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von Csiky-Sessoms S, Correa Da Rosa J, Han J, Dubin D, Lebwohl M. The reliability of disease severity assessment in psoriasis patients of color: Results of an educational intervention. J Am Acad Dermatol 2023; 88:895-897. [PMID: 36252689 DOI: 10.1016/j.jaad.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | - Joel Correa Da Rosa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danielle Dubin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Yasmeen N, Sawyer LM, Malottki K, Levin LÅ, Didriksen Apol E, Jemec GB. Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year. J DERMATOL TREAT 2020; 33:204-218. [DOI: 10.1080/09546634.2020.1743811] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | - Lars-Åke Levin
- Institute of Health and Medicine, University of Linköping, Linköping, Sweden
| | | | - Gregor B. Jemec
- Department of Dermatology, Sjaellands Universitetshospital, Roskilde, Denmark
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Fink C, Fuchs T, Enk A, Haenssle HA. Design of an Algorithm for Automated, Computer-Guided PASI Measurements by Digital Image Analysis. J Med Syst 2018; 42:248. [DOI: 10.1007/s10916-018-1110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
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4
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Augustin M, Langenbruch A, Gutknecht M, Reich K, Körber A, Maaßen D, Mrowietz U, Thaçi D, von Kiedrowski R, Radtke M. Definition of psoriasis severity in routine clinical care: current guidelines fail to capture the complexity of long-term psoriasis management. Br J Dermatol 2018; 179:1385-1391. [DOI: 10.1111/bjd.17128] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 12/21/2022]
Affiliation(s)
- M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M. Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - K. Reich
- Dematologikum Berlin; Berlin Germany
| | - A. Körber
- Clinic for Dermatology; Essen University Hospital; Essen Germany
| | - D. Maaßen
- Dermatological Practice Maxdorf; Maxdorf Germany
| | - U. Mrowietz
- Department for Dermatology, Venerology and Allergology; University Medical Center Schleswig-Holstein; Kiel Germany
| | - D. Thaçi
- Comprehensive Center for Inflammation Medicine; University Medical Center Schleswig-Holstein; Lübeck Germany
| | | | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle H. Precision and reproducibility of automated computer‐guided Psoriasis Area and Severity Index measurements in comparison with trained physicians. Br J Dermatol 2018; 180:390-396. [DOI: 10.1111/bjd.17200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 01/05/2023]
Affiliation(s)
- C. Fink
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Alt
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - L. Uhlmann
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Klose
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - A. Enk
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - H.A. Haenssle
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle HA. Intra- and interobserver variability of image-based PASI assessments in 120 patients suffering from plaque-type psoriasis. J Eur Acad Dermatol Venereol 2018; 32:1314-1319. [PMID: 29569769 DOI: 10.1111/jdv.14960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Psoriasis Area and Severity Index (PASI) is the standard for psoriasis severity assessment. However, PASI measurement is complex and subjective, frequently leading to a high intra- and interobserver variability. To date, the precise extent of variability in PASI measurements and its underlying causes remain unknown. OBJECTIVE To determine the inter- and intrarater variability of image-based PASI measurements by calculating Intra-Class-Correlation-Coefficients (ICCs) and to investigate the impact of the different PASI components and specific anatomic regions on the extent of variability. METHODS First, the methodology of 'image-based' vs. commonly used 'live' PASI measurements was validated in a pilot study. Next, in an observational cohort study, PASI scores of 120 patients affected by plaque psoriasis were prospectively evaluated by three formally trained physicians by means of total body images (TBI). Each observer independently performed two rounds of image-based PASI calculations in all patients at two different time points. RESULTS Overall, 720 image-based PASI scores were calculated with a mean PASI of 8.8 (range 0.7-34.8). An interrater variability with an ICC of 0.895 and mean absolute difference (MAD) of 3.3 PASI points were observed. Intrarater variability showed a mean ICC of 0.877 and a MAD of 2.2 points. When considering specific PASI components, the highest agreement was found for the assessment of the involved body surface area (BSA), while the lowest ICCs were calculated for severity scoring of 'scaling' and 'induration'. As BSA scores serve as a multiplier in the calculation of PASI, minor inaccuracies were capable of inducing a large share of variability. CONCLUSION The overall inter- and intrarater reliability of image-based PASI measurements in this study was good. However, physicians were formally trained and experienced, which frequently is not the case in a real-life clinical setting. Therefore, new strategies for higher standardization and objectivity of PASI calculations are needed.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Alt
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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7
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Panda S, Bandyopadhyay D. Rational use of drugs in dermatology: A paradigm lost? Indian J Dermatol Venereol Leprol 2018; 84:1-5. [DOI: 10.4103/ijdvl.ijdvl_886_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Carrera CG, Dapavo P, Malagoli P, Naldi L, Arancio L, Gaiani F, Egan CG, Di Mercurio M, Cattaneo A. PACE study: real-life Psoriasis Area and Severity Index (PASI) 100 response with biological agents in moderate-severe psoriasis. J DERMATOL TREAT 2017; 29:481-486. [DOI: 10.1080/09546634.2017.1395805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Carlo Giovanni Carrera
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | | | - Luigi Naldi
- U.O.C. Dermatologia, Ospedale San Bortolo – Azienda ULSS8, Berica (VI), Italy
| | - Luisa Arancio
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Gaiani
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | | | | | - Angelo Cattaneo
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
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9
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Iskandar IYK, Ashcroft DM, Warren RB, Lunt M, McElhone K, Smith CH, Reynolds NJ, Griffiths CEM. Comparative effectiveness of biological therapies on improvements in quality of life in patients with psoriasis. Br J Dermatol 2017; 177:1410-1421. [PMID: 28369707 PMCID: PMC6487951 DOI: 10.1111/bjd.15531] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/12/2023]
Abstract
Background Evidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life (HRQoL) in routine clinical practice is limited. Objectives To examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQoL in patients with psoriasis, and to identify potential predictors for improved HRQoL. Methods This was a prospective cohort study in which changes in HRQoL were assessed using the Dermatology Life Quality Index (DLQI) and EuroQoL‐5D (EQ‐5D) at 6 and 12 months. Multivariable regression models were developed to identify factors associated with achieving a DLQI of 0/1 and improvements in the EQ‐5D utility score. Results In total, 2152 patients with psoriasis were included, with 1239 patients on adalimumab, 517 on etanercept and 396 on ustekinumab; 81% were biologic naïve. For the entire cohort, the median (interquartile range) DLQI and EQ‐5D improved from 18 (13–24) and 0·73 (0·69–0·80) at baseline to 2 (0–7) and 0·85 (0·69–1·00) at 6 months, respectively (P < 0·001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female sex, multiple comorbidities, smoking and a higher DLQI or a lower EQ‐5D utility score at baseline predicted a lower likelihood of achieving a DLQI of 0/1 or improvement in the EQ‐5D. Compared with adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biological therapies in EQ‐5D improvement. Conclusions In routine clinical practice biological therapies produce marked improvement in HRQoL, which is influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biological therapy for patients related to improvements in HRQoL. What's already known about this topic? Evidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life (HRQoL) in routine clinical practice is limited. Earlier observational studies were either cross‐sectional, thereby limiting the ability to compare changes in HRQoL, or cohort studies that have not taken into account important clinical factors that could influence treatment response, such as alterations in dosing regimens of biological therapies and the concomitant use of conventional systemic treatments for psoriasis.
What does this study add? This large prospective cohort study found that in routine clinical practice, the use of biological therapies for psoriasis was associated with marked improvements in HRQoL over 12 months. These improvements were influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. Compared with adalimumab, patients receiving etanercept were less likely to achieve a DLQI of 0/1, but there was no significant difference between ustekinumab and adalimumab in the proportion of patients achieving a DLQI of 0/1. There was no significant difference between the three biological therapies in level of improvement in the EQ‐5D.
Linked Comment: Finlay. Br J Dermatol 2017; 177:1164–1165.
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Affiliation(s)
- I Y K Iskandar
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
| | - M Lunt
- Arthritis Research U.K. Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - N J Reynolds
- Institute of Cellular Medicine, Medical School, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K.,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K.,Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K
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Nergard-Martin J, Siddiqui F, Kailas A, Winslow M, Solomon JA. Why Outcome Measures in Dermatology Are Becoming Patient Centric. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strober BE, Bissonnette R, Fiorentino D, Kimball AB, Naldi L, Shear NH, Goyal K, Fakharzadeh S, Calabro S, Langholff W, You Y, Galindo C, Lee S, Lebwohl MG. Comparative effectiveness of biologic agents for the treatment of psoriasis in a real-world setting: Results from a large, prospective, observational study (Psoriasis Longitudinal Assessment and Registry [PSOLAR]). J Am Acad Dermatol 2016; 74:851-61.e4. [DOI: 10.1016/j.jaad.2015.12.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022]
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Remröd C, Sjöström K, Svensson Å. Subjective stress reactivity in psoriasis - a cross sectional study of associated psychological traits. BMC DERMATOLOGY 2015; 15:6. [PMID: 25934133 PMCID: PMC4423403 DOI: 10.1186/s12895-015-0026-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/22/2015] [Indexed: 02/08/2023]
Abstract
Background Stress or psychological distress is often described as a causative or maintaining factor in psoriasis. Psychological traits may influence the appraisal, interpretation and coping ability regarding stressful situations. Detailed investigations of psychological traits in relation to stress reactivity in psoriasis are rare. The aim of this study was to examine whether patients with psoriasis who report an association between psychological distress and exacerbation, “stress reactors” (SRs), differ psychologically from those with no stress reactivity “non-stress reactors” (NSRs). Methods This cross-sectional study was conducted among 101 consecutively recruited outpatients with plaque psoriasis. A psychosocial interview was performed including questions concerning stress reactivity in relation to onset and exacerbation. Three validated self-rating scales were used: Spielberger State-Trait Anxiety Inventory (STAI, Form-Y), Beck Depression Inventory (BDI-II) and Swedish Universities Scales of Personality (SSP). Independent samples t-tests, Chi-square tests and one-way ANOVA analyses were used for group comparisons when appropriate. A logistic regression model was designed with SR as the dependent variable. Results Sixty-four patients (63%) reported a subjective association between disease exacerbation and stress (SRs). Patients defined as SRs reported significantly higher mean scores regarding state and trait anxiety, depression, and also five SSP scale personality traits, i.e. somatic trait anxiety, psychic trait anxiety, stress susceptibility, lack of assertiveness and mistrust, compared with NSRs. In multivariate analysis, SSP-stress susceptibility was the strongest explanatory variable for SR, i.e. OR (95% CI) = 1.13 (1.02 – 1.24), p = 0.018. Conclusion According to our results, patients who perceive stress as a causal factor in their psoriasis might have a more vulnerable psychological constitution. This finding suggests important opportunities for clinicians to identify patients who may benefit from additional psychological exploration and support.
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Affiliation(s)
- Charlotta Remröd
- Department of Dermatology and Venereology, University of Lund, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
| | - Karin Sjöström
- Psychiatric consultant at the Department of Dermatology and Venereology, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
| | - Åke Svensson
- Department of Dermatology and Venereology, University of Lund, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
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Manalo IF, Gilbert KE, Wu JJ. An updated survey for the 2007-2013 period of randomized controlled trials for psoriasis: treatment modalities, study designs, comparators, outcome measures and sponsorship. J Eur Acad Dermatol Venereol 2015; 29:1945-50. [PMID: 25763768 DOI: 10.1111/jdv.13089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two reports from the European Dermato-Epidemiology Network psoriasis project have analysed randomized controlled trials for psoriasis published during the periods of 1977-2000 and 2001-2006. OBJECTIVE We sought to update the analysis of randomized controlled trials for the 2007-2013 period from 10 high-impact dermatology and medical journals. METHODS This survey was conducted by electronic search on the PubMed database for eligible papers. We assessed and compared results to the two aforementioned published reports. RESULTS In total, 84 studies were evaluated. Over half of the total trials studied novel therapeutics: 40 (47.6%) trials examined biologics and five (6.0%) examined novel oral agents. Proportion of trials studying more than one treatment modality increased from 7.1% in 2001-2006 to 25.0% in 2007-2013, with a decreased proportion of placebo-controlled studies from 69.3% to 47.1%. CONCLUSION The proportion of trials on novel therapies, including novel oral and biologic agents, has increased. The quality of trials has improved in the aspects of increased active treatment comparisons, including between biologics and conventional agents, and increased study size. Further insight into the influence of pharmaceutical companies can be studied by extending analysis to extension studies and subanalyses.
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Affiliation(s)
- I F Manalo
- Medical College of Georgia at Georgia Regents University, Augusta, GA, USA
| | - K E Gilbert
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Biologic therapy with or without topical treatment in psoriasis: what does the current evidence say? Am J Clin Dermatol 2014; 15:379-85. [PMID: 25027461 DOI: 10.1007/s40257-014-0089-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Biologic therapy represents a relatively new class of drugs which have revolutionized the treatment of psoriasis and are used with increasing frequency in order to control this chronic, systemic inflammatory disease. However, it is unclear what role there is for combination therapy of biologics with traditional topical agents. The purpose of this article is to assess the literature on the role of topical agents as adjuvants to biological treatments in the treatment of psoriasis and identify areas for further research. A MEDLINE search was performed in order to identify English-language publications from 1996 to 2014 examining combination biologic therapy with topical medications in the treatment of psoriasis. Data from these clinical studies are summarized and the outcomes are discussed. In general, the addition of adjuvant topical therapy to systemic biologic therapy allowed for a reduction in dosage and side effects of both agents, maintenance of initial response to biologics, treatment of recalcitrant lesions in partial responders, and potential acceleration of response to biologic therapies. The current data, though limited, suggest that using topical therapies as adjunct treatment to biologics is a well tolerated and effective means of controlling psoriasis and improving quality of life for patients. However, the treating physician should remain attentive to signs of adverse events and seek opportunities to reduce the dose or treatment frequency during chronic use.
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Williams H. The outstanding record of clinical trials in the British Journal of Dermatology. Br J Dermatol 2014; 170:761-3. [PMID: 24734944 DOI: 10.1111/bjd.13011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Williams
- Centre of Evidence-Based Dermatology, King's Meadow Campus, University of Nottingham, Lenton Lane, Nottingham, NG7 2NR, U.K
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16
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Remröd C, Sjöström K, Svensson A. Psychological differences between early- and late-onset psoriasis: a study of personality traits, anxiety and depression in psoriasis. Br J Dermatol 2014; 169:344-50. [PMID: 23565588 DOI: 10.1111/bjd.12371] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited. OBJECTIVES To examine whether patients with early-onset psoriasis differ psychologically from patients with late-onset psoriasis, regarding personality traits, anxiety and depression. METHODS A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires: Swedish Universities Scales of Personality (SSP), Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory. Psoriasis severity was assessed by the Psoriasis Area and Severity Index. RESULTS Patients with early-onset psoriasis (age < 20 years) were significantly more anxious and depressed than patients with late-onset psoriasis. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits: SSP-embitterment, -trait irritability, -mistrust and -verbal trait aggression. CONCLUSIONS Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with the early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and/or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis.
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Affiliation(s)
- C Remröd
- Department of Dermatology, University of Lund, Malmö, Sweden.
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Walsh JA, McFadden M, Woodcock J, Clegg DO, Helliwell P, Dommasch E, Gelfand JM, Krueger GG, Duffin KC. Product of the Physician Global Assessment and body surface area: A simple static measure of psoriasis severity in a longitudinal cohort. J Am Acad Dermatol 2013; 69:931-7. [DOI: 10.1016/j.jaad.2013.07.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/15/2022]
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Callis Duffin K, Gottlieb AB. Outcome Measures for Psoriasis Severity: A Report from the GRAPPA 2012 Annual Meeting. J Rheumatol 2013; 40:1423-4. [DOI: 10.3899/jrheum.130454] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Stockholm, Sweden, dermatology members provided summaries of ongoing work with outcome measures for psoriasis severity. Controversies around the physician global assessment (PGA) were summarized, including discussions of variations and limitations of the static PGA instruments in use. The Psoriasis Outcome Measures project was introduced, with a goal of developing measures for use in clinical trials and practice. This project will follow the Outcome Measures in Rheumatology (OMERACT) process and may become a model for outcome measures of other dermatologic diseases.
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Outcomes in Psoriasis Clinical Trials from January 2011 to March 2012. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bishop FL, Jacobson EE, Shaw J, Kaptchuk TJ. Participants' experiences of being debriefed to placebo allocation in a clinical trial. QUALITATIVE HEALTH RESEARCH 2012; 22:1138-1149. [PMID: 22673094 PMCID: PMC3645341 DOI: 10.1177/1049732312448544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Participants in placebo-controlled clinical trials give informed consent to be randomized to verum or placebo. However, researchers rarely tell participants which treatment they actually received. We interviewed 4 participants in a trial of acupuncture for irritable bowel syndrome before, during, and after they received a course of placebo treatments over 6 weeks. During the final interview, we informed participants that they had received a course of placebo treatments. We used an idiographic phenomenological approach based on the Sheffield School to describe each participant's experiences of being blinded to and then debriefed to placebo allocation. The participants' experiences of blinding and debriefing were embodied, related to their goals in undertaking the study, and social (e.g., embedded in trusting and valued relationships with acupuncturists). We suggest ways in which debriefing to placebo allocation can be managed sensitively to facilitate positive outcomes for participants.
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Affiliation(s)
- Felicity L Bishop
- Psychology, Faculty of Human and Social Sciences, University of Southampton, Southampton, United Kingdom.
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Gelfand JM, Wan J, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Stierstorfer MB, Brod BA, Schleicher SM, Bebo BF, Troxel AB, Shin DB, Steinemann JM, Goldfarb J, Yeung H, Van Voorhees AS. Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting. ACTA ACUST UNITED AC 2012; 148:487-94. [PMID: 22508874 DOI: 10.1001/archdermatol.2012.370] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis. DESIGN A cross-sectional design was used. SETTING Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study. PARTICIPANTS A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy. MAIN OUTCOME MEASURES The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index. RESULTS The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency. CONCLUSIONS The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.
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Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Wan J, Abuabara K, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Dermatologist preferences for treatments to compare in future randomized controlled comparative effectiveness trials for moderate to severe psoriasis. ACTA ACUST UNITED AC 2012; 148:539-41. [PMID: 22508884 DOI: 10.1001/archdermatol.2011.1399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Williams HC, Dellavalle RP. The Growth of Clinical Trials and Systematic Reviews in Informing Dermatological Patient Care. J Invest Dermatol 2012; 132:1008-17. [DOI: 10.1038/jid.2011.337] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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De Mozzi P, Johnston G, Alexandroff A. Psoriasis: an evidence-based update. Report of the 9th Evidenced Based Update Meeting, 12 May 2011, Loughborough, U.K. Br J Dermatol 2012; 166:252-60. [DOI: 10.1111/j.1365-2133.2011.10767.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Although the isolated clinical cases published are sometimes helpful in individual situations in which the therapeutic options have been exhausted, this type of publication cannot be generalized. For this reason, the selection presented covering the period from November 2009 to October 2010 is to a very large extent based on controlled trials, either because they contribute important information or because they raise great hope for a significant number of patients. For the first time in cutaneous oncology, a treatment (ipilimumab) has significantly increased overall survival in patients with metastatic melanoma (phase III), although this gain remains modest (4-6 months) and adverse immunological effects are frequent (30-40%). A phase I trial with treatment specifically targeting the mutant BRAF protein has shown an objective response in 81% of the patients treated in the metastatic phase of melanoma, thus allowing its development to be pursued. Grouping two studies in a rare tumor such as dermatofibrosarcoma also gives hope with imatinib as a neoadjuvant treatment when the initial tumor is inoperable, with, however, an inconsistent response of approximately 50% and only if the tumor presents reorganization of chromosomes 17 and 22. Cutaneous inflammatory diseases are still dominated by dual therapies in psoriasis, with, notably, an effectiveness trial on etanercept at different doses not showing a difference in efficacy depending on dose for the joint component of psoriasis, but also by the publication of a direct comparison of two dual therapies, ustekinumab versus etanercept. In atopic dermatitis, a controversial article invites one to reflect upon the progress made in the management of children by clinical nurses, as in the Netherlands and in Great Britain, in an attempt to contend with the shortage of dermatologists. Since the use of biotherapies is not the prerogative of psoriasis, infliximab was assessed in a phase II trial in Verneuil disease without demonstrating significant efficacy on the main criterion, but it did show a tendency to reduce the score used. This trial suffered from a weakness both in methodology and statistical power, thus precluding any conclusion. The rarity of therapeutic trials on drug eruptions warrants their mention. A French phase II study gives a glimpse of a trend toward efficacy in terms of survival in the treatment of toxic epidermal necrolysis with cyclosporine. As for infectious dermatosis and sexually transmitted infections, a French multicenter study has shown significantly higher efficacy with ivermectin than with malathion in treating pediculosis without increasing the side effects. Today, however, this systemic treatment cannot be a first-line treatment outside of certain specific situations. A large cohort study (somewhat unsatisfactory in its methodology) has not demonstrated the teratogenicity of antiherpes treatments in 830,000 infants. In prevention of HIV transmission, no microbicidal gel had shown efficacy to date. This has now been accomplished in South Africa with a 1% tenofovir gel. The results of a preliminary trial on therapeutic vaccination against HPV16 proposed to women who are carriers of cervical intraepithelial neoplasia opens the way for wide vaccine therapy of cutaneous virus-induced neoplasia. In conclusion, several articles analyzing the dermatology literature provide an opportunity to reflect on the quality of such articles, Boutron's being absolutely in-dis-pen-sa-ble!
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Affiliation(s)
- L Martin
- Service de Dermatologie, CHU d'Angers, 4 rue Larrey, 49933 Angers cedex 9, France.
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Actualités sur le psoriasis lors des Journées Dermatologiques de Paris. Ann Dermatol Venereol 2011; 138:H1-10. [DOI: 10.1016/s0151-9638(11)70073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Porzsolt F. [From the design of use study to the assessment of the benefit: with or without pharmaceutical industry?]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2010; 105:930-935. [PMID: 21240593 DOI: 10.1007/s00063-010-1159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 10/17/2010] [Indexed: 05/30/2023]
Abstract
The financing of clinical studies by the pharmaceutical industry is a controversial topic both internationally and in here in Germany. The well-known unacceptable shortcomings require no further confirmation. It is, however, indisputable that the pharmaceutical industry and medical science are co-dependent. Neither the marketing of industrial products nor the research and education of clinical scientists could function without this cooperation. Therefore, all partners need suggestions concerning goal orientation and consensus. The aim of this discussion is to formulate just such suggestions. To structure this discussion, we have raised the following questions: Must we always be suspicious of the results of studies financed by the pharmaceutical industry? We have to keep in mind that in Germany all clinical trials leading to approval of a drug were supported by the industry. What, exactly, do we want to achieve with our explicit and often justified criticism of these studies? What should be done to achieve a higher validity of the published data if we avoid answering the decisive question of whether we accept the challenge of continuing to let research and teaching be financed by the pharmaceutical industry or reject this kind of cooperation and support altogether.
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Kerkhof PVD, Barker J, Griffiths CEM, Menter A, Leonardi C, Young M, Kemeny L, Pincelli C, Bachelez H, Katsambas A, Ståhle M, Horn EJ, Sterry W. Improving clinical trial design in psoriasis: Perspectives from the global dermatology community. J DERMATOL TREAT 2010; 22:187-93. [DOI: 10.3109/09546634.2010.487888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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