Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO - Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society)

Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study

Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.

[Translated article] Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study

Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.

Biologics recommendations for patients with psoriasis: a critical appraisal of clinical practice guidelines for psoriasis

PURPOSE

This review article serves to assess the consistency of recommendations from guidelines on biologic agents for psoriasis, based on the quality evaluation of psoriasis Clinical Practice Guidelines (CPGs).

METHODS

We conducted a systematic literature search to identify CPGs that provide recommendations on diagnosis and treatment for psoriasis. Four reviewers performed a quality assessment of the included CPGs with the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument.

RESULTS

A total of 51 sets of CPGs from 22 medical societies or separate working groups fulfilled the inclusion criteria. The overall quality of the eligible sets of guidelines was moderate to high, with an overall average score of 55%The highest domain scores were Score and Purpose (70%) and Clarity of Presentation (68%). A total of 95 biologic agent recommendations were extracted from the 18 recommended CPGs.Three biologic agents (Etanercept, Adalimumab, Ustekinumab) were recommended for pediatric patients. Three biologic agents (Adalimumab, Ustekinumab, Secukinumab) were recommended as first-line biologic agents for adults with psoriasis.

CONCLUSION

The overall methodological quality of CPGs for psoriasis is medium to high. More attention should be paid to applicability in guideline development. The recommendations and the basis for them among various sets guidelines were almost consistent.

The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines

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.

Traditional Chinese medicine for psoriasis vulgaris: A Protocol of a prospective, multicenter cohort study

INTRODUCTION

The incidence of psoriasis vulgaris is increasing worldwide. Chronic recurrence of the disease, as well as accompanying cardiovascular disease, metabolic syndrome, and depression has affected the physical and mental health of these patients. Psoriasis vulgaris is a difficult and major disease in the dermatology field. Short-term curative effects using conventional therapy for psoriasis vulgaris has made major strides. However, traditional Chinese medicine (TCM) treatment has long-term curative advantages for psoriasis vulgaris but lacks the scientific and clinical evidence for its use. This study intends to demonstrate and provide scientific and clinical evidence for the use of TCM to delay the recurrence of psoriasis vulgaris.

METHODS AND ANALYSIS

This will be a prospective, multicenter cohort study. We intend to recruit 1521 psoriasis vulgaris patients from 14 hospitals in Beijing, Tianjin, and Hebei. Treatment will be based on the diagnosis specifications and clinical practice guidelines of TCM and conventional therapy. During inclusion and the subsequent follow-up period, doctors through electronic case reports will collect different therapeutic TCM regimens and conventional therapy that were administered. Information on life condition, skin lesions at each visit, World Health Organization Quality of Life Instruments, Zung Self-rating Anxiety Scale, Zung Self-assessment of Depression, laboratory examinations, incidence of new rash and recurrence during the remission and recurrence stages will be recorded.

ETHICS AND DISSEMINATION

The clinical trial protocol for this study was approved by the ethics committee of the Beijing hospital of TCM affiliated to capital medical university (Ethics number: 2019BL02-010-02). We will publish and present our results at national and international conferences and in peer-reviewed journals specialized in dermatology.

TRIAL REGISTRATION

This protocol has been registered in clinicaltrials. gov (ChiCTR1900021629).

Moving cupping therapy for plaque psoriasis: A PRISMA-compliant study of 16 randomized controlled trials

BACKGROUND

Clinical treatment of plaque psoriasis typically involves a comprehensive therapy, which is expensive and unsatisfactory, and some medications have serious side effects. Moving cupping therapy has shown good clinical efficacy in the treatment of plaque psoriasis; it can significantly relieve skin inflammation and excessive thickening of plaque psoriasis and has fewer side effects. However, a comprehensive evaluation of the current clinical evidence regarding its use is lacking.

METHODS

Several databases were systematically searched from inception to March 2, 2020, including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure, and Wan Fang. This review included randomized controlled trials on plaque psoriasis treatment with the use of moving cupping and in combination with Chinese herbs or conventional Western medicine therapy. These trial findings were compared with the treatment results using placebo, pharmaceutical medications, or Chinese herbs. Moving cupping treatment frequency was also compared.

RESULTS

Sixteen trials with 1164 participants met the inclusion criteria. Meta-analysis showed that the intervention group (moving cupping therapy) had a significant effect compared with the no-moving cupping therapy group (weighted mean difference = -1.22, 95% confidence interval [CI] [-1.58, -0.85], P < .00001 random model; I = 85%). Furthermore, moving cupping (weighted mean difference = -1.19, 95% CI [-1.98, -0.39], P = .003 random model; I = 85%) or combined with pharmaceutical medications (weighted mean difference = -1.55, 95% CI [-1.89, -1.20], P < .00001 random model; I = 0%) were better than pharmaceutical medications alone in treating plaque psoriasis. Cupping therapy significantly improved psoriasis recurrence rate (risk ratio = 0.33, 95% CI [0.16, 0.68], P = .003 fixed model; I = 28%). However, for the visual analogue score, moving cupping showed no obvious advantages (weighted mean difference = -0.27, 95% CI [-0.71, 0.17], P = .22 random model; I = 64%). Moreover, studies reported that moving cupping reduced serum tumor necrosis factor-α and vascular endothelial growth factor levels more significantly than pharmaceutical medications. Moving cupping was associated with few transient adverse reactions, such as redness, itching, and local skin burning.

CONCLUSION

Moving cupping therapy could be an effective treatment either alone or as a combination therapy for plaque psoriasis. However, further large-scale, rigorously designed trials are needed to confirm these findings.

Pharmacotherapy and inappropriate prescriptions in patients with psoriasis

Background Psoriasis is a chronic inflammatory and systemic disease that primarily affects the skin, nails, and joints. Some medications have been linked to worsening clinical manifestations of cutaneous psoriasis. Objective To identify pharmacological treatments and drugs related to worsening dermatological lesions in patients with psoriasis. Setting Patients diagnosed with psoriasis or psoriatic arthritis between November 1, 2018, and October 30, 2019. Methods This was a cross-sectional study from a population database that identified the prescriptions of patients with psoriasis during 2019. All medications prescribed for the treatment of psoriasis and other comorbidities were investigated. Main outcome measure Potentially inappropriate medications. Results We identified 2088 patients with psoriasis, with a mean age of 53.6 ± 15.5 years, and 52.9% were men. A total of 92.6% received pharmacological treatment, and of these, topical corticosteroids were the most commonly used group (76.6%). A total of 55.3% of patients with cutaneous psoriasis received at least one drug associated with worsening dermatological lesions. The most frequent were naproxen (25.5%), diclofenac (14.7%), and dexamethasone (10.8%). Residing in Barranquilla (odds ratio 1.27, 95%confidence interval 1.009-1.607), having any chronic comorbidities (odds ratio 1.94, 95%confidence interval 1.566-2.402), and having a history of coronary heart disease (odds ratio 6.25, 95%confidence interval 1.895-20.645) increased the probability of receiving these prescriptions. Conclusions The pharmacological treatment of psoriasis was in accordance with the recommendations of the clinical practice guidelines, but the high proportion of potentially inappropriate prescriptions makes it necessary to promote educational and pharmacovigilance strategies that improve the formulation habits of the physicians involved in the treatment of these patients.

Practical compendium for psoriasis management

Psoriasis management is complex and challenging. It should be tailored for each patient. Treatment strategy differs according to patient's age, sex, disease type, disease severity, burden on patient's quality of life, comorbidities, involvement of specific sites, and pregnancy. The choice of the appropriate therapeutic must take into consideration the availability, the price, and the patient's preferences. It is very important that the chosen treatment is not more unpleasant, intolerable, or dangerous than the disease itself. According to the disease type, severity, and effect on patient's quality of life, dermatologist chooses whether to start with topical therapy, phototherapy or systemic therapy, or a combination of two or more of them. Under each category, there are different types of therapies that can be the first line therapeutics, second line, or even contraindicated. In this compendium, we provide dermatologists with different treatment plans considering all the mentioned variables so that a dermatologist can choose the optimum plan for the patient.

Results of the long-term observational noninterventional prospective study BODYGUARD in psoriasis patients

Introduction. Currently there is insufficient data regarding routine use of various topical treatments for plaque psoriasis outside from randomized clinical trials, their efficacy, cost-effectiveness and perception by dermatologists and patients. The primary rationale for this study was local data generation for the long-term (up to 52 weeks) treatment of body psoriasis in Russian patients’ population with fixed-dose combination of calcipotriol and betamethasone dipropionate in the formulation of gel to evaluate patient’s adherence to the therapy and their satisfaction level.

Materials and methods. Primary study objectives were evaluation of the long-term (up to 52 weeks) treatment success of body psoriasis with fixed-dose combination of calcipotriol and betamethasone dipropionate gel by Physician (Physician Psoriasis Global Assessment (PsGA, 5-point scale)) and by patient (Patient’s Global Psoriasis Assessment (PaGA, 5-point scale) and overall patient’s satisfaction using 4-point scale), patient’s satisfaction with the treatment via Patient Preference Questionnaire (PPQ), patients’ adherence to the treatment using Questionnaire of Adherence, impact of treatment on patients’ quality of life using DLQI questionnaire, and patients’ readiness to buy topical therapy product out of pocket based on consumption of the study medication during follow up period. Patients received treatment with topical calcipotriol/betamethasone gel which was prescribed as a routine medication without connection to the study purposes for up to 8 weeks. After the treatment patients were followed up for up to 52 weeks; during this period they were allowed to continue treatment with either maintenance or intermittent schedule. 128 dermatologists participated in the study, 612 patients with body plaque psoriasis (mean age 42.0 ± 13.30 years) were included; from this sample 544 (88.7 %) patients underwent follow up.

Results. All 612 included patients received initial therapy with calcipotriol/betamethasone gel; during follow-up period 410 (76.1 %) patients received treatment by any schedule (out of 539 assessed). Overall treatment success based on average PsGA score: initially 3.0 ± 0.54, after appr.8 weeks — 1.3 ± 0.80 and after appr.52 week 1.1 ± 0.96; based on average PaGA score — initially 3.0 ± 0.54, after appr.8 weeks — 1.5 ± 0.88 and after appr.52 week 1.1 ± 0.99. The proportion of patients which described their overall satisfaction with the treatment as “satisfied” or “absolutely satisfied” equaled 92.3 % at visit at the end of active treatment and 93.1 % at visit up to 52 weeks afterwards. Also at visit at the end of active treatment 93.8 % of patients considered their current treatment as “more effective” than previous topical treatment they received. Patients’ adherence to the therapy was satisfactory — average application rate of calcipotriol/betamethasone (should be applied daily) gel at the last 7 days of treatment at visit at the end of active treatment comprised 5.6 ± 2.6 days, which means that 6 out of 7 days of the treatment were not missed. Initial DLQI score was 13.6 ± 5.95 and it reduced down to 3.89 ± 5.95 at visit at the end of active treatment (p < 0.001) reflecting positive impact of successful therapy on patients’ psychosocial wellbeing.

Discussion. Results of this study provides additional information regarding routine topical therapy in patients with plaque psoriasis. These findings demonstrate that the therapy of body plaque psoriasis with calcipotriol/betamethasone gel is effective both in short and long term according to the evaluation by dermatologists and by patients themselves. This therapy provides good rate of adherence and patients’ satisfaction as well as affects positively at patients’ psychosocial wellbeing assessed by DLQI score.