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Norlin JM, Löfvendahl S, Schmitt-Egenolf M. Health-related quality of life in patients with generalized pustular psoriasis - a Swedish register study. Ann Med 2024; 56:2341252. [PMID: 38738413 PMCID: PMC11095275 DOI: 10.1080/07853890.2024.2341252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Real-world data on health-related quality of life (HRQoL) in generalized pustular psoriasis (GPP) are scarce and studies have been restricted in terms of instruments used for assessments. OBJECTIVE To assess generic and dermatology-specific HRQoL of patients with GPP compared with patients with plaque psoriasis using real-world data from the Swedish National Register for Systemic Treatment of Psoriasis. METHODS Cross-sectional data from 2006 to 2021 including 7041 individuals with plaque psoriasis without GPP and 80 patients with GPP, of which 19% also had plaque psoriasis. Total scores for the EuroQol-5 Dimensions (EQ-5D) and Dermatology Life Quality Index (DLQI), as well as degree of severity within the instruments' dimensions/questions, were compared between patient groups. RESULTS EQ-5D scores were significantly (p < .01) lower (worse) in patients with GPP (mean [standard deviation (SD)] 0.613 [0.346]) vs. patients with plaque psoriasis (mean [SD] 0.715 [0.274]), indicating lower generic HRQoL of patients with GPP. Significantly (p < .01) higher (worse) total DLQI scores were observed for patients with GPP (mean [SD] 10.6 [8.9]) compared with patients with plaque psoriasis (mean [SD] 7.7 [7.1]), with proportionally more patients with GPP having severe (20% vs. 16%) and very severe (17% vs. 8%) problems. The worsened scores for GPP vs. plaque psoriasis were consistent across EQ-5D dimensions and DLQI questions. CONCLUSIONS Individuals with GPP have a considerable impairment in both generic and dermatology-specific HRQoL. The HRQoL was significantly worse in individuals with GPP compared to individuals with plaque psoriasis. The significant HRQoL impairment of GPP shows the potential value of better healthcare interventions for this multisystem disease.
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Affiliation(s)
- Jenny M. Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Sofia Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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Ghezzi G, Costanzo A, Borroni RG. Health-Related Quality of Life in Psoriasis: Literature Review. J Clin Med 2024; 13:4623. [PMID: 39200764 PMCID: PMC11354811 DOI: 10.3390/jcm13164623] [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: 07/19/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
The assessment of quality of life (QoL) in patients with psoriasis plays a crucial role in understanding the impact of the disease and evaluating treatment outcomes. We provide an overview of the key measures used to assess QoL in psoriasis patients, including both generic and psoriasis-specific instruments. The limitations and strengths of instruments such as the Dermatology Life Quality Index (DLQI), Skindex, and Psoriasis Disability Index (PDI) are discussed, highlighting their psychometric properties and areas for improvement. Furthermore, this review examines the potential of disease-specific QoL measures in providing greater sensitivity to disease-related burden and change compared to generic instruments. However, most of the available psoriasis-specific patient-reported outcome measures need further validation. We aim to provide valuable insights into the importance of using validated QoL measures in clinical practice and research, ultimately contributing to a more comprehensive assessment of the impact of psoriasis on patients' lives and enhancing the evaluation of treatment interventions.
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Affiliation(s)
- Gioele Ghezzi
- Humanitas University, 20072 Pieve Emanuele, MI, Italy;
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
| | - Antonio Costanzo
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
| | - Riccardo G. Borroni
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
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3
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Chen R, Zhong X, Huang D, Chen Z, Yu Y, Lu J, Wang Q, Kong L, Yi X, Zhao Y, Ding Y, Guo L, Shi Y. Advantages of ultrasound imaging for the early diagnosis of psoriatic arthritis in patients with moderate to severe psoriasis. Heliyon 2024; 10:e34136. [PMID: 39055795 PMCID: PMC11269902 DOI: 10.1016/j.heliyon.2024.e34136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Background Psoriatic arthritis (PsA) is an immune-mediated form of chronic inflammatory arthritis associated with psoriasis (PsO). It constitutes a significant comorbidity of PsO and is distinguished by the presence of widespread musculoskeletal inflammation. Objective The aim of this study is to precisely detect asymptomatic PsA using ultrasound (US) examinations and to distinguish between various stages of PsO. Methods All patients with moderate-to-severe PsO, who consented to undergo musculoskeletal US examinations during their hospitalization between September 2020 and January 2022, were enrolled in the study. We compared patients' demographic characteristics, comorbidities, disease duration, relevant laboratory parameters, and musculoskeletal US findings. Results A total of 547 patients with PsO were included in the study, and 114 of them received a diagnosis of PsA. Furthermore, 16.45 % of patients with moderate to severe PsO displayed subclinical PsA. We observed a significantly higher frequency of abnormal US findings in patients with PsA compared to those without PsA, with a sensitivity of 95.61 % and a specificity of 79.22 %. Additionally, the incidence of enthesitis and synovitis varied significantly between PsA and non-PsA patients, and they were identified as independent variables predicting the presence of PsA. Furthermore, the interphalangeal joint, knee joint, and calcaneal tendon were the most frequently affected areas in PsA, as indicated by the observed US changes. Conclusion Ultrasound examination proves to be a valuable tool for detecting subclinical PsA, facilitating early screening of the condition. Particular attention should be directed towards changes in the interphalangeal joint, knee joint, and calcaneal tendon when reviewing ultrasound images of asymptomatic patients.
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Affiliation(s)
- Rongfen Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xiaoyuan Zhong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Dawei Huang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Zitong Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Department of Medical Imaging, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingyuan Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Department of Medical Imaging, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Luyang Kong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xuemei Yi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Yujing Zhao
- Department of Medical Imaging, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
| | - Lehang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Department of Medical Imaging, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, 200443, China
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Huo Y, Huang Y, Lee T, Lin M, Chun W. An observational study on treatment regimens and effectiveness for psoriasis in real-world settings among 407 patients in Southeast China. Front Med (Lausanne) 2024; 11:1328750. [PMID: 38348339 PMCID: PMC10860679 DOI: 10.3389/fmed.2024.1328750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction While new targeted therapies have advanced psoriasis treatment, real-world data on comparative effectiveness is lacking. This study analyzed treatment regimens and response in an observational cohort, examining potential disparities between clinical trials and routine practice. Methods Data from the Psoriasis Standardized Diagnosis and Treatment Center registry were analyzed. Patients with ≥1 follow-up were included. Treatment response was assessed using PASI 50/90 criteria. Factors associated with response were analyzed. Results 407 patients were included (46 first-time diagnosed, 361 previously diagnosed). A higher proportion of first-time diagnosed patients achieved treatment response than previously diagnosed (76.1% vs. 62.6%). Multivariable analysis identified factors associated with reduced response in previously treated patients. Conclusion This real-world study found lower treatment response rates compared to clinical trials, especially in previously treated patients. Disparities highlight remaining unmet needs for psoriasis management. Combination and rotational strategies may improve outcomes in patients unresponsive to available therapies. Ongoing research on novel targets and pathways is warranted to address treatment gaps.
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Affiliation(s)
- Yuping Huo
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Yike Huang
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Tungchun Lee
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Maoying Lin
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
| | - Wenhung Chun
- Department of Dermatology, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, Fujian, China
- Department of Dermatology, Linkou Chang-Gung Memorial Hospital, Taiwan, China
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Merola JF, Ogdie A, Gottlieb AB, Stein Gold L, Flower A, Jardon S, Klyachkin Y, Lebwohl M. Patient and Physician Perceptions of Psoriatic Disease in the United States: Results from the UPLIFT Survey. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00929-9. [PMID: 37183192 PMCID: PMC10183304 DOI: 10.1007/s13555-023-00929-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION The Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey study was conducted globally in 2020 to understand how disease perceptions, including disease severity, treatment goals, and quality of life (QoL), have evolved recently, especially for mild-to-moderate psoriatic disease. Here, key findings from the UPLIFT survey based on respondents located in the US are presented. Leveraging results from the UPLIFT survey could lead to more effective interactions between patients and physicians and greater patient satisfaction. METHODS UPLIFT was a multinational web-based survey of dermatologists, rheumatologists, and patients who self-reported a healthcare provider diagnosis of psoriasis (PsO) and/or psoriatic arthritis (PsA) conducted from March 2, 2020, to June 3, 2020. RESULTS US respondents included 1006 patients (26.4% of global population; PsO only, n = 535; PsA only, n = 72; PsO and PsA, n = 399) and 216 physicians (dermatologists, n = 115; rheumatologists, n = 101). Most patients (66.4%) reported a body surface area (BSA; assessed by number of palms) of ≤ 3; of these, 56.2% rated their disease as moderate or severe. Most patients with PsO felt they were somewhat (40.1%) or very (49.3%) closely aligned with their dermatologists regarding treatment goals. Alternately, most patients with PsA felt that they were not too closely (32.1%) or not at all (59.3%) aligned with their rheumatologists. Most patients reported either a moderate (PsO, 35.5%; PsA, 31.8%) or strong (PsO, 47.7%; PsA, 53.9%) need for better treatments. Across BSA subgroups, most patients (60.8% to 86.1%) had a Dermatology Life Quality Index score ≥ 6, indicating at least a moderately impacted QoL. CONCLUSIONS Despite more treatment options, management of psoriatic disease remains suboptimal, with many patients reporting moderate-to-severe disease and impaired QoL, even with limited skin involvement. Results further suggest an unmet need for alignment between patients and physicians in the US to optimize the management of PsO and PsA.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jonak C, Göttfried I, Perl-Convalexius S, Gruber B, Schütz-Bergmayr M, Vujic I, Weger W, Schicher N, Semlin L, Hemetsberger M, Cordey M, Sator P. Characteristics and outcomes of patients with psoriasis treated with apremilast in the real-world in Austria - results the APPRECIATE study. Ther Adv Chronic Dis 2023; 14:20406223231152785. [PMID: 36777399 PMCID: PMC9909071 DOI: 10.1177/20406223231152785] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background Apremilast, an oral phosphodiesterase 4 inhibitor, is approved in the European Union for the treatment of moderate-to-severe chronic plaque psoriasis in adult patients refractory or contraindicated to or intolerant of other systemic therapies. Objectives The APPRECIATE study assessed apremilast use in real-world practice and its clinical value to physicians and patients. APPRECIATE was a multinational, observational, retrospective, cross-sectional study. Methods Apremilast effectiveness at 6 (±1) months was assessed on the basis of psoriasis severity and health-related quality-of-life scores and treatment satisfaction using physician/patient-reported outcomes, respectively. We report the Austrian cohort of 72 patients. Results At 6 (±1) months, three-quarters of patients remained on apremilast, while physicians and patients reported treatment benefits across all psoriasis symptoms and manifestations. Of patients, the majority were satisfied with their treatment and achieved treatment goals considered most relevant. Patients' and physicians' perceptions of treatment effectiveness were aligned, and health-related quality-of-life scores indicated an improvement in the majority of patients. Apremilast tolerability was consistent with the known safety profile. Conclusions Among psoriasis patients receiving apremilast in Austria, improvement in clinical outcomes were observed and satisfaction with apremilast treatment among patients and physicians was high. Registration ClinicalTrials.gov NCT02740218.
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Affiliation(s)
- Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Barbara Gruber
- Department of Dermatology and Venerology, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Igor Vujic
- Faculty of Medicine and Dentistry, Danube Private University, Krems an der Donau, Austria,Department of Dermatology, Klinik Landstraße, Vienna, Austria
| | - Wolfgang Weger
- Department of Dermatology, Medical University Graz, Graz, Austria
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Torii H, Kishimoto M, Tanaka M, Noguchi H, Chaudhari S. Patient perceptions of psoriatic disease in Japan: Results from the Japanese subgroup of the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey. J Dermatol 2022; 49:818-828. [PMID: 35624553 PMCID: PMC9542208 DOI: 10.1111/1346-8138.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
The population‐based Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey was designed to better understand patient and dermatologist perceptions of the disease burden of psoriasis (PsO) and their treatment expectations. UPLIFT was a cross‐sectional, quantitative, online survey conducted in Europe, North America, and Japan between 2 March and 3 June 2020. In Japan, 391 patients reporting a diagnosis of PsO and/or psoriatic arthritis (PsA) were surveyed (75% had PsO alone, 23% had PsO and PsA, and 2% had PsA alone). Self‐reported body surface area (BSA) data were available for 309 Japanese patients, with the majority (80%) reporting PsO‐involved BSA ≤3 palms. Current symptoms of PsO were rated as moderate or severe by 43% of Japanese patients with BSA ≤3 palms, and severe by 44% of patients with BSA 4–10 palms. PsO frequently occurred in ≥1 special areas, most commonly the scalp in 76% of Japanese patients with BSA ≤3 palms, and ≥90% of those with BSA ≥4 palms. Furthermore, musculoskeletal symptoms in 42% of patients with PsO alone were suggestive of PsA. Whereas Japanese patients with BSA ≤3 palms mainly reported receiving topical therapy alone (34%) or no treatment (32%), 64% patients with BSA 4–10 palms reported receiving systemic therapy. Overall, 21% of Japanese patients with self‐perceived mild symptoms of PsO and 48% of patients with special area involvement experienced at least a moderate impact of disease on quality of life (Dermatology Life Quality Index score >5). Moreover, patients and dermatologists differed in their perceptions of determinants of PsO severity and treatment, and office visit discussions. In general, these findings from the Japanese subgroup of the UPLIFT survey demonstrated that a high proportion of patients perceived their symptoms to be moderate or severe irrespective of the level of skin involvement, suggesting a persistent unmet treatment need.
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Affiliation(s)
- Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
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Moderate Psoriasis in Clinical Practice: French Expert Consensus Using a Modified Delphi Method. Adv Ther 2022; 39:5203-5215. [PMID: 36112312 PMCID: PMC9525374 DOI: 10.1007/s12325-022-02305-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/16/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Despite the existence of multiple assessment scores for psoriasis severity, skin disease with limited skin lesions but significant impairment of quality of life can be difficult to classify, leading to under- or overtreatment. Our objective was to obtain consensus on clinical criteria to classify psoriasis severity in French clinical practice, with a focus on moderate disease, using a modified Delphi method. METHODS A steering committee (SC) formulated a 22-item questionnaire to classify moderate psoriasis. An independent panel of French dermatologists indicated their level of agreement for each item using a 9-point Likert scale (round 1). Items without a strong consensus were modified and included in round 2. For each item, strong consensus was defined as at least 75% of scores ≥ 7 and median score ≥ 8; good consensus was defined as at least 75% of scores ≥ 7 or median score ≥ 8. RESULTS Of 80 dermatologists who agreed to participate, 47 (59%) responded in round 1. All participants from round 1 responded in round 2. Fifteen (68%) items achieved strong consensus and four (18%) achieved good consensus. For psoriasis severity, several clinical dimensions assessed both by the physician (location, symptoms, temporality, previous treatments) and the patient (perception, physical and psychological impairment) obtained consensus. The following were considered sufficient to confirm that psoriasis is at least at a moderate stage: limited involvement but with an impact on patient/family quality of life; involvement of a special area; presence of uncontrolled symptoms (scaling, bleeding, pruritus, insomnia); accumulation of mild intensity symptoms; presence of burdensome onychodystrophy; failure of well-applied topical treatments. There was strong consensus that recognition of moderate psoriasis should lead to reassessment of topical treatments. CONCLUSION Our modified Delphi panel suggests detailed criteria to help physicians classify patients with psoriasis which is at least at a moderate stage, which could, in turn, improve treatment in these patients.
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Reich K, Korge B, Magnolo N, Manasterski M, Schwichtenberg U, Staubach-Renz P, Kaiser S, Roemmler-Zehrer J, Gómez NN, Lorenz-Baath K. Quality-of-Life Outcomes, Effectiveness and Tolerability of Apremilast in Patients with Plaque Psoriasis and Routine German Dermatology Care: Results from LAPIS-PSO. Dermatol Ther (Heidelb) 2021; 12:203-221. [PMID: 34913153 PMCID: PMC8776950 DOI: 10.1007/s13555-021-00658-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psoriasis is a systemic inflammatory disease characterised by pruritic skin lesions that impair quality of life (QOL). Long-Term Documentation of the Utilization of Apremilast in Patients with Plaque Psoriasis under Routine Conditions (LAPIS-PSO; ClinicalTrials.gov: NCT02626793) was a 52-week, prospective, multicentre, observational cohort study conducted in real-world dermatology clinical settings in Germany. We evaluated physician- and patient-reported outcomes for QOL, effectiveness and tolerability in patients with moderate to severe psoriasis vulgaris in LAPIS-PSO. METHODS The primary endpoint was the percentage of patients achieving Dermatology Life Quality Index (DLQI) score ≤ 5 or ≥ 5-point improvement from baseline in DLQI score at visit 2 (~ 4 months after baseline). Secondary endpoints included assessments of symptoms and disease severity. Tolerability was evaluated based on adverse events (AEs). A pre-defined subgroup analysis based on baseline Physician's Global Assessment (PGA) score (2 or 3 versus 4) was performed. Data were examined descriptively through visit 5 (~ 13 months) using the last-observation-carried-forward (LOCF) approach and data as observed. RESULTS In total, 257 patients were included for efficacy assessment. On LOCF analysis, most patients achieved the primary endpoint at visit 2 (66.5%); DLQI response was maintained at visit 5 (72.4%). Earlier treatment response was observed in patients with a PGA score of 2 or 3 versus 4 (visit 1 PASI ≤ 3: 20.5% versus 10.8%). Adverse events were consistent with the known safety profile of apremilast. CONCLUSIONS In routine clinical care in Germany, patients with moderate to severe plaque psoriasis benefited from apremilast treatment up to ~ 13 months, consistent with findings from clinical trials, with a good safety profile.
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Affiliation(s)
- Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building West 38/Room 514, 20246, Hamburg, Germany.
| | - Bernhard Korge
- Hautarztpraxis Priv. Doz. Dr. med. Bernhard Korge, Düren, Germany
| | - Nina Magnolo
- Department of Dermatology, University Hospital Muenster, Münster, Germany
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Salgado-Boquete L, Carrascosa JM, Llamas-Velasco M, Ruiz-Villaverde R, de la Cueva P, Belinchón I. A New Classification of the Severity of Psoriasis: What's Moderate Psoriasis? Life (Basel) 2021; 11:life11070627. [PMID: 34209585 PMCID: PMC8307918 DOI: 10.3390/life11070627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to propose a ranking system for the severity of psoriasis. The consensus method of selecting the indices to include and the classification of real patient profiles by an expert panel to create a gold standard of severity were used. The performance of potential cut-offs was evaluated to create a ranking algorithm. The combined use of PASI, BSA, and sPGA may allow the classification of the severity of psoriatic patients. The final algorithm identifies severe patients in a single step (2 out 3 are met: PASI ≥ 11 or BSA ≥ 10 or sPGA ≥ 3), while two steps are required for mild ((2 out 3 are met: PASI ≤ 3 or BSA ≤ 5 or sPGA ≤ 2) and DLQI < 5) and moderate forms (the patient does not meet 2 out 3 (PASI ≥ 11 or BSA ≥ 10 or sPGA ≥ 3) but has a DLQI ≥ 5. A ranking algorithm is presented, consisting of different measures of disease which classifies psoriatic patients into three categories: mild, moderate, and severe.
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Affiliation(s)
- Laura Salgado-Boquete
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, 36003 Pontevedra, Spain;
| | - José Manuel Carrascosa
- Dermatology Department, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, IGTP, 08916 Badalona, Spain
- Correspondence:
| | - Mar Llamas-Velasco
- Dermatology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain;
| | - Ricardo Ruiz-Villaverde
- Dermatology Department, Hospital Universitario San Cecilio, Instituto Biosanitario de Granada, Ibs, 18016 Granada, Spain;
| | - Pablo de la Cueva
- Dermatology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Isabel Belinchón
- Dermatology Department, Hospital General Universitario de Alicante-ISABIAL-UMH, 03010 Alicante, Spain;
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Schneider-Burrus S, Tsaousi A, Barbus S, Huss-Marp J, Witte K, Wolk K, Fritz B, Sabat R. Features Associated With Quality of Life Impairment in Hidradenitis Suppurativa Patients. Front Med (Lausanne) 2021; 8:676241. [PMID: 33987196 PMCID: PMC8112201 DOI: 10.3389/fmed.2021.676241] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an adverse impact on patients' quality of life (QoL). Objectives: To quantify QoL impairment in patients in Germany suffering from HS and to identify the parameters associated with QoL impairment. Methods: A non-interventional, cross-sectional, mono-centric study with 500 HS patients. QoL data (measured using the Dermatology Life Quality Index; DLQI) and demographic, anamnestic, clinical, and blood parameters were collected. All patients were examined by dermatologists that documented the skin alterations. QoL data from 462 HS patients were available and evaluated. Results: The mean (± standard deviation) DLQI score of HS patients was 13.18 ± 7.99. Approximately 40% and 20% of HS patients declared very large and extremely large QoL impairment, respectively. The degree of QoL disturbance correlated with the severity of skin alterations, blood leucocyte count and, in particular, with anogenital localization and the presence of nodules and fistulas. Furthermore, QoL impairment was associated with specific comorbidities, such as adiposity and back pain, but not with HS family history. QoL impairment was not influenced by whether or not the patients had undergone resection surgery or antibiotic treatment but was more severe in HS patients that had undergone abscess lancing compared to patients without such treatment in the past. Limitations: It was a mono-centric study and most data were obtained from self-administered patient questionnaires. The association of QoL with type of treatment was analyzed for abscess lancing, resection surgery, and antibiotic treatment. Further therapeutic modalities recommended in the guidelines were not investigated. Conclusion: A profound impairment in QoL was present in patients with HS, and this was higher than that observed in other studied dermatoses. The degree of impairment correlated with the extent of cutaneous and some extra-cutaneous alterations. Surgical and conventional medicamentous therapies of HS were not associated with long-lasting reduction of QoL impairment. Our data support the implementation of patient-reported outcome measures for the assessment of therapy responses.
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Affiliation(s)
- Sylke Schneider-Burrus
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Dermatosurgery, Havelklinik, Berlin, Germany
| | - Athanasia Tsaousi
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Katrin Witte
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Dermatology, Venereology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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12
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Lee H, He M, Cho SK, Bessette L, Tong AY, Merola JF, Wegrzyn LR, Kilpatrick RD, Kim SC. Validation of claims-based algorithms to identify patients with psoriasis. Pharmacoepidemiol Drug Saf 2021; 30:868-874. [PMID: 33715280 DOI: 10.1002/pds.5229] [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: 09/20/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Accurately identifying patients with psoriasis (PsO) is crucial for generating real-world evidence on PsO disease course and treatment utilization. METHODS We developed nine claims-based algorithms for PsO using a combination of the International Classification of Diseases (ICD)-9 codes, specialist visit, and medication dispensing using Medicare linked to electronic health records data (2013-2014) in two healthcare provider networks in Boston, Massachusetts. We calculated positive predictive value (PPV) and 95% confidence interval (CI) for each algorithm using the treating physician's diagnosis of PsO via chart review as the gold standard. Among the confirmed PsO cases, we assessed their PsO disease activity. RESULTS The nine claims-based algorithms identified 990 unique patient records. Of those, 918 (92.7%) with adequate information were reviewed. The PPV of the algorithms ranged from 65.1 to 82.9%. An algorithm defined as ≥1 ICD-9 diagnosis code for PsO and ≥1 prescription claim for topical vitamin D agents showed the highest PPV (82.9%). The PPV of the algorithm requiring ≥2 ICD-9 diagnosis codes and ≥1 prescription claim for PsO treatment excluding topical steroids was 81.1% but higher (82.5%) when ≥1 diagnosis was from a dermatologist. Among 411 PsO patients with adequate information on PsO disease activity in EHRs, 1.5-5.8% had no disease activity, 31.3-36.8% mild, and 26.9-35.1% moderate-to-severe across the algorithms. CONCLUSIONS Claims-based algorithms based on a combination of PsO diagnosis codes and dispensing for PsO-specific treatments had a moderate-to-high PPV. These algorithms can serve as a useful tool to identify patients with PsO in future real-world data pharmacoepidemiologic studies.
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Affiliation(s)
- Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mengdong He
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Soo-Kyung Cho
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Lily Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Y Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Lani R Wegrzyn
- Global Epidemiology, Pharmacovigilance and Patient Safety, AbbVie, Inc, North Chicago, Illinois, USA
| | - Ryan D Kilpatrick
- Global Epidemiology, Pharmacovigilance and Patient Safety, AbbVie, Inc, North Chicago, Illinois, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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13
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Abdulridha SH, Kadhim DJ, Razzak SAA. Beliefs about Medicines among a Sample of Iraqi patients with Psoriasis. Innov Pharm 2021; 12:10.24926/iip.v12i1.3584. [PMID: 34007676 PMCID: PMC8102969 DOI: 10.24926/iip.v12i1.3584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate beliefs about use of medications for a sample of Iraqi psoriasis patients, and to examine the association between these beliefs and selected patient's related factors. METHODS This cross-sectional study included 300 patients with diagnosed psoriasis. Participants were recruited at the center of Dermatology and Venereology, Medical City in Baghdad, the capital city of Iraq. Patients' mean age was 35.15years (±10.54). Beliefs about medicines were measured by the Arabic version of Beliefs about Medicines Questionnaire. RESULTS Most the patients (76.7%) had strong beliefs in the need (acceptance beliefs) for their psoriasis medicines (specific-necessity score higher than specific-concern), whereas 15.0% of patients had specific-concern score higher than specific-necessity and 8.3% of patients had specific-necessity score equal to specific-concern. At the same time, 74.4% of the patients believed that the medicines disrupt their lives and (35.6%) of them had concerns about the possibility of becoming addicted on these medicines. Many other patients were worried about the long-term consequences of the medicines (58.7%). In addition, 31.0% of the participants believe that all medicines are poisoning, and that they do more harm than good. Finally, many of the participants believed that physicians prescribe too many medicines (46.7%), and they can minimize the number of prescribed medicines by spending more time with their patients (32.6%). CONCLUSIONS Female gender and longer disease duration have direct association with specific necessity, while psoriasis severity has a direct association with specific concern. In conclusion, Beliefs about medications and habit strength are important modifiable drivers to enhance adherence and clinical outcomes in the control of psoriasis.
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Affiliation(s)
| | - Dheyaa J. Kadhim
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
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14
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Imafuku S, Kanai Y, Murotani K, Nomura T, Ito K, Ohata C, Yamazaki F, Miyagi T, Takahashi H, Okubo Y, Saeki H, Honma M, Tada Y, Mabuchi T, Higashiyama M, Kobayashi S, Hashimoto Y, Seishima M, Kakuma T. Utility of the Dermatology Life Quality Index at initiation or switching of biologics in real-life Japanese patients with plaque psoriasis: Results from the ProLOGUE study. J Dermatol Sci 2021; 101:185-193. [PMID: 33495058 DOI: 10.1016/j.jdermsci.2021.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/27/2020] [Accepted: 01/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Plaque psoriasis significantly affects patients' health-related quality of life. To aid treatment decisions, not only objective assessment by physicians but also subjective assessment by patients is important. OBJECTIVE To assess the significance of Dermatology Life Quality Index (DLQI) evaluation at the time of biologics introduction in clinical practice in Japanese patients with plaque psoriasis. METHODS This was a single-arm, open-label, multicenter study. At baseline, Psoriasis Area and Severity Index (PASI) and DLQI scores were measured and stratified based on DLQI scores ≥6/≤5 and PASI scores ≤10/>10. Other patient-reported outcomes assessed included EQ-5D-5L, itch numerical rating scale (NRS), skin pain NRS, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), Sleep Problem Index-II (SPI-II), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). RESULTS Of the 73 enrolled patients, 23 had PASI scores ≤10. Those with PASI/DLQI scores >10/≥6 had a significantly higher median PASI score than those with PASI/DLQI scores >10/≤5 (p = 0.0125). Regardless of PASI scores (>10/≤10), median itch NRS and GAD-7 scores were significantly higher in patients with DLQI scores ≥6 than in those with DLQI scores ≤5 (itch NRS, p = 0.0361 and p = 0.0086, respectively; GAD-7, p = 0.0167 and p = 0.0273, respectively). Patients with PASI/DLQI scores ≤10/≥6 had significantly higher skin pain NRS (p = 0.0292) and PHQ-8 (p = 0.0255) scores and significantly lower median SPI-II scores (p = 0.0137) and TSQM-9 Effectiveness domain scores (p = 0.0178) than those with PASI/DLQI scores ≤10/≤5. CONCLUSION DLQI may be useful for assessing patients' concerns that cannot be identified by PASI alone while initiating biologics or switching from other biologics in clinical practice.
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Affiliation(s)
- Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
| | | | | | | | - Kei Ito
- Department of Dermatology, JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Chika Ohata
- Department of Dermatology, Osaka General Medical Center, Osaka, Japan
| | | | - Takuya Miyagi
- Department of Dermatology, University of the Ryukyus, Okinawa, Japan
| | | | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Satomi Kobayashi
- Department of Dermatology, Seibo International Catholic Hospital, Tokyo, Japan
| | - Yuki Hashimoto
- Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
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15
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Golbari NM, van der Walt JM, Blauvelt A, Ryan C, van de Kerkhof P, Kimball AB. Psoriasis severity: commonly used clinical thresholds may not adequately convey patient impact. J Eur Acad Dermatol Venereol 2020; 35:417-421. [PMID: 32978847 DOI: 10.1111/jdv.16966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Psoriasis severity is usually evaluated using quantitative and qualitative measures, including per cent body surface area (BSA) involvement, the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI), a patient-reported questionnaire. However, standardized definitions for psoriasis severity categories have not been well established. A PASI of 10 or 12 has remained the minimal severity threshold defining eligibility for psoriasis treatments. In the present study, the validity of this cut-off was re-evaluated in the context of quality of life. OBJECTIVE To determine whether the thresholds commonly used to define moderate psoriasis (PASI of 10-12 and BSA of 10) are supported by patient-reported DLQI data. METHODS A systematic review of randomized controlled trials that enrolled mild or moderate patients published between January 2000 and June 2017 was used to assess correlations between provider and patient-generated severity at baseline. RESULTS For subject groups with high impact on quality of life (DLQI > 10), the mean weighted BSA was 7.6 (Range: 7.1-8.4) and the mean weighted DLQI was 11 (Range: 10.2-12.2). Similarly, the mean weighted PASI for patients with DLQI > 10 was 8.7 (Range: 7.1-10.1) and the mean weighted DLQI was 10.9 (Range: 10.1-12.2). CONCLUSION Patients with PASI or BSA scores less than 10 can have major quality of life impairment. In general, the objective measures of BSA and PASI alone, when excluding DLQI, may not fully capture the impact of disease severity.
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Affiliation(s)
| | | | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, USA
| | - C Ryan
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | | | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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16
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Augustin M, Kleyn C, Conrad C, Sator P, Ståhle M, Eyerich K, Radtke M, Bundy C, Mellars L, Greggio C, Cordey M, Koscielny V, Griffiths C. Characteristics and outcomes of patients treated with apremilast in the real world: results from the APPRECIATE study. J Eur Acad Dermatol Venereol 2020; 35:123-134. [DOI: 10.1111/jdv.16431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022]
Affiliation(s)
- M. Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - C.E. Kleyn
- The Dermatology Centre The University of ManchesterNIHR Manchester Biomedical Research Centre Manchester UK
| | - C. Conrad
- Service of Dermatology and Venereology Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - P.G. Sator
- Department of Dermatology Hietzing Hospital Vienna Austria
| | - M. Ståhle
- Unit of Dermatology Department of Medicine Karolinska Institutet Stockholm Sweden
| | - K. Eyerich
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | | | - C. Bundy
- College of Biomedical and Health Sciences Cardiff University Cardiff UK
| | | | - C. Greggio
- Celgene International Boudry Switzerland
| | - M. Cordey
- Amgen Europe GmbH Rotkreuz Switzerland
| | | | - C.E.M. Griffiths
- The Dermatology Centre The University of ManchesterNIHR Manchester Biomedical Research Centre Manchester UK
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17
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Carretero G, Carrascosa JM, Puig L, Sánchez-Carazo JL, López-Ferrer A, Cueva P, Soria C, Rivera R, Belinchón I. Definition of minimal disease activity in psoriasis. J Eur Acad Dermatol Venereol 2020; 35:422-430. [PMID: 32367536 DOI: 10.1111/jdv.16564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To generate an operational definition to adequately reflect the construct 'Minimal Disease Activity (MDA)' in psoriasis. METHODS A systematic review of domains included in clinical trials of psoriasis was presented to a panel of dermatologists and patients. Further domains were elicited by panel discussions. Domains (and instruments measuring these) were items of two consecutive Delphi rounds targeting dermatologists from the Psoriasis Group of the Spanish Academy of Dermatology and Venereology and patients from the Acción Psoriasis association. The instruments selected were used to generate 388 patient vignettes. The expert group then classified these vignettes as 'No MDA/MDA/Unclassifiable'. The items were further reduced by factorial analysis. Using the classification variable as gold standard, several operational constructions were tested in regression models and ROC curves and accuracy was evaluated with area under the curve (AUC). RESULTS The following domains were included: itching, scaling, erythema and visibility by 0-10 scales, extension by BSA, impact on quality of life by DLQI, special location and presence of arthritis as yes/no. The definition with the highest AUC and best balance between sensitivity and specificity was the one including no presence of arthritis plus at least three others below the upper limit of the 95% confidence interval (AUC, 0.897; sensitivity, 95.2%, specificity, 84.1%). CONCLUSION This study provides, for the very first time, the construct of 'Minimal Disease Activity' in psoriasis as agreed by dermatologists and patients. MDA is defined as absence of active arthritis plus 3 out of 6: itching ≤ 1/10; scaling ≤ 2/10; redness ≤ 2/10; visibility ≤ 2/10; BSA ≤ 2; DLQI ≤ 2; and no lesions in special locations. By design, domains are representative of disease impact. This MDA definition may be used as a measure of adequate management and replace other subjective or restrictive tools.
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Affiliation(s)
- G Carretero
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - J M Carrascosa
- Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Puig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - P Cueva
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Soria
- Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain
| | - R Rivera
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Belinchón
- Hospital General Universitario de Alicante, Alicante, Spain
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18
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Abji F, Lee KA, Pollock RA, Machhar R, Cook RJ, Chandran V, Gladman DD. Declining levels of serum chemokine (C-X-C motif) ligand 10 over time are associated with new onset of psoriatic arthritis in patients with psoriasis: a new biomarker? Br J Dermatol 2020; 183:920-927. [PMID: 32037514 DOI: 10.1111/bjd.18940] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND We previously found that serum levels of chemokine (C-X-C motif) ligand 10 (CXCL10) decreased after the onset of psoriatic arthritis (PsA). OBJECTIVES We measured CXCL10 levels over time in patients with psoriasis who developed PsA to determine whether the drop in CXCL10 was specific to these patients and further assess its association with PsA development. METHODS Prospectively followed patients with psoriasis without arthritis [cutaneous psoriasis (PsC)] were assessed yearly by rheumatologists for the presence of PsA. Patients with PsC who developed PsA (converters) were matched to those that did not develop PsA (nonconverters) based on psoriasis duration and the interval between follow-up visits. The duration between baseline and the first visit postconversion in converters was used to assign a pseudoconversion date in nonconverters. Linear mixed-effects models were used to model the expression of CXCL10 over time. RESULTS CXCL10 significantly declined over time in converters prior to PsA development with a significant difference in the trend over time between converters (n = 29) and nonconverters (n = 52; P < 0·001). CXCL10 continued to decline after PsA onset in a subset of converters. There was a significant difference in the trend of CXCL10 levels between converters (n = 24) and nonconverters (n = 16; P = 0·01) preconversion/pseudoconversion. This difference remained postconversion (P = 0·006) and was not different from the preconversion period (P = 0·75). CONCLUSIONS A large difference in CXCL10 was identified in patients with PsC that are destined to develop PsA over time. This exploratory analysis supports the association of CXCL10 with PsA development in patients with PsC and warrants further study of the predictive ability of this chemokine. What is already known about this topic? Chemokine (C-X-C motif) ligand 10 (CXCL10) is elevated in psoriatic affected tissues and serum and/or plasma. Patients with psoriasis that develop psoriatic arthritis (PsA) have elevated CXCL10 levels at baseline and these levels drop after arthritis onset. What does this study add? By monitoring levels of CXCL10 in serum over multiple visits in patients with psoriasis that develop PsA as well as those that do not develop PsA, an association was identified between CXCL10 and PsA development. What is the translational message? CXCL10 is a strong candidate for use by physicians for the detection of patients with psoriasis that are at risk of developing PsA. Linked Comment: Kirby and Fitzgerald. Br J Dermatol 2020; 183:805-806.
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Affiliation(s)
- F Abji
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - K-A Lee
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - R A Pollock
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - R Machhar
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - R J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - V Chandran
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - D D Gladman
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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19
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Dimethyl fumarate is efficacious in severe plaque psoriasis. Wien Klin Wochenschr 2019; 131:485-492. [DOI: 10.1007/s00508-019-01551-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
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20
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Ciuluvica C, Fulcheri M, Amerio P. Expressive Suppression and Negative Affect, Pathways of Emotional Dysregulation in Psoriasis Patients. Front Psychol 2019; 10:1907. [PMID: 31496974 PMCID: PMC6712996 DOI: 10.3389/fpsyg.2019.01907] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
The main goal of this study was to assess the emotion regulation (ER) mechanisms, such as expressive suppression and cognitive reappraisal, in patients with psoriasis, as compared with healthy persons not afflicted by dermatological diseases. Moreover, the study intended to carry on a multidimensional assessment of emotional mechanisms in persons with psoriasis, highlighting the differences between psoriasis patients and healthy participants, in order to identify the specific patterns of emotion dysregulation (ED) in psoriasis. Another goal of the study was to investigate the predictors of ED among different emotional patterns. We presumed that the maladaptive ER mechanisms are higher in psoriasis patients than in the control group and there are specific dysregulation patterns in psoriasis patients as negative emotions tendency. This cross-sectional study was performed on 192 individuals aged between 35 and 75 years (mean age 59). The sample was divided in two groups: the clinical group including 91 patients with a diagnosis of psoriasis vulgaris and the control group including 101 healthy persons. The results of the present study suggest that psoriasis patients more frequently used emotional suppression - a maladaptive ER mechanism - as well as ED patterns - i.e., impulse control difficulties, and nonacceptance of emotional responses. They also displayed trait tendency to a negative emotional response. In fact, in people with psoriasis, the presence of suppression mechanism and negative affect of trait could predict that 35% of patients will show emotional dysregulated patterns, while living with higher levels of ED. The results of our study are important in the clinical practice, helping clinicians to better understand the emotional vulnerability of people that live with psoriatic disease, and to optimize the disease management and patient care in an interdisciplinary approach.
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Affiliation(s)
- Cristina Ciuluvica
- Department of Psychological Sciences, Health and Territory (DISPUTer), University G. D'Annunzio Chieti - Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological Sciences, Health and Territory (DISPUTer), University G. D'Annunzio Chieti - Pescara, Chieti, Italy
| | - Paolo Amerio
- Clinic of Dermatology, Department of Medicine and Aging Sciences, University G. D'Annunzio Chieti - Pescara, Chieti, Italy
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21
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Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, Blauvelt A. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol 2019; 82:117-122. [PMID: 31425723 DOI: 10.1016/j.jaad.2019.08.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, owing to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be miscategorized, which can lead to undertreatment of psoriasis. OBJECTIVE To develop a consensus statement on the classification of psoriasis severity. METHODS A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity. RESULTS After completion of the exercise, 7 severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate, and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: (1) body surface area >10%, (2) disease involving special areas, and (3) failure of topical therapy. LIMITATIONS This effort might have suffered from a lack of representation by all relevant stakeholders, including patients. CONCLUSION The consensus statement describes 2 categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.
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Affiliation(s)
- Bruce Strober
- Yale University School of Medicine, New Haven, Connecticut; Central Connecticut Dermatology, Cromwell, Connecticut.
| | - Caitriona Ryan
- Blackrock Clinic Dublin and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | | | | | - Alexa B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan Barker
- St John's Institute of Dermatology, King's College London, London, United Kingdom
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22
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Affiliation(s)
- Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona,
Spain
| | - Anna López-Ferrer
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona,
Spain
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23
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Rodríguez-Cerdeira C, Neissa-Vasquez J, Carnero-Gregorio M, FiaÑo-Valverde C, Muñoz-Garzón V. Myxoid liposarcoma associated with adalimumab treatment: A case report. Mol Clin Oncol 2019; 10:454-456. [PMID: 30931117 DOI: 10.3892/mco.2019.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/06/2022] Open
Abstract
Biological agents that suppress inflammation, such as tumour necrosis factor (TNF-α) inhibitors, are being successfully used at an increasing frequency for the treatment of chronic inflammatory diseases, such as psoriasis. However, these drugs are not free of side effects, and although the general rates of malignancy in patients using anti-TNF-α therapies are not high, certain tumours of cutaneous origin, particularly carcinomas, have been reported. We herein present the case of a 47-year-old female patient with moderate-to-severe psoriasis for 20 years under treatment with adalimumab administered at the standard dose of 40 mg, injected subcutaneously each fortnight, with good efficacy. To the best of our knowledge, this is the first reported case of a low-grade (grade 1) myxoid liposarcoma in a patient receiving treatment with adalimumab since 2009. A review of the relevant literature was also conducted. Continuous investigation of such cases is crucial in order to elucidate the iatrogenic risk of rare cancers, such as myxoid liposarcoma, in patients undergoing treatment with currently available as well as future biological therapies.
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Affiliation(s)
- Carmen Rodríguez-Cerdeira
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, 36200 Vigo, Spain.,Department of Dermatology, Meixoeiro Hospital, CHUVI, 36200 Vigo, Spain
| | | | - Miguel Carnero-Gregorio
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, 36200 Vigo, Spain
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24
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Chernyshov PV. The Evolution of Quality of Life Assessment and Use in Dermatology. Dermatology 2019; 235:167-174. [PMID: 30928986 DOI: 10.1159/000496923] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/15/2019] [Indexed: 11/19/2022] Open
Abstract
The creation of the Dermatology Life Quality Index (DLQI) questionnaire facilitated many studies on the impact of skin diseases on patients' quality of life (QoL). Many national and international guidelines recommend QoL assessment in dermatology, and some of them contain detailed recommendations on treatment goals and changes of treatment approaches based on DLQI score banding and minimal clinically important difference. The methodology of QoL in strument development and validation is constantly becoming more rigorous. Initiatives on selection of core outcome sets for skin diseases are focused on clinical trials but may also be beneficial for clinicians. There are various benefits of using QoL information in clinical practice, but experience of this is very limited at the moment. QoL assessment in dermatology is a rapidly developing field with a gradual shift from theory to practice.
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Affiliation(s)
- Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine,
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