Paul C, De La Brassinne M, Telle-Sauvant H, Corgibet-Escallier F, Tanasescu S, Roux B, Girardot-Seguin S, Duval-Modeste AB. Decision-making factors for the long-term topical treatment of mild-to-moderate plaque psoriasis: TEPPSO, a case-vignette study on clinical practice. Ann Dermatol Venereol 2023; 150:28-34. [PMID: 35787804 DOI: 10.1016/j.annder.2022.05.003] [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: 10/26/2021] [Revised: 02/01/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Topical maintenance therapy strategy with regard to patients with mild-to-moderate plaque psoriasis (PP) continues to be heterogeneous and insufficiently investigated in real-life clinical practice. The objective of this study was to describe the initiation of long-term maintenance treatment and to identify clinical parameters influencing the therapeutic decision. METHODS TEPPSO was a French and Belgian multicentre cross-sectional study based on completion of questionnaires and assessment of credible clinical scenarios of mild-to-moderate PP by physicians using the validated case-vignette method. RESULTS Maintenance therapy was recommended by dermatologists (Ds) and by general practitioners (GPs) in 79.1% and 76.8% of cases, respectively. GPs recommended the use of a fixed-dose combination of corticosteroid and vitamin D analogues in only 14.8% of cases, whereas this therapy was recommended by French and Belgian Ds in 54.8% and 39.8% of cases, respectively. In a multivariate analysis, significant determinants of the therapeutic decision were skin lesions impacting quality of life (OR 1.9 [95% CI: 1.1; 3.2] P=0.01) for Ds, and patient corticophobia (OR 1.7 [95% CI: 1.1; 2.7] P=0.03) or the presence of skin pruritus (OR 1.8 [95% CI: 1.2; 1.8] P=0.004) for GPs, respectively. CONCLUSIONS Maintenance treatment with topical agents in patients with mild-to-moderate PP was considered in more than two thirds of cases. Heterogeneity in the choice of topical agents was evidenced particularly between Ds and GPs. Our study is the first to identify significant clinical determinants affecting the therapeutic decision. Updated and validated clinical practice guidelines are needed to ensure uniform therapeutic choices.
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Affiliation(s)
| | - C Paul
- Dermatologie, Hôpital Larrey, Toulouse, France
| | | | | | | | - S Tanasescu
- Dermatologie, Clinique Du Cèdre, Bois-Guillaume, France
| | - B Roux
- Recherche clinique, Société FAST4, Nîmes, France
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4
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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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Cline A, Unrue EL, Cardwell LA, Alinia H, Tull R, Feldman SR, Huang WW. Internet-based survey intervention improves adherence to methotrexate among psoriasis patients. J DERMATOL TREAT 2022; 33:2784-2789. [PMID: 35485939 DOI: 10.1080/09546634.2022.2071821] [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: 10/18/2022]
Abstract
BACKGROUND While it is known that psoriasis patients have poor adherence to both topical and systemic medications, adherence to methotrexate is not well-characterized, and ways to improve methotrexate adherence have not been addressed. OBJECTIVE To evaluate whether a digital intervention improved adherence to oral methotrexate as measured by electronic monitoring. METHODS Twenty-nine patients were randomized to receive either weekly digital interventions assessing treatment adherence or no intervention for 24 weeks. Patients received medication bottles with electronic monitoring, and returned at weeks 4, 12, and 24 to evaluate disease severity. RESULTS The intervention group took methotrexate correctly 77.1% of the weeks observed compared to the control group which averaged 64.5%. More intervention patients took methotrexate as directed compared to the control group (78.3% vs 64.2%, p < 0.0001). Patients were most adherent around follow-up visits, with 100% of digital intervention patients and 80% of control patients taking methotrexate correctly during the week of a follow-up visit (p = 0.02). The digital intervention did not significantly improve disease severity in the intervention group compared to the nonintervention group. CONCLUSIONS Low cost, scalable digital interventions may have the potential to increase psoriasis patient adherence to methotrexate, although the mechanism for the improvement is not yet well defined.
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Affiliation(s)
- Abigail Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily L Unrue
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Leah A Cardwell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hossein Alinia
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rechelle Tull
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William W Huang
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Tan S, Phan P, Law JY, Choi E, Chandran NS. Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients. BMJ Open 2022; 12:e060867. [PMID: 35296492 PMCID: PMC8928312 DOI: 10.1136/bmjopen-2022-060867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the phenomenon of topical corticosteroid (TCS) phobia and comprehensively understand the factors driving TCS concerns, in particular pertaining to steroid addiction and withdrawal. DESIGN Prospective qualitative study using 1:1 in-depth semistructured interviews and analysed using grounded theory. PARTICIPANTS Patients with a prior experience of TCS use for a dermatological condition recruited from a tertiary academic dermatology clinic, or through word of mouth and online social media platforms. RESULTS 26 participants encompassing those with positive, neutral and negative opinions towards TCS were interviewed. 13 reported having topical steroid addiction or withdrawal. The drivers of TCS concerns could be categorised into seven themes: attitudes towards TCS (comprising beliefs and knowledge about TCS), availability of alternatives, treatment inconvenience, personality, patient's ongoing evaluation of clinical response to TCS, doctor-patient relationship and healthcare-seeking behaviour. Of mention, patients placed high value and trust on their own experiences with TCS, such as their perceived experienced side effects. The doctor who failed to acknowledge the patient's opinions and instead emphasised the safety of TCS was often viewed as dismissive, resulting in a deteriorating patient-doctor relationship. CONCLUSION Provision of knowledge and education is important but may be ineffective if the basis for TCS concern regarding safety is reasonable, or when the patient has a firmly established belief supporting his/her concern. In such instances, failure to acknowledge and respect the patient's decision to avoid TCS could worsen the doctor-patient relationship.
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Affiliation(s)
- Sean Tan
- Dermatology, National University Healthcare System, Singapore
| | - Phillip Phan
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Carey Business School, Baltimore, Maryland, USA
- Medicine, National University of Singapore, Singapore
| | - Je Yin Law
- Medicine, National University of Singapore, Singapore
| | - Ellie Choi
- Dermatology, National University Healthcare System, Singapore
- Medicine, National University of Singapore, Singapore
| | - Nisha Suyien Chandran
- Dermatology, National University Healthcare System, Singapore
- Medicine, National University of Singapore, Singapore
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7
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Lis-Święty A, Frątczak A. Proactive therapy: new perspectives for long-term topical treatment of psoriasis. Dermatol Ther 2022; 35:e15364. [PMID: 35133689 DOI: 10.1111/dth.15364] [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: 08/13/2021] [Revised: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
Mild to moderate psoriasis is most often treated with topical therapy. The article reviews literature on topical treatments that have been assessed in clinical trials and real-life studies lasting at least 12 months. Calcipotriol/bethamethasone dipropionate foam in maintenance treatment following the induction phase can improve efficacy and safety of topical therapy in psoriatic patients. Introduction of new topical nonsteroidal drugs and the wider use of proactive therapy seem to be crucial to achieve satisfactory long-term outcomes in psoriasis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna Lis-Święty
- Chair and Department of Dermatology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Frątczak
- Chair and Department of Dermatology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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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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9
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Fabbrocini G, De Simone C, Dapavo P, Malagoli P, Martella A, Calzavara Pinton P. Long-term maintenance treatment of psoriasis: the role of calcipotriol/betamethasone dipropionate aerosol foam in clinical practice. J DERMATOL TREAT 2021; 33:2425-2432. [PMID: 34694953 DOI: 10.1080/09546634.2021.1998310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Most patients with psoriasis present with localized mild-to-moderate disease. In this case, the application of topical treatments in the first-line setting is recommended in most cases.Among different topical options, the fixed-dose combination of betamethasone dipropionate (BD) and vitamin D analogue (Cal) aerosol foam (Enstilar®, Leo Pharma) is approved as first-line topical therapy for the treatment of psoriasis in USA and the EU, due to its high efficacy and its favorable administration scheme.The PSO-LONG was the first trial to report on the long-term efficacy and safety of the Cal/DB foam treatment for the proactive management of psoriasis and now, the indications of Cal/BD foam included its use in the psoriasis maintenance treatment. However, the precise role of this treatment and the potential therapeutic schemes in the long-term management of psoriasis need further clarification.This Position Paper, authored by a group of Italian Expert Dermatologists, critically discusses the long-term management of psoriasis with Cal/BD foam in clinical practice. In particular, the biological rationale in the proactive treatment with Cal/BD foam and current evidence regarding this therapeutic approach are presented, along with its application also in patients with moderate-to-severe disease, difficult-to-treat lesions, or within combination regimens. In addition, strategies to improve adherence to long-term treatment of psoriasis are discussed.
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Affiliation(s)
- G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Policlinico "A. Gemelli", IRCCS, Rome, Italy
| | - P Dapavo
- ASO City of Health and Science, University Dermatological Clinic, Corso Vittorio Emanuele II, 62, Torino, Italy
| | - P Malagoli
- Head Psocare Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato, Milano, Italy
| | - A Martella
- Myskin Dermatology Practice, Tiggiano, Lecce, Italy
| | - P Calzavara Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili, P.le Spedali Civili, 1, Brescia, Italy
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Papp KA, Dhadwal G, Gooderham M, Guenther L, Turchin I, Wiseman M, Yeung J. Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review. Dermatol Ther 2021; 34:e15104. [PMID: 34418251 PMCID: PMC9286633 DOI: 10.1111/dth.15104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 01/23/2023]
Abstract
Psoriasis (PsO) requires safe and effective long‐term management to reduce the risk of recurrence and decrease the frequency of relapse. Topical PsO therapies are a cornerstone in the management of PsO though safety concerns limit the chronic, continuous use of topical corticosteroids and/or vitamin D3 analogs. Evidence‐based guidelines on optimal treatment targets and maintenance therapy regimens are currently lacking. This review explores the evidence supporting approaches to maintenance topical therapy for PsO including continuous long‐term therapy, chronic intermittent use, step‐down therapy, sequential or pulse therapy regimens, and proactive maintenance therapy. Several unaddressed questions are discussed including how and when to transition from acute to maintenance therapy, strategies for monitoring long‐term treatment, the role of topical maintenance therapy in the context of systemic and biologic therapies, risks of maintenance therapy, prescribing a topical preparation suitable for patients' preferences and skin type, and key concepts for patient education to maximize long‐term outcomes. Overall, emerging evidence supports a paradigm shift toward proactive treatment once skin is completely clear as a strategy to enhance disease control without compromising safety.
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Affiliation(s)
- Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, Canada
| | - Gurbir Dhadwal
- Guildford Dermatology, Probity Medical Research, and St. Paul's Hospital, Surrey, Canada
| | - Melinda Gooderham
- Department of Medicine, SKiN Centre for Dermatology, Probity Medical Research, and Queen's University, Peterborough, Canada
| | - Lyn Guenther
- Department of Dermatology, Guenther Dermatology Research Inc. and Western University, London, Canada
| | - Irina Turchin
- Department of Medicine, Brunswick Dermatology Centre, Probity Medical Research, Dalhousie University, and Memorial University Faculty of Medicine, St. John's, Halifax, Canada
| | - Marni Wiseman
- Department of Internal Medicine, SKiNWISE Dermatology, Probity Medical Research and University of Manitoba, Winnipeg, Canada
| | - Jensen Yeung
- Department of Medicine, Women's College Hospital, Sunnybrook Health Sciences Centre, Probity Medical Research and University of Toronto, Toronto, Canada
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11
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Teixeira A, Teixeira M, Bento C, Azevedo LF, Vasconcelos V, Bahia MF, Torres T, Morna C, Castro E, Vidal DG, E Sousa HFP, Dinis MAP, Almeida IF, Almeida V. Patterns of dosage regimen instructions regarding topical medicines: how is the information perceived by patients? J DERMATOL TREAT 2021; 33:2325-2330. [PMID: 34334082 DOI: 10.1080/09546634.2021.1960262] [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: 10/20/2022]
Abstract
BACKGROUND The communication of dosage regimen instructions by physicians is of utmost importance on treatment adherence. Few studies until now have approached the topical treatment adherence subject. OBJECTIVE This study aims the characterization of dosage regimen instructions given by physicians and the assessment of chronic dermatological patients' perception regarding these instructions. METHODS Two instruments one for physicians (PHYSDOSAGE) and one for patients (PATIENTDOSAGE) were developed and applied in a cross-sectional, descriptive and exploratory study to two independent samples composed by 91 physicians and 43 patients. RESULTS Most of physicians reported to provide dosage regimen instructions. When cross checking information from both studied samples, physicians and patients, it was concluded that physicians reported to provide more frequently oral and written treatment instructions, e.g. electronic prescription, than patients reported having received it. Also, physicians claimed to often provide information about the duration of treatment and the frequency of topical medicines' application, which was not acknowledged by patients. CONCLUSIONS Contradictory results were found between the physicians' information input and the patients' perception about dosage regimen instructions provided during the consultation. These findings could negatively influence the treatment adherence and the clinical outcomes. Thus, it is of paramount importance the implementation of strategies to improve optimal communication of dosage regimen instructions for topical medicines.
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Affiliation(s)
- Ana Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Maribel Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Carmen Bento
- Universitary Clinic of Paediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Filipe Azevedo
- Department of Health Information and Decision Sciences (CIDES) and Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | - Viviana Vasconcelos
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Maria Fernanda Bahia
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Tiago Torres
- Serviço de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Carla Morna
- USF das Ondas, Aces Grande Porto IV-Póvoa de Varzim/Vila do Conde, Vila do Conde, Portugal
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar de S. João, Porto, Portugal
| | - Diogo Guedes Vidal
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | | | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | - Isabel F Almeida
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Vera Almeida
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
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12
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Bark C, Brown C, Svangren P. Systematic literature review of long-term efficacy data for topical psoriasis treatments. J DERMATOL TREAT 2021; 33:2118-2128. [PMID: 33945378 DOI: 10.1080/09546634.2021.1925211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify long-term efficacy evidence that supports use of topical therapies as regular maintenance therapy in the prevention of psoriasis relapse. METHODS A systematic literature review identified clinical trials and observational studies that reported efficacy outcomes for topical psoriasis therapies with treatment durations of at least 12 weeks. For therapies with long-term data, the approved treatment schedules in product labels were reviewed. RESULTS Forty-six studies with at least 12-week efficacy outcomes were identified. Eight randomized controlled trials and six observational studies or single-arm open-label studies reported efficacy data for >12-week treatment periods. Most studies used treatment regimens that reflect current standard of care of repeated treatment of relapses. The PSO-LONG study is the only identified randomized controlled trial to have compared regular proactive maintenance use of a topical treatment (calcipotriol/betamethasone foam) with reactive management in response to psoriasis relapses. CONCLUSIONS Limited high-quality long-term efficacy data are available for topical psoriasis therapies. While some product labels mention clinical experience of up to 12 months, they do not provide specific recommendations on the optimal long-term regimen. Calcipotriol/betamethasone foam is the only treatment for which the approved label allows either reactive treatment of relapse or regular (twice weekly) maintenance use.
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Affiliation(s)
| | | | - Per Svangren
- Svangren Life Science Consulting, Barseback, Sweden
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13
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Zhao Y, Asahina A, Asawanonda P, Frez ML, Imafuku S, Hyun Kim D, Theng C, Wang L, Zhang JA, Zimmo S. Systematic review and practical guidance on the use of topical calcipotriol and topical calcipotriol with betamethasone dipropionate as long-term therapy for mild-to-moderate plaque psoriasis. J Dermatol 2021; 48:940-960. [PMID: 34036631 DOI: 10.1111/1346-8138.15806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
While many patients with psoriasis are candidates for topical agents, long-term treatment effects are unclear. This systematic review evaluated global findings from clinical trials and real-world studies of topical calcipotriol and the two-compound formulation of calcipotriol and betamethasone dipropionate for mild-to-moderate plaque psoriasis (including scalp psoriasis). PubMed, Embase and MEDLINE were searched for relevant English-language publications along with Chinese, Japanese, Korean and Latin American publication databases. Identified articles were screened by title and abstract against predefined inclusion/exclusion criteria. A narrative synthesis of key efficacy and safety findings from the full papers of selected publications was developed. Thirty-seven relevant papers were identified (25 English, 11 Chinese and one Japanese-language study) including 28 randomized controlled trials. While there was significant heterogeneity in study length, treatment intensity and clinical measures, following a critical review of the published data combined with expert opinion, the following clinical practice recommendations were agreed in order to assist healthcare providers: in adults, long-term treatment with calcipotriol/betamethasone dipropionate is well tolerated and efficacious for up to 1 year on an 'as needed' basis, and for up to 16 weeks on a fixed-treatment regimen. Calcipotriol is also well tolerated and efficacious when used long term (up to 52 weeks) 'as needed' and for up to 20 weeks on a fixed-treatment regimen. Used on an 'as needed' basis for up to 1 year, the safety and efficacy profile of fixed-dose combination calcipotriol/betamethasone dipropionate is more favorable than calcipotriol alone; regular consultation between patients and their dermatologist/primary care physician is required to review psoriasis symptoms and adjust treatment accordingly; a specific treatment goal should be agreed on initiation of topical agent(s) to determine when long-term treatment can begin or if a regimen change is warranted; and application frequency during the continued treatment phase should consider the patients' treatment expectations and goals.
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Affiliation(s)
- Yi Zhao
- Tsinghua University, Tsinghua, China
| | | | | | - Ma Lorna Frez
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Dong Hyun Kim
- CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Colin Theng
- Mt Alvernia Medical Centre, Singapore, Singapore
| | | | - Jiang An Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Maul JT, Anzengruber F, Conrad C, Cozzio A, Häusermann P, Jalili A, Kolios AGA, Laffitte E, Lapointe AK, Mainetti C, Schlapbach C, Trüeb R, Yawalkar N, Dippel M, Navarini AA. Topical Treatment of Psoriasis Vulgaris: The Swiss Treatment Pathway. Dermatology 2021; 237:166-178. [PMID: 33406520 DOI: 10.1159/000512930] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
Topical treatment is crucial for the successful management of plaque psoriasis. Topicals are used either as a stand-alone therapy for mild psoriasis or else in combination with UV or systemic treatment for moderate-to-severe disease. For the choice of a suitable topical treatment, the formulation matters and not just the active substances. This expert opinion paper was developed via a non-structured consensus process by Swiss dermatologists in hospitals and private practices to illustrate the current treatment options to general practitioners and dermatologists in Switzerland. Defining treatment goals together with the patient is crucial and increases treatment adherence. Patients' personal preferences and pre-existing experiences should be considered and their satisfaction with treatment and outcome regularly assessed. During the induction phase of "classical" mild-to-moderate psoriasis, the fixed combination of topical calcipotriol (Cal) 50 μg/g and betamethasone dipropionate (BD) 0.5 mg/g once daily is frequently used for 4-8 weeks. During the maintenance phase, a twice weekly (proactive) management has proved to reduce the risk of relapse. Of the fixed combinations, Cal/BD aerosol foam is the most effective formulation. However, the individual choice of formulation should be based on a patient's preference and the location of the psoriatic plaques. Tailored recommendations are given for the topical management of specific areas (scalp, facial, intertriginous/genital, or palmoplantar lesions), certain symptoms (hyperkeratotic or hyperinflammatory forms) as well as during pregnancy or a period of breastfeeding. As concomitant basic therapy, several emollients are recommended. If topical treatment alone does not appear to be sufficient, the regimen should be escalated according to the Swiss S1-guideline for the systemic treatment of psoriasis.
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Affiliation(s)
- Julia-Tatjana Maul
- Department of Dermatology and Venereology, University Hospital of Zurich (USZ), Zurich, Switzerland,
| | - Florian Anzengruber
- Department of Dermatology and Venereology, University Hospital of Zurich (USZ), Zurich, Switzerland
| | - Curdin Conrad
- Department of Dermatology and Venereology, University Hospital of Vaude (CHUV), Lausanne, Switzerland
| | - Antonio Cozzio
- Department of Dermatology and Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Peter Häusermann
- Department of Dermatology and Venereology, University Hospital of Basel, Basel, Switzerland
| | - Ahmad Jalili
- Dermatology and Skin Care, Bürgenstock Medical Center, Obbürgen, Switzerland
| | - Antonios G A Kolios
- Department of Immunology, University Hospital of Zurich, Zurich, Switzerland.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Emmanuel Laffitte
- Department of Dermatology and Venereology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | | | - Carlo Mainetti
- Department of Dermatology and Venereology, Regional Hospital of Bellinzona, Bellinzona, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology and Venereology, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - Ralph Trüeb
- Center for Dermatology and Hair Diseases, Zurich, Switzerland
| | - Nikhil Yawalkar
- Department of Dermatology and Venereology, Inselspital, University Hospital of Berne, Berne, Switzerland
| | | | - Alexander A Navarini
- Department of Dermatology and Venereology, University Hospital of Basel, Basel, Switzerland
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15
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Thaçi D, de la Cueva P, Pink AE, Jalili A, Segaert S, Hjuler KF, Calzavara-Pinton P. General practice recommendations for the topical treatment of psoriasis: a modified-Delphi approach. BJGP Open 2020; 4:bjgpopen20X101108. [PMID: 33144365 PMCID: PMC7880171 DOI: 10.3399/bjgpopen20x101108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although GPs are usually the first port of call for patients with psoriasis, there is a lack of consistent and up-to-date clinical recommendations for interventions for patients with mild-to-moderate disease. AIM To provide practical recommendations for GPs to optimise psoriasis treatment with topical therapies in four key areas: patient identification; treatment decision making with topical theory; topical treatment outcomes; and optimising patient adherence. DESIGN & SETTING A consensus-seeking programme (modified-Delphi approach) was undertaken to assess the literature and develop recommendations for GPs, based on evidence and expert opinion. METHOD Three dermatologists compiled 47 questions that were subsequently ranked and refined according to clinical relevance or importance using an online survey. Thereafter, 19 dermatologists from different European countries developed statements and clinical recommendations for the top seven ranked topical treatment and GP-relevant questions based on literature research and clinical experience. The final recommendations were based on 100% agreement among a final panel of seven experts. RESULTS The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy, in addition to good physician-patient communication, are important for optimising patient adherence and maximising efficacy. Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis. CONCLUSION Simple but detailed practical guidance is provided, which is formed from evidence and expert clinical recommendations, to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment.
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Affiliation(s)
- Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Pablo de la Cueva
- Department of Dermatology, University Hospital Infanta Leonor de Madrid, Madrid, Spain
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ahmad Jalili
- Department of Dermatology, Bürgenstock Medical Center, Obbürgen, Switzerland
| | | | - Kasper F Hjuler
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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16
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Stein Gold L, Alonso-Llamazares J, Lacour JP, Warren RB, Tyring SK, Kircik L, Yamauchi P, Lebwohl M. PSO-LONG: Design of a Novel, 12-Month Clinical Trial of Topical, Proactive Maintenance with Twice-Weekly Cal/BD Foam in Psoriasis. Adv Ther 2020; 37:4730-4753. [PMID: 32965655 PMCID: PMC7547957 DOI: 10.1007/s12325-020-01497-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022]
Abstract
Background Psoriasis vulgaris is commonly treated with topical corticosteroids and vitamin D analogues. Although potent and super-potent topical corticosteroids are very effective at clearing psoriasis, with short-term reactive treatment durations, symptoms usually recur after treatment discontinuation, necessitating long-term disease management strategies. A foam formulation of calcipotriol and betamethasone dipropionate (Cal/BD foam), consisting of calcipotriol 50 μg/g and betamethasone dipropionate 0.5 mg/g, is approved for the daily treatment of psoriasis for up to 4 weeks. Here, we describe a clinical trial protocol for evaluating the long-term safety and efficacy of twice-weekly Cal/BD foam as a proactive topical maintenance therapy for plaque psoriasis for up to 52 weeks. Objective The aim of this trial was to evaluate the safety and efficacy of Cal/BD foam when applied twice weekly for up to 52 weeks as proactive maintenance therapy, with the goal of preventing or delaying disease relapse as long as possible while minimizing adverse effects. Methods Once-daily Cal/BD foam treatment responders from an initial 4-week open-label period were randomized to receive Cal/BD foam or foam vehicle applied to previously cleared plaques twice weekly for up to 52 weeks. In case of relapse, affected subjects in either group received rescue therapy with once-daily Cal/BD foam for 4 weeks on active areas. Thus, the trial (NCT02899962) compared the long-term use of Cal/BD foam in a proactive approach with a conventional, reactive approach. Planned Outcomes Efficacy endpoints included the time to first relapse, the number of relapse-free days, and the number of relapses during the maintenance phase. Safety assessments included adverse events, incidence of rebound, local safety and tolerability scores, and effects on calcium metabolism and hypothalamic–pituitary–adrenal axis function. Trial registration ClinicalTrials.gov identifier, NCT02899962. Electronic supplementary material The online version of this article (10.1007/s12325-020-01497-6) contains supplementary material, which is available to authorized users.
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17
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Carrascosa JM, Theng C, Thaçi D. Spotlight on Topical Long-Term Management of Plaque Psoriasis. Clin Cosmet Investig Dermatol 2020; 13:495-498. [PMID: 32801825 PMCID: PMC7397561 DOI: 10.2147/ccid.s254114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
During the 28th Congress of the European Academy of Dermatology and Venereology (EADV) held in Madrid in October 2019, an industry hub was dedicated to the long-term management of psoriasis. Psoriasis is a systemic inflammatory disease primarily involving the skin that affects up to 4% of the European population, the majority of whom present with chronic plaque psoriasis. Topical therapies are well established in the first-line treatment of psoriatic plaque flares. Nevertheless, as psoriasis is a chronic disease, long-term control should be considered. The aim of the session was to provide expert opinion on the benefit of long-term maintenance therapy in chronic plaque psoriasis and introduce the concept of pro-active management to decrease the number of relapses and improve patient quality of life. The current guidelines and recommendations were reviewed, as well as the available data on published clinical trials. There is still an important role for topical therapy in psoriasis and current recommendations suggest a maintenance regimen for psoriasis. Adherence optimization and proactive management of relapse can be key factors for obtaining clinical outcomes in topical long-term therapy. Calcipotriol/betamethasone dipropionate foam is the only topical formulation with long-term data as a twice-weekly proactive treatment approach for up to 52 weeks for chronic plaque psoriasis.
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Affiliation(s)
| | - Colin Theng
- The Skin Specialists & Laser Clinic, Singapore
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
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18
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Megna M, Cinelli E, Camela E, Fabbrocini G. Calcipotriol/betamethasone dipropionate formulations for psoriasis: an overview of the options and efficacy data. Expert Rev Clin Immunol 2020; 16:599-620. [PMID: 32476507 DOI: 10.1080/1744666x.2020.1776116] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Psoriasis is a very common chronic inflammatory skin disease affecting up to 3% of the general population with 75% of the psoriasis subjects being affected by a mild form of disease. Hence, topical therapy is the most frequent employed treatment in psoriasis also because it can be easily combined with systemic therapy. In this context, calcipotriol/betamethasone dipropionate (Cal/BD) fixed-dose association represents the first-line treatment due to its efficacy and once-daily application. Different Cal/BD formulations, such as ointment, gel (topical suspension), and aerosol foam, are approved by US Food and Drug Administration. AREAS COVERED For this review, relevant English literature (trials, real-life studies, case series, and reviews) regarding Cal/BD different formulations efficacy in psoriasis was searched for through to 28 January 2020. The following database were consulted: PubMed, Embase, the Cochrane Library, Google Scholar, EBSCO, and clinicaltrials.gov. EXPERT OPINION Cal/BD formulations are efficacious treatment for psoriasis. Cal/BD aerosol foam shows a higher efficacy compared to Cal/BD ointment or gel formulations, appearing as a game-changer in psoriasis therapy not only for mild disease but also for moderate psoriasis as well as in selected severe cases in combination with systemic treatments.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
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19
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Johnson Girard V, Hill A, Glaser E, Lussier MT. Optimizing Communication About Topical Corticosteroids: A Quality Improvement Study. J Cutan Med Surg 2020; 24:240-248. [DOI: 10.1177/1203475420908250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients are often non-adherent to topical corticosteroids (TCS). This may be in part due to poor communication between patients and dermatologists. Objectives This quality improvement (QI) study aims to describe dermatologist–patient communication about TCS treatments and to compare communication before and after the implementation of an educational intervention. Methods This QI study assesses the communication between dermatologists and new dermatology outpatients receiving a TCS prescription in a tertiary care center. The QI intervention is 2-pronged, consisting of an educational pamphlet for patients and a communication workshop for the dermatology team. Encounters were audiotaped, and communication was analyzed using a coding system (MEDICODE). Phase 1 recordings happened preintervention and reflect the usual dermatologist–patient communication in this practice setting and phase 2 recordings were postintervention. Results Phase 1 reveals that dermatologists frequently address informational medication themes, such as naming the medications and informing patients about their proper use. They less frequently discuss patient experience themes, such as goals of treatment, adverse effects of treatments, and exploring patients’ emotions about medications (such as anxiety, fears, etc.). After the intervention, there was more frequent discussion of patient experience themes without increasing consultation length. But, in both phases, physicians address most themes as a monolog with little verbal input from patients. Conclusions Our study raises awareness regarding dermatologists’ communication patterns about TCS, identifying specific areas for improvement, such as discussions of adverse effects, and explicitly addressing patients’ attitudes and emotions. This is an essential step to foster a sense-making of TCS for patients.
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Affiliation(s)
- Valérie Johnson Girard
- Department of Medicine (Dermatology), Hôpital de la Cité-de-la-Santé, Laval, Centre intégré de santé et des services sociaux de Laval, Quebec, Canada
| | - Ashley Hill
- Department of Medicine (Dermatology), Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Emma Glaser
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, University of Montreal, Quebec, Canada
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20
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Segaert S, Calzavara-Pinton P, de la Cueva P, Jalili A, Lons Danic D, Pink AE, Thaçi D, Gooderham M. Long-term topical management of psoriasis: the road ahead. J DERMATOL TREAT 2020; 33:111-120. [DOI: 10.1080/09546634.2020.1729335] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Pablo de la Cueva
- Department of Dermatology, University Hospital Infanta Leonor de Madrid, Madrid, Spain
| | - Ahmad Jalili
- Department of Dermatology, Bürgenstock Medical Center, Obbürgen, Switzerland
| | | | - Andrew E. Pink
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Probity Medical Research and Queen’s University, Peterborough, Canada
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21
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Zhao Y, Wang G, Ni W, Song Z, Chen K, Zhang C, Zhang S, Ding Y, Zheng M, Shi Y, Lin Z, Liu X, Zhang X, Zhou Q, Ahmed KD. Visit Adherence of Mild to Moderate Psoriasis Patients: A Mobile-Based Randomized Study. Patient Prefer Adherence 2020; 14:2551-2557. [PMID: 33447016 PMCID: PMC7802013 DOI: 10.2147/ppa.s277103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/10/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We aimed to prospectively evaluate the visit adherence in mild to moderate psoriasis patients. METHODS Plaque psoriasis patients aged 18 or above who were prescribed with a two-component formula ointment were eligible for the study. The patients were randomly assigned to group A or B, and received management with or without planned patient-doctor communication via a mobile platform. The outpatient visit was scheduled at week 2, 8, 16, 28, 48, and 52. Visit adherence was evaluated as the visit rate of the patients. RESULTS Two hundred twenty-one patients were included. Generally, the visit adherence dropped over time during follow-up. The visit rates in group A were 5.2-15.7% through the 52 weeks, and similar rates were found in group B (7.5-17.0%, vs group A, P > 0.05). A negative binomial regression model showed that older age and higher BSA were correlated with more frequent visits. CONCLUSION The visit adherence of mild to moderate psoriasis patients was very low in China. Proactive inquiries of the doctors via the mobile platform failed to improve the visit adherence of the patients.
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Affiliation(s)
- Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
- Correspondence: Yi ZhaoDepartment of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing102218, People’s Republic of China Email
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
- Gang WangDepartment of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an710032, People’s Republic of China Email
| | - Wenqiong Ni
- Department of Dermatology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, People’s Republic of China
| | - Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, People’s Republic of China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Shoumin Zhang
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou450003, People’s Republic of China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, People’s Republic of China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yulin Shi
- Department of Dermatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zhimiao Lin
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xiaomin Liu
- Department of Dermatology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Qintian Zhou
- Scientific Affairs and MSL Department, LEOPharma China, Shanghai, People’s Republic of China
| | - Kazi Deluwar Ahmed
- Scientific Affairs and MSL Department, LEOPharma China, Shanghai, People’s Republic of China
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22
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Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol 2019; 33:2253-2263. [PMID: 31454113 DOI: 10.1111/jdv.15913] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022]
Abstract
Adherence describes how a patient follows a medical regime recommended by a healthcare provider. Poor treatment adherence represents a complex and challenging problem of international healthcare systems, as it has a substantial impact on clinical outcomes and patient safety and constitutes an important financial burden. Since it is one of the most common causes of treatment failure, it is extremely important for physicians to reliably distinguish between non-adherence and non-response. This systematic review aims to summarize the current literature on treatment adherence in dermatology, focusing on chronic inflammatory skin diseases such as psoriasis, atopic dermatitis and acne. A systematic literature search was performed using the PubMed Database, including articles from 2008 to 2018. Low treatment adherence is a multidimensional phenomenon defined by the interplay of numerous factors and should under no circumstances be considered as the patient's fault alone. Factors influencing treatment adherence in dermatology include patient characteristics and beliefs, treatment efficacy and duration, administration routes, disease chronicity and the disease itself. Moreover, the quality of the physician-patient relationship including physician-time available for the patient plays an important role. Understanding patients' adherence patterns and the main drivers of non-adherence creates opportunities to improve adherence in the future. Strategies to increase treatment adherence range from reminder programs to simplifying prescriptions or educational interventions. Absolute adherence to treatment may not be realistically achievable, but efforts need to be made to raise awareness in order to maximize adherence as far as possible.
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Affiliation(s)
- L Eicher
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - M Knop
- Derma I, München Klinik, Munich, Germany
| | - N Aszodi
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - S Senner
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - L E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.,Derma I, München Klinik, Munich, Germany
| | - A Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.,Derma I, München Klinik, Munich, Germany
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23
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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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24
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Homayoon D, Dahlhoff P, Augustin M. [Adequate prescription and application of topicals : How to calculate the right volume for the prescription of ointment needed?]. Hautarzt 2019; 69:478-483. [PMID: 29247255 DOI: 10.1007/s00105-017-4088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncertainty regarding the suitable amount of prescribed ointment and its application by patients may cause insufficient or uneconomic health care provision. To address this issue, standardized methods and experts' knowledge on the suitable amount and coherent patient's elucidation for application of topicals are needed. OBJECTIVES Presented are current data in routine care and scientific evidence on the prescribed amount of topical agents as well as its application by patients in dermatological care. MATERIALS AND METHODS A literature review was conducted via PubMed using the keywords as individual and pooled search terms: "local therapy", "topical treatment", "prescription", "amount of ointment needed", "involved area", "BSA", "finger-tip-unit", "Rule of Hand", "calculated dosage" and "rule of nines". We included original studies by manually screening title and abstract according to the relevance of the topic. RESULTS The search strategy identified 19 clinical trials. The fingertip unit (FTU) is the most frequently used measurement for accurate application of external agents. Appropriate prescribed amount is calculated by required topical agent per involved surface area. CONCLUSIONS There is still a need for clarification to which extent the optimized amount of ointment is prescribed and advice for its application in routine care is given. The FTU combined with the "Rule of Hand" is an adequate measurement for patient's guidance on self-application.
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Affiliation(s)
- D Homayoon
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - P Dahlhoff
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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25
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Dressler C, Lambert J, Grine L, Galdas P, Paul C, Zidane M, Nast A. Therapeutische Patientenschulungsprogramme und Unterstützung beim Selbstmanagement für Patienten mit Psoriasis – eine systematische Übersicht. J Dtsch Dermatol Ges 2019; 17:685-697. [DOI: 10.1111/ddg.13840_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Corinna Dressler
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Jo Lambert
- Department of DermatologyGhent University Hospital Ghent Belgium
| | - Lynda Grine
- Department of DermatologyGhent University Hospital Ghent Belgium
| | - Paul Galdas
- Department of Health SciencesFaculty of ScienceUniversity of York York United Kingdom
| | - Carle Paul
- Department of DermatologyCHU and Paul Sabatier University Toulouse France
| | - Miriam Zidane
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Alexander Nast
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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26
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Ludwig‐Peitsch W. Patientenedukation und Selbstmanagement bei Psoriasis. J Dtsch Dermatol Ges 2019; 17:679-680. [DOI: 10.1111/ddg.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Svendsen MT, Feldmann S, Tiedemann SN, Sørensen ASS, Rivas CMR, Andersen KE. Improving psoriasis patients' adherence to topical drugs: a systematic review. J DERMATOL TREAT 2019; 31:776-785. [PMID: 31122090 DOI: 10.1080/09546634.2019.1623371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Poor adherence to topical antipsoriatic drugs limits treatment effectiveness.Objective: The aim of this study was to investigate how health care providers may improve psoriasis patients' adherence to topical treatment.Materials and methods: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library.Results: Ten studies of varying quality were identified. Two randomized controlled trials (RCTs) testing the adherence-improving potential of interventions by health care providers to support patients showed improvement in adherence to topical treatment. In a prospective study with a pre/postdesign, an individualized, face-to-face consultation reported an improvement in patient-reported adherence to topical treatment over a 9-week period. Based on seven qualitative studies obtaining insights from either patients or health care providers, health care providers may need to address socio-economic factors, health care system factors, and treatment-, patient-, and disease-related factors in interventions that aim to improve the adherence of psoriasis patients to topical antipsoriatic drugs.Conclusion: There is a need to develop better adherence-improving interventions. A good patient-health care provider relationship is considered crucial to adherence and may be an important intervention target. Before interventions to improve adherence to topicals can be recommended for the clinic, the intervention should be tested in high-quality RCTs.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark
| | - Steven Feldmann
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark.,Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Klaus Ejner Andersen
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark
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28
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Dressler C, Lambert J, Grine L, Galdas P, Paul C, Zidane M, Nast A. Therapeutic patient education and self‐management support for patients with psoriasis – a systematic review. J Dtsch Dermatol Ges 2019; 17:685-695. [DOI: 10.1111/ddg.13840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/20/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Corinna Dressler
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin BerlinCorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlinand Berlin Institute of Health Berlin Germany
| | - Jo Lambert
- Department of DermatologyGhent University Hospital Ghent Belgium
| | - Lynda Grine
- Department of DermatologyGhent University Hospital Ghent Belgium
| | - Paul Galdas
- Department of Health SciencesFaculty of ScienceUniversity of York York United Kingdom
| | - Carle Paul
- Department of DermatologyCHU and Paul Sabatier University Toulouse France
| | - Miriam Zidane
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin BerlinCorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlinand Berlin Institute of Health Berlin Germany
| | - Alexander Nast
- Division of Evidence‐Based MedicineDepartment of DermatologyCharité – Universitätsmedizin BerlinCorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlinand Berlin Institute of Health Berlin Germany
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29
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Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies. Am J Clin Dermatol 2019; 20:13-29. [PMID: 30324563 DOI: 10.1007/s40257-018-0390-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with psoriasis face numerous treatment and self-management decisions. Shared decision making is a novel approach where patients' preferences and values are considered in cooperation with healthcare professionals before making treatment decisions. OBJECTIVE The objective of this systematic review was to explore what is illuminated in psoriasis research regarding shared decision making, and to estimate the effects of shared decision-making interventions in this context. METHODS Qualitative, quantitative, and mixed-methods studies were eligible for inclusion. We searched six electronic databases up to January 2018. Two reviewers independently applied inclusion and quality criteria. The SPIDER framework was used to identify eligibility criteria for study inclusion. Narrative and thematic syntheses were utilized to identify prominent themes emerging from the data. RESULTS A total of 23 studies were included in the review. Of these, we included 18 studies (19 papers) to describe what was illuminated with regard to shared decision making in psoriasis research. Four major themes emerged: interpersonal communication; exchange of competence and knowledge; different world view; and involvement and preference, organized under two analytical themes; "Co-creation of decisions" and "Organization of treatment and treatment needs". For shared decision-making effects, we included four controlled studies. These varied in scope and interventional length and showed limited use of shared decision making-specific outcome measures, reflecting the early stage of the literature. Because of study heterogeneity, a meta-synthesis was not justified. CONCLUSIONS There appears to be a need to strengthen the relationship between medical doctors and patients with psoriasis. The evident lack of knowledge about each other's competence and the lack of self-efficacy for both patients and providers challenges the basic principles of shared decision making. The effects of shared decision making in psoriasis are inconclusive, and more research appears necessary to determine the possible benefits of shared decision-making interventions.
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Alpalhão M, Antunes J, Gouveia A, Travassos R, Lopes L, Sanches M, Pinto A, Rodrigues B, Calado S, Ferreira J, Filipe P. A randomized controlled clinical trial to assess the impact of motivational phone calls on therapeutic adherence in patients suffering from psoriasis. Dermatol Ther 2018; 31:e12667. [DOI: 10.1111/dth.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Miguel Alpalhão
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
| | - Joana Antunes
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Ana Gouveia
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Rita Travassos
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Leonor Lopes
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Maria Sanches
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Ana Pinto
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Bruno Rodrigues
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Susana Calado
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - João Ferreira
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Paulo Filipe
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
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31
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Mak A. The Impact of Vitamin D on the Immunopathophysiology, Disease Activity, and Extra-Musculoskeletal Manifestations of Systemic Lupus Erythematosus. Int J Mol Sci 2018; 19:ijms19082355. [PMID: 30103428 PMCID: PMC6121378 DOI: 10.3390/ijms19082355] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades it has been increasingly recognized that vitamin D, aside from its crucial involvement in calcium and phosphate homeostasis and the dynamics of the musculoskeletal system, exerts its influential impact on the immune system. The mechanistic roles that vitamin D plays regarding immune activation for combating infection, as well as pathologically and mediating autoimmune conditions, have been progressively unraveled. In vitro and in vivo models have demonstrated that the action of vitamin D on various immunocytes is not unidirectional. Rather, how vitamin D affects immunocyte functions depends on the context of the immune response, in the way that its suppressive or stimulatory action offers physiologically appropriate and immunologically advantageous outcomes. In this review, the relationship between various aspects of vitamin D, starting from its adequacy in circulation to its immunological functions, as well as its autoimmune conditions, in particular systemic lupus erythematosus (SLE), a prototype autoimmune condition characterized by immune-complex mediated inflammation, will be discussed. Concurring with other groups of investigators, our group found that vitamin D deficiency is highly prevalent in patients with SLE. Furthermore, the circulating vitamin D levels appear to be correlated with a higher disease activity of SLE as well as extra-musculoskeletal complications of SLE such as fatigue, cardiovascular risk, and cognitive impairment.
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Affiliation(s)
- Anselm Mak
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore.
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Imafuku S, Zheng M, Tada Y, Zhang X, Theng C, Thevarajah S, Zhao Y, Song HJ. Asian consensus on assessment and management of mild to moderate plaque psoriasis with topical therapy. J Dermatol 2018; 45:805-811. [PMID: 29740870 PMCID: PMC6055873 DOI: 10.1111/1346-8138.14338] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
A working group of dermatologists in Asian countries assessed the current status of psoriatic management in the region to prepare a consensus report on topical treatment in mild to moderate plaque psoriasis. Even though the association of psoriasis with systemic comorbidities is increasingly acknowledged, psoriasis is still lower in health‐care priority lists in the region. The psychosocial impact of psoriasis may be greater in Asian countries due to cultural norms and social discrimination. Non‐adherence to treatment is also common among Asians. The current care given to patients with mild to moderate psoriasis needs to be streamlined, enhanced and organized with a patient‐centered care approach to achieve better outcomes. A comprehensive assessment of the disease severity and its impact on a patient's life is required before initiating treatment. Education and active involvement of the patient in the treatment plan is an important part of psoriatic management. It is recommended to personalize topical treatment to meet the needs of the patient, depending on disease severity, psychosocial impact, the patient's expectations and, more importantly, the patient's willingness and ability to actively follow the treatment procedure. Fixed‐dose combination of corticosteroid and vitamin D analogs is the preferred topical medication for both initial and maintenance phases of treatment. The fast containment of the disease is the goal of the initial phase of 4–8 weeks and it demands a potent fast‐acting topical therapy. Satisfactory control of the disease and prevention of relapses should be achieved during the maintenance phase with twice a week or weekend applications.
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Affiliation(s)
- Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, China
| | - Colin Theng
- The Skin Specialists & Laser Clinic, Singapore
| | | | - Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hae Jun Song
- Department of Dermatology, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
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