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Zou Q, Luo Y, Hao D, Li M, Jihui C. Validation and application of the Dermatology Life Quality Index score, a modification of the DLQI score, in psoriasis patients. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:92. [PMID: 38909238 PMCID: PMC11193232 DOI: 10.1186/s41043-024-00587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND All the scoring methods for the DLQI miss the moderate impact of the disease on patients, which may underestimate the impact of psoriasis on patients' quality of life. To improve the accuracy of the assessment of the Dermatology Life Quality Index score (DLQI) for patients with psoriasis, this study proposed and validated a new scoring method, the DLQI-NS, which includes the moderate impact option in the self-assessment of each item in psoriasis patients. METHODS A cross-sectional study was conducted in which patients with psoriasis were enrolled. A total of 425 participants completed the DLQI, DLQI-NS and Skindex-16 questionnaires. Reliability, validity, ceiling and floor effects were evaluated of both DLQI and DLQI-NS questionnaires. RESULTS About 14.4-32.5% of the patients reported a moderate impact on quality of life. The DLQI-NS allowed 17 more patients (4.0%) to achieve severe disease. The Cronbach's alpha coefficient of the DLQI-NS was 0.90, and that of the DLQI was 0.89. The KMO test results for the DLQI-NS and DLQI were 0.927 and 0.916, respectively. One factor was identified for each questionnaire. The items of the DLQI-NS showed an item-total correlation from 0.52 to 0.82, and the DLQI questionnaire's item-total correlation ranged from 0.47 to 0.83. The DLQI-NS, DLQI total score and Skindex-16 had Spearman's rank correlation coefficients of 0.89 and 0.84, respectively. Both the DLQI-NS and DLQI showed significant moderate correlations with the BSA (0.51 vs. 0.50) and PASI (0.47 vs. 0.46). No ceiling effects were observed for any of the items of both questionnaires. CONCLUSION The validity and reliability of the DLQI-NS and DLQI were good, but the DLQI-NS was superior to the DLQI. The DLQI-NS is an effective self-assessment tool for assessing quality of life in psoriasis patients.
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Affiliation(s)
- Qin Zou
- Department of Dermatology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China.
- West China School of Nursing, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China.
| | - Yibo Luo
- Department of Dermatology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China.
- West China School of Nursing, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China.
| | - Dan Hao
- Department of Dermatology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China
| | - Mengmeng Li
- Department of Dermatology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China
| | - Chen Jihui
- Department of Dermatology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China
- West China School of Nursing, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, 610041, PR China
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Van Hal TW, Mulder MLM, Wenink MH, Pasch MC, Van den Hoogen FHJ, Van den Reek JMPA, De Jong EMGJ. Discovery of Psoriatic Arthritis in Psoriasis Patients for Early Rheumatological Referral (DAPPER) Study: A Prospective Observational Cohort. Acta Derm Venereol 2022; 102:adv00768. [PMID: 35818734 PMCID: PMC9593480 DOI: 10.2340/actadv.v102.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients with psoriasis are at risk of developing psoriatic arthritis, which can lead to irreversible joint damage. However, a proportion of patients with psoriasis and concomitant psoriatic arthritis remain undiscovered in practice. The aims of this study were: to prospectively determine prevalence, characteristics, and disease burden of psoriatic arthritis in a psoriasis population; and to determine the prevalence and characteristics of patients with active psoriatic arthritis, who were not under rheumatological care. Patients with psoriasis were screened by a rheumatologist at the dermatology outpatient clinic for psoriatic arthritis. Patients with suspected active psoriatic arthritis who were not seeing a rheumatologist were referred to a rheumatologist for confirmation. The total prevalence of psoriatic arthritis in this observational, prospective cohort (n = 303) was 24%. Patients with psoriasis with concomitant psoriatic arthritis had longer duration of skin disease and more often a treatment history with systemic therapies. In this academic, specialized, setting, 2.3% of patients (n = 7), were not receiving rheumatological care despite having active psoriatic arthritis. These patients were characterized by a combination of low (perceived) disease burden and low yield of screening questionnaires, making it difficult for dermatologists to discover psoriatic arthritis in these patients. Thus, screening for more subtle active arthritis in patients with psoriasis in a dermatology setting could be improved.
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Affiliation(s)
- Tamara W Van Hal
- Department of Rheumatology, Sint Maartenskliniek, Hengstdal 3, PO Box 9011, NL-6500 GM Nijmegen, The Netherlands.
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Bruins FM, Van Acht MR, Bronckers IMGJ, Groenewoud HMM, De Jong EMGJ, Seyger MMB. Real-world Methotrexate Use in a Prospective Cohort of Paediatric Patients with Plaque Psoriasis: Effectiveness, Adverse Events and Folic Acid Regimen. Acta Derm Venereol 2022; 102:adv00745. [PMID: 35604240 PMCID: PMC9558319 DOI: 10.2340/actadv.v102.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In paediatric psoriasis, few studies have evaluated methotrexate effectiveness, adverse events and folic acid regimen. Therefore this study prospectively assessed methotrexate adverse events and effectiveness in paediatric patients with psoriasis in a real-world setting. Furthermore, gastrointestinal adverse events and methotrexate effectiveness were compared between folic acid regimens (5 mg once weekly vs 1 mg 6 times weekly). Data for paediatric patients with psoriasis treated with methotrexate from September 2008 to October 2020 were extracted from Child-CAPTURE, a prospective, daily clinical practice registry. Effectiveness was determined by Psoriasis Area and Severity Index (PASI). Comparison of persistent gastrointestinal adverse events between folic acid regimens were assessed through Kaplan–Meier analysis. A total of 105 paediatric patients with plaque psoriasis (41.0% male, mean age 14.1 years) were included. At week 24 and 48, an absolute PASI ≤ 2.0 was achieved by approximately one-third of all patients. During follow-up, 46.7% reported ≥ 1 persistent adverse events. After 1 and 2 years, approximately one-quarter of patients achieved a PASI ≤ 2.0 without persistent adverse events. Although non-significant, a possible trend towards lower occurrence of gastrointestinal adverse events was found for folic acid 1 mg 6 times weekly (p = 0.196), with similar effectiveness between folic acid regimens. These findings show that a subgroup of paediatric patients with psoriasis responded well to methotrexate treatment without considerable side-effects during a 2-year follow-up.
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Affiliation(s)
- Finola M Bruins
- Department of Dermatology, Radboud university medical centre, René Descartesdreef 1, PO Box 9101, NL-6500 HB, The Netherlands.
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Adalimumab with methotrexate versus adalimumab monotherapy in psoriasis: First-year results of a single-blind randomized controlled trial. J Invest Dermatol 2022; 142:2375-2383.e6. [DOI: 10.1016/j.jid.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/07/2023]
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Szabó Á, Brodszky V, Rencz F. A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI-Relevant and Skindex-16. Br J Dermatol 2021; 186:485-495. [PMID: 34724199 DOI: 10.1111/bjd.20765] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used dermatology-specific health-related quality-of-life (HRQoL) instruments. DLQI has two common scoring methods, the original and the DLQI-Relevant (DLQI-R) modification. Head-to-head comparisons of the measurement properties of the DLQI, DLQI-R and Skindex-16 are currently lacking. OBJECTIVES We aim to compare the measurement properties of the DLQI, DLQI-R and Skindex-16. METHODS We analysed data from 618 patients with self-reported physician-diagnosed dermatological conditions from a cross-sectional survey carried out in Hungary in early 2020. DLQI, DLQI-R and Skindex-16 were compared in terms of ceiling and floor effects, informativity, convergent validity and known-group validity. RESULTS Mean DLQI, DLQI-R and Skindex-16 total scores were 3·76 ± 5·03, 4·11 ± 5·34 and 29·36 ± 26·62, respectively. Among patients with a DLQI/DLQI-R total score of zero, 64% reported problems on Skindex-16. Overall, 23-38% of patients with 'not relevant' responses on DLQI items 3 (shopping/home/gardening), 7 (working/studying), 8 (interpersonal problems) and 9 (sexual difficulties) reported problems on their corresponding Skindex-16 items. Average relative informativity (Shannon's evenness index) was the highest for Skindex-16 (0·85), followed by DLQI-R (0·66) and DLQI (0·54). DLQI, DLQI-R and Skindex-16 demonstrated similar convergent validity. DLQI was able to better discriminate between known groups of patients based on overall skin-related HRQoL impairment, whereas DLQI-R and Skindex-16 performed better with respect to self-perceived health status. CONCLUSIONS Skindex-16 seems to be more sensitive than DLQI/DLQI-R in capturing mild impairment in HRQoL. Our findings help to provide a fuller understanding of the difference between DLQI, DLQI-R and Skindex-16 and support the informed choice of instrument for clinical and research purposes.
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Affiliation(s)
- Á Szabó
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary.,Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői út, H-1085, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
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Lu Y, Chen H, Zhang J, Tang B, Zhang H, Ma C, Tang X, Li L, Wu J, Wei J, Li S, Yang L, Han L, Lu C. Fuzhenghefuzhiyang Formula (FZHFZY) Improves Epidermal Differentiation via Suppression of the Akt/mTORC1/S6K1 Signalling Pathway in Psoriatic Models. Front Pharmacol 2021; 12:650816. [PMID: 34456715 PMCID: PMC8386017 DOI: 10.3389/fphar.2021.650816] [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: 01/08/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a chronic proliferative skin disorder characterised by abnormal epidermal differentiation. The Fuzhenghefuzhiyang (FZHFZY) formula created by Chuanjian Lu, a master of Chinese medicine in dermatology, has been external used in the Guangdong Provincial Hospital of Chinese Medicine for the treatment of psoriasis, but its mechanisms of action against psoriasis remain poorly understood. This study involved an exploration of the effects of FZHFZY on epidermal differentiation and its underlying mechanisms in interleukin (IL)-17A/IL-22/interferon (IFN)-γ/tumour necrosis factor (TNF)-α–stimulated HaCaT cells and in a mouse model of imiquimod (IMQ)-induced psoriasis. Cell viability was assessed by MTT assay. Epidermal differentiation was detected by reverse-transcription polymerase chain reaction and western blotting. Histological evaluation of the skin tissue was performed via haematoxylin and eosin staining, and the Akt/mTORC1/S6K1 pathway was analysed by western blotting. FZHFZY inhibited proliferation and improved epidermal differentiation in IL-17A/IL-22/IFN-γ/TNF-α–induced HaCaT cells. FZHFZY ameliorated symptoms of psoriasis, regulated epidermal differentiation and inhibited phosphorylation of the Akt/mTORC1/S6K1 pathway in the skin of mice with imiquimod-induced psoriasis. Our results suggest that FZHFZY may exhibit therapeutic action against psoriasis by regulating epidermal differentiation via inhibition of the Akt/mTORC1/S6K1 pathway.
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Affiliation(s)
- Yue Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haiming Chen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhong Zhang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Tang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongyu Zhang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changju Ma
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojuan Tang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Li
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingjing Wu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianan Wei
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaoping Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, China
| | - Lei Yang
- Guangzhou Youcare Biopharmaceutics Co., Ltd, Guangzhou, China
| | - Ling Han
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanjian Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.,Guangdong Provincial Clinical Medicine Research Center for Chinese Medicine Dermatology, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
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Zhang J, Yu Q, Peng L, Qin Y, Jing M, Huang D, Guo J, Xiao M, Chen M. Benefits and Safety of Chinese Herbal Medicine in Treating Psoriasis: An Overview of Systematic Reviews. Front Pharmacol 2021; 12:680172. [PMID: 34276371 PMCID: PMC8281221 DOI: 10.3389/fphar.2021.680172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background: In recent years, systematic reviews/meta-analyses (SRs/MAs) of Chinese herbal medicine (CHM) for psoriasis have continuously emerged. Their methods and evidence quality, however, are yet to be evaluated, and whether their conclusions can provide clinicians with reliable evidence is still debatable. Objectives: This overview aims to evaluate the methodological quality, risk of bias, and reporting quality of relevant SRs/MAs, as well as the current evidence of CHM for treating psoriasis. Methods: We searched nine electronic databases from their respective time of establishment to January 20, 2021, as well as the reference lists of the included SRs/MAs, protocol registries, and gray literature. Two reviewers independently used the following: A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) to evaluate the methodological quality, risk of bias, reporting quality, and evidence quality of the included SRs/MAs. Results: This review included 14 SRs/MAs involving 45 outcomes, of which 12 (85.71%) SRs/MAs had a very low quality evaluated by AMSTAR 2 and 7 (50.00%) SRs/MAs had a high risk of bias assessed by ROBIS. The protocol and registration and funding statements were the major reporting flaws according to the PRISMA checklist. The evaluation with the GRADE system demonstrated no outcome of high-quality evidence, and inconsistent efficacy evaluations were found in this overview. Only 15 (33.33%) outcomes were moderate-quality evidence, supporting the claim that CHM plus Western medicine (WM) was superior to WM. Generally low quality of evidence showed no difference in the incidence of adverse events between the combined therapy and WM. However, the conclusion that CHM was superior to WM cannot be drawn due to the inconsistent results. Conclusion: Despite that CHM has the potential benefit and safety in the adjuvant treatment of psoriasis, the conclusion should be treated with caution because of the generally low quality of methodology and evidence. In the future, high-quality randomized controlled trials (RCTs) should be carried out, and the quality of relevant SRs should also be improved to promote their clinical application.
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Affiliation(s)
- Jie Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qianying Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuesi Qin
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Mingyi Jing
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dan Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Jacobi A, Weidemann-Röver B, Barbus S, Mrowietz U. Reaching Treatment Goals in Psoriasis with Conventional Systemic Drugs: How Long Are We Willing to Wait? Dermatology 2021; 238:292-300. [PMID: 34107489 DOI: 10.1159/000515765] [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: 12/07/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the attainment of treatment goals according to the European Consensus Programme (ECP-TGs) from 2011 in patients with moderate to severe psoriasis (Pso) treated with the first conventional systemic therapy and to identify factors that might compromise the attainment of these treatment goals. METHODS In a multicenter, prospective observational study, patients with moderate to severe Pso, defined as either body surface area (BSA) >10% or psoriasis area severity index (PASI) >10 and dermatology life quality index (DLQI) >10, received a conventional systemic therapy that could be modified at each follow-up visit over the course of 18 months. All subjects signed an informed consent form, were ≥18 years of age as well as systemic therapy naïve, and had regular study visits at months 3, 6, 9, 12, and 18 after baseline. Among others and in addition to demographic and disease-related characteristics at baseline, we documented BSA, PASI, DLQI, and the physician-reported attainment of treatment goals at each follow-up visit. Factors related to a failure in achieving the ECP-TGs (i.e., either Δ PASI ≥75 or Δ PASI ≥50 and <75 with a DLQI ≤5) at month 18 were investigated by multiple logistic regression. Descriptive results are presented as the mean ± SD for interval data, and absolute as well as relative frequencies for nominal data. For this part of the analysis, data at baseline and months 6, 12, and 18 are presented. RESULTS A total of 133 Pso patients with a mean age and disease duration of 49.5 ± 14.4 and 15.6 ± 12.8 years, respectively, were included in the analysis; 54.1% (n = 72) were male. The mean baseline disease-related outcomes were: BSA: 21.5 ± 15.8%, PASI: 13.7 ± 7.14, and DLQI: 12.0 ± 6.11. The most common conventional systemic therapies initiated at baseline were fumaric acid esters (n = 74, 55.6%), methotrexate (n = 46, 34,6%), and ciclosporin (n = 6, 4.5%). The ECP-TGs were achieved by 58 patients (43.6%) at month 6, 86 patients (64.7%) at month 12, and 97 patients (72.9%) at month 18. An optimized reduced logistic regression model identified the presence of onycholysis/nail dystrophy at two or more digits to be associated with failing to attain the ECP-TGs (OR 10.7, 95% CI 2.5-46.7, p = 0.002). CONCLUSION Patients with onycholysis/nail dystrophy at two or more digits were identified as having a higher risk of not achieving ECP-TGs under conventional systemic therapy. The ECP-TGs from 2011 were attained by 43.6% of our patients 6 months after starting conventional systemic therapies. In the era of safe, fast, and efficacious Pso therapies, much higher treatment goals might be achieved during therapy. New treatment goals are only of use if patients and dermatologists strive to attain them.
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Affiliation(s)
- Arnd Jacobi
- Ophthalmology and Dermatology Center, Practice C. Jacobi (MD) and A. Jacobi (MD), Nuremberg, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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9
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Huang G, Yan J, Zou J, Hu C, Huang D, Huang Q, Chen P, Zhang F, Gong L. Fire needle therapy for blood stasis syndrome of plaque psoriasis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25312. [PMID: 33787623 PMCID: PMC8021280 DOI: 10.1097/md.0000000000025312] [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] [Received: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Plaque psoriasis (PSO) is a common clinical chronic inflammatory skin disease. The incidence rate is increasing year by year due to the fast pace of work and unhealthy diet. Fire needle has been widely used in the treatment of PSO. However, the efficacy of fire needle for PSO is uncertain. Thus, the purpose of this systematic review is to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome). METHODS The following electronic databases will be searched from inception to October 2020:PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. In addition, other documents that meet the requirements will be manually searched, including conference papers, dissertations, etc. All randomized controlled trials using fire needle to treat PSO (blood stasis syndrome) that meet the criteria for inclusion will be included. The primary outcomes are clinical efficacy, Psoriasis area and severity index. Secondary outcomes include Itchy, TCM evaluation standard syndrome score, Dermatological quality of life index, and adverse events. To complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software. RESULTS The review results will be published in a peer-reviewed journal. CONCLUSION This study will provide high-quality evidence based medicine to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome), and further seek its scientific and effective chinese medicine treatment methods. INPLASY REGISTRATION NUMBER INPLASY202120007.
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Affiliation(s)
- Gang Huang
- Affifiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Juan Yan
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jiahua Zou
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Chuxiang Hu
- Affifiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Dongbei Huang
- The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
| | - Qiang Huang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Peize Chen
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Feiyan Zhang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Liping Gong
- Affifiliated Hospital of Jiangxi University of Traditional Chinese Medicine
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10
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Zou J, Huang G, Hu C, Yan J, Zhang F, Shi H, Yuan X, Fu J, Gong L. Moxibustion therapy for treating psoriasis vulgaris: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25250. [PMID: 33761722 PMCID: PMC9281951 DOI: 10.1097/md.0000000000025250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psoriasis vulgaris (PV) is an immune-mediated skin disease, which has seriously affected the quality of life of patients. At present, moxibustion therapy has been widely used in the treatment of PV. The purpose of this study is to provide high-quality evidence-based medicine to evaluate the effectiveness and safety of moxibustion for PV. METHODS We will search the following Electronic databases from their inceptions to February 2021 without any language limitation: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. What's more, the grey literature and the references of all included literature will also be retrieved manually. Any clinical randomized controlled trials (RCTs) related to moxibustion therapy for PV will be taken into. In order to complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software. RESULTS This systematic review will provide an assessment of the current state of moxibustion for PV, aiming to assess the efficacy and safety of moxibustion for patients with PV. CONCLUSION This systematic review will establish convincing evidence to prove the effectiveness and safety of moxibustion for PV. INPLASY REGISTRATION NUMBER INPLASY202120008.
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Affiliation(s)
- Jiahua Zou
- Jiangxi University of Traditional Chinese Medicine
| | - Gang Huang
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Chuxiang Hu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Juan Yan
- Jiangxi University of Traditional Chinese Medicine
| | - Feiyan Zhang
- Jiangxi University of Traditional Chinese Medicine
| | - Haiyong Shi
- Jiangxi University of Traditional Chinese Medicine
| | - Xian Yuan
- Jiangxi University of Traditional Chinese Medicine
| | - Jiajun Fu
- Jiangxi University of Traditional Chinese Medicine
| | - Liping Gong
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatol Venereol 2021; 35:281-317. [DOI: 10.1111/jdv.16926] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Affiliation(s)
- A. Nast
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University Medical Centre Nijmegen Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de Investigación. Fundación Piel Sana AEDV Madrid Spain
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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12
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The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines. Postepy Dermatol Alergol 2021; 37:821-830. [PMID: 33603597 PMCID: PMC7874874 DOI: 10.5114/ada.2020.102089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Information on the possibility of using biological drugs in psoriasis patients planning to conceive, patients who are pregnant or during lactation is limited. Aim Presenting recommendations published in clinical guidelines regarding the use of biological drugs – adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab, by psoriasis patients in the period of planning pregnancy, during pregnancy or during lactation. Material and methods The paper was based on a comprehensive review of over 40 websites of HTA agencies, dermatological associations worldwide and medical databases (PubMed, Embase), the objective of which was to identify clinical guidelines relating to biological treatment of women of childbearing potential, published after 2018, which used GRADE – a system for rating the quality of a body of evidence. Findings Certolizumab pegol is recommended in women who are planning to conceive. Furthermore, guidelines indicate other TNF-α inhibitors as possible treatment. Certolizumab pegol is also recommended as first-line treatment in pregnant patients. Furthermore, for trimesters 2 and 3, guidelines allow using other TNF-α inhibitors. Treatment with secukinumab and ustekinumab should be discontinued when planning pregnancy or when pregnancy was diagnosed. Biological treatment during pregnancy and lactation (continuation or initiation of treatment) can be used only after an analysis of risks and benefits has been conducted. Conclusions TNF-α inhibitors seem to be the safest and most researched biological drugs used in psoriasis treatment of patients planning to conceive, during pregnancy or lactation. Given its non-existent or minimal placental permeability, most likely the safest alternative is certolizumab pegol.
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13
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van der Kraaij GE, van Huizen AM, Baerveldt EM, Boshuizen M, Determann D, van Ee I, Hageman M, de Kort W, Tafuni G, Smeets PMG, Spuls PI. Online decision aid for patients with psoriasis. Br J Dermatol 2020; 184:981-983. [PMID: 33369728 PMCID: PMC8248141 DOI: 10.1111/bjd.19761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- G E van der Kraaij
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - A M van Huizen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - E M Baerveldt
- Bravis hospital, Department of Dermatology, Bergen op Zoom, the Netherlands
| | - M Boshuizen
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - D Determann
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - M Hageman
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - W de Kort
- Amphia hospital, Department of Dermatology, Breda, the Netherlands
| | - G Tafuni
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - P M G Smeets
- University Medical Center Utrecht, Department of Dermatology, Utrecht, the Netherlands
| | - Ph I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
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14
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol 2020; 34:2461-2498. [DOI: 10.1111/jdv.16915] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- A. Nast
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University medical centre Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de InvestigaciónFundación Piel Sana AEDV Madrid España
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warszawa Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
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15
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Zhang J, Yu Q, Peng L, Lin W, Qin Y, He Y, Guo J, Xiao M, Chen M. Chinese herbal medicine for psoriasis: Protocol for an overview of systematic reviews. Medicine (Baltimore) 2020; 99:e22400. [PMID: 32991465 PMCID: PMC7523869 DOI: 10.1097/md.0000000000022400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic recurrent dermatological disease that patents always suffer from different comorbidities. Chinese herbal medicine (CHM) has been commonly used in the treatment of psoriasis for a long history. Previous systematic reviews (SRs)/meta-analyses (MAs) have shown that CHM may benefit patients with psoriasis. This overview aims to summarize the evidence from published SRs/MAs for clinical application and to provide several directions for future researches. METHODS Nine electronic databases (Medline, Embase, Cochrane Library, AMED, CINAHL, CBM, CNKI, VIP Database, Wanfang Databases) will be searched from their inceptions to September 2020 without language restrictions. At least 2 reviewers will independently conduct the study selection, data extraction, and quality assessment. The methodological quality, risk of bias, reporting quality, and evidence quality will be respectively evaluated by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2), the Risk of Bias in Systematic Reviews, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS The results of this overview will be submitted to a peer-reviewed journal for publication. CONCLUSIONS We expect to compile current evidence from published SRs/MAs of CHM for patients with psoriasis in an accessible and useful document. ETHICS AND DISSEMINATION This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/VC654.
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Affiliation(s)
- Jie Zhang
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Qianying Yu
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Li Peng
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Wenxia Lin
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yuesi Qin
- Chengdu Integrated TCM & Western Medicine Hospital, Chengdu, Sichuan Province, P. R. China
| | - Ying He
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jing Guo
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Min Xiao
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Mingling Chen
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
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16
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Bruins FM, Bronckers IMGJ, Cai R, Groenewoud JMM, Krol M, de Jong EMGJ, Seyger MMB. Treatment persistence in paediatric and adolescent patients with psoriasis followed into young adulthood. From topical to systemic treatment: a prospective, longitudinal, observational cohort study of 448 patients. Br J Dermatol 2020; 184:464-472. [PMID: 32510578 PMCID: PMC7984075 DOI: 10.1111/bjd.19301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
Background Although solely topical treatment often suffices, patients with psoriasis may require more intensive treatment (phototherapy and/or systemic treatments) to control their disease. However, in paediatric, adolescent and young adult patients, little is known about persistence of topical treatment and time until switch to systemic treatment. Objectives To determine the median time from psoriasis onset until (i) discontinuation of solely topical agents and (ii) switch to systemic treatment, and to identify patient characteristics associated with switching to systemic treatments. Methods Data were extracted from the Child‐CAPTURE registry, a prospective, observational cohort of patients with paediatric‐onset psoriasis followed into young adulthood from 2008 to 2018. Data prior to inclusion in the registry were collected retrospectively. Median times were determined through Kaplan–Meier survival analyses. Cox regression analysis was used to identify patient characteristics associated with switch to systemic treatment. Results Of 448 patients, 62·3% stayed on solely topical treatment until data lock; 14·3% switched from topicals to phototherapy, but not to systemic treatment; and 23·4% switched to systemic treatment. The median time from psoriasis onset until discontinuation of solely topical treatment was 7·3 years, and until switch to systemics was 10·8 years. Higher Psoriasis Area and Severity Index and (Children’s) Dermatology Life Quality Index > 5 were independently associated with switching to systemic treatment. Conclusions In a population of paediatric and adolescent patients with mild‐to‐severe psoriasis, one‐third needed more intensive treatment than solely topical therapy to control their disease. We consider the median time until switching to systemics to be long. What is already known about this topic? Psoriasis in the majority of paediatric and adolescent patients can be adequately managed with solely topical treatment. However, some patients require a switch to more intensive treatment in order to control their disease. Little is known about persistence of topical treatment and time until switch to systemic treatment.
What does this study add? In 448 paediatric patients with mild‐to‐severe psoriasis, 62·3% persisted on solely topical treatment, 14·3% switched to phototherapy, but not to systemics, and 23·4% switched to systemic treatment at data lock (total median follow‐up 4·2 years, interquartile range 1·8–7·5). The median time from psoriasis onset until discontinuation of solely topical treatment was 7·3 years, and until switch to systemic treatment 10·8 years. Higher Psoriasis Area and Severity Index and (Children’s) Dermatology Life Quality Index > 5 at switch were independent characteristics associated with switching to systemic treatment.
Linked Comment: Salman. Br J Dermatol 2021; 184:387–388. Plain language summary available online
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Affiliation(s)
- F M Bruins
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I M G J Bronckers
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R Cai
- Real-World Evidence Solutions, IQVIA, Amsterdam, the Netherlands
| | - J M M Groenewoud
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - M Krol
- Real-World Evidence Solutions, IQVIA, Amsterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Zhang J, Yu Q, Peng L, Zhang F, Lin W, Guo J, Xiao M, Chen M. Cupping for psoriasis vulgaris: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20348. [PMID: 32443388 PMCID: PMC7253533 DOI: 10.1097/md.0000000000020348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Psoriasis vulgaris (PV) is a chronic, immune-mediated dermatological disease that significantly affects the patient's health and quality of life. At present, cupping has been widely used in the treatment of psoriasis. However, the effectiveness and safety of cupping in patients with PV are still controversial. Therefore, this review aims to evaluate the efficacy and safety of cupping therapy on PV. METHODS The following databases will be searched from their inceptions to April 2020 with a language limitation of English and Chinese: Pubmed, Medline, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Databas, China National Knowledge Infrastructure Database, Wanfang database and Chinese Scientific Journal Database. The reference lists of eligible studies and other resources will also be searched. Two researchers will independently perform the selection of studies, data extraction, and data analysis. A fixed or random-effect model will be applied to synthesize data depend on the heterogeneity test. The primary outcome is the proportion of patients achieving at least a 60% improvement in psoriasis area and severity index (PASI) score from baseline (PASI 60). Secondary outcomes include the proportion of patients achieving at least a 90% improvement in PASI score from baseline (PASI 90), the mean change of PASI and dermatology life quality index score, the itching index, adverse events, and recurrence rate. RevMan V.5.3 software will be used for meta-analysis. RESULTS The study will provide a high-quality evidence-based review of cupping for PV. CONCLUSIONS The study will be conducted to evaluate the efficacy and safety of cupping in the treatment of PV and supposed to provide clear evidence for the clinical application of cupping therapy. ETHICS AND DISSEMINATION As the study is a protocol of systematic review and meta-analysis that does not involve individual data, ethical approval will not be required. The results will be published in a peer-reviewed journal. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/KV4CJ.
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Ormerod A. Dutch guidelines for psoriasis treatment. Br J Dermatol 2019; 180:11. [DOI: 10.1111/bjd.17390] [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]
Affiliation(s)
- A.D. Ormerod
- University of Aberdeen Foresterhill Aberdeen AB25 2ZD U.K
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