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Parker S, Zhang AL, Zhang CS, Goodman G, Wen Z, Yan Y, Yao D, Wu H, Deng H, Lu C, Xue CC. Add-on effect of PSORI-CM01 to topical calcipotriol for moderate psoriasis vulgaris: A multi-center, randomized, double-blind pilot study. Clin Transl Med 2021; 11:e286. [PMID: 33463052 PMCID: PMC7809599 DOI: 10.1002/ctm2.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mild-moderate psoriasis vulgaris is a common dermatological autoimmune condition with limited conventional therapeutic options. Safe and effective adjunct therapies to topical non-steroidal antipsoriatic therapy are needed. The oral Chinese herbal medicine (CHM) formula PSORI-CM01 has been evidenced potential antipsoriatic pharmacological activity. This article reports a pilot study which was designed as a double-blinded, placebo-controlled randomized controlled trial (RCT) evaluating the effects of PSORI-CM01 when added to topical calcipotriol cream. METHODS People with moderate psoriasis vulgaris were randomized to receive oral PSORI-CM01 or placebo administered for 12 weeks in combination with calcipotriol. The primary clinical outcome was the change of psoriasis area severity index (PASI) score at week 12 and week 24. Secondary clinical outcomes were PASI75, PASI50, relapse rate, change in body surface area, dermatology life quality index and Skindex29, and adverse events (AEs). Participants' satisfaction and willingness to repeat were also assessed. RESULTS The pilot study was conducted in Australia and China, 29 participants were randomized with 26 completed the treatment and follow-up. Participants' baseline basic characteristics were comparable. No between-group statistical significance was found on pre-defined clinical outcome measures, although there seemed a trend of treatment effects favoring the combination of PSORI-CM01 with calcipotriol. Frequency and severity of AEs were similar between two groups, with no severe AEs reported. CONCLUSIONS The design and duration of the study appears feasible. A proper powered RCT with slight adjustments in the methods is needed to reveal the add-on effects of oral CHM PSORI-CM01. The experience and results from this pilot study will contribute to the refine of objectives and design of a future study, and assist the sample size calculation for the full-scale RCT.
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Affiliation(s)
- Shefton Parker
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Greg Goodman
- The Dermatological Institute of Victoria, South Yarra, Victoria, Australia
| | - Zehuai Wen
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yuhong Yan
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Danni Yao
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Huimei Wu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hao Deng
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Chuanjian Lu
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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2
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Read C, Armstrong AW. Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians. JAMA Dermatol 2020; 156:754-762. [PMID: 32374350 DOI: 10.1001/jamadermatol.2020.1054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance How patients' mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions. Objective To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians. Design, Setting, and Participants This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder). Main Outcomes and Measures Patient satisfaction with physician, measured by the patient-physician communication composite score. Results A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001). Conclusions and Relevance This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.
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Affiliation(s)
- Charlotte Read
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.,Department of Medicine, Imperial College London, London, United Kingdom
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
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Young M, Aldredge L, Parker P. Psoriasis for the primary care practitioner. J Am Assoc Nurse Pract 2017; 29:157-178. [PMID: 28233460 DOI: 10.1002/2327-6924.12443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance.
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Affiliation(s)
- Melodie Young
- Modern Dermatology, Baylor-Health Texas Affiliate, Dallas, Texas
| | - Lakshi Aldredge
- Dermatology Service, Operative Care Division, VA Portland Health Care System, Portland, Oregon
| | - Patti Parker
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
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Svendsen MT, Jeyabalan J, Andersen KE, Andersen F, Johannessen H. Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review. J DERMATOL TREAT 2016; 28:374-383. [PMID: 27786594 DOI: 10.1080/09546634.2016.1254331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review published literature describing the global use of topical antipsoriatics. MATERIALS AND METHODS Search for English-language articles in Embase, Pubmed, PsycINFO and Cochrane Library. RESULTS Fifty-four selected publications were found, describing psoriasis patients' use of topical antipsoriatics, using six different methods to collect data. The eight most frequently used topical treatments from the regions North/South America, North/Central/South Europe, Asia, Middle East and Australia were: corticosteroids used by 16-79%, complementary and alternative medicines used by 10-62%, phototherapies used by 0.4-75%, calcipotriol used by 4.2-73%, corticosteroid/calcipotriol combinations used by 3.3-71%, tar used by 0.8-66%, anthralin used by 15% and emollients used as monotherapy by 1-23%. Rates of patient-reported adherence to topical remedies ranged from 51% to 90% and rates of patient-reported satisfaction with topical as it pertains to symptom control ranged from 12% to 52%. CONCLUSION The identified use patterns are varying and reflect a lack of data from large parts of the world and noncomparable studies using heterogeneous study designs. However, this study emphasizes the importance of medical professionals involvement of the patient with respect to choosing prescribed topical treatment and the possibility of patients' use of alternative treatments. More drug utilization studies, both survey and register based, from different parts of the world are needed to provide more conclusive evidence about patients' use of topical antipsoriatics.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- a Department of Dermatology and Allergy Centre , Odense University Hospital , Odense C , Denmark.,b Dermatological Investigations Scandinavia, University of Southern Denmark , Odense C , Denmark.,c Centre for Innovative Medical Technology , Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
| | - Janithika Jeyabalan
- a Department of Dermatology and Allergy Centre , Odense University Hospital , Odense C , Denmark
| | - Klaus Ejner Andersen
- a Department of Dermatology and Allergy Centre , Odense University Hospital , Odense C , Denmark.,b Dermatological Investigations Scandinavia, University of Southern Denmark , Odense C , Denmark.,c Centre for Innovative Medical Technology , Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
| | - Flemming Andersen
- a Department of Dermatology and Allergy Centre , Odense University Hospital , Odense C , Denmark.,b Dermatological Investigations Scandinavia, University of Southern Denmark , Odense C , Denmark
| | - Helle Johannessen
- d Research Unit of User Perspectives, Department of Public Health , University of Southern Denmark , Odense C , Denmark
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Evaluating the economic burden of psoriasis in the United States. J Am Acad Dermatol 2015; 72:961-7.e5. [DOI: 10.1016/j.jaad.2015.02.1099] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/31/2015] [Accepted: 02/09/2015] [Indexed: 02/08/2023]
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Parker S, Zhang AL, Zhang CS, Goodman G, Wen Z, Lu C, Xue CC. Oral granulated Chinese herbal medicine (YXBCM01) plus topical calcipotriol for psoriasis vulgaris: study protocol for a double-blind, randomized placebo controlled trial. Trials 2014; 15:495. [PMID: 25526951 PMCID: PMC4302103 DOI: 10.1186/1745-6215-15-495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022] Open
Abstract
Background Probably related to immune dysfunction, psoriasis vulgaris is a chronic, painful, disfiguring and disabling dermatological disease, carrying an increased risk of serious comorbidities. Current conventional therapies can be costly, show risks of side effects and have limited efficacy, with relapse common on treatment cessation. Chinese herbal medicine is effective in treating psoriasis vulgaris. However, any benefit of adding Chinese herbal medicine to conventional treatments when treating psoriasis vulgaris is yet to be determined. Methods/design This is a pilot randomized, placebo controlled, double-blinded trial. The pilot is primarily to determine the feasibility of undertaking a full size randomized trial. Thirty participants with psoriasis vulgaris and Psoriasis Area Severity Index (PASI) scores ≥7 and ≤12 will be included. Participants will be randomized (in a 1:1 ratio) to receive oral granulated Chinese herbal medicine YXBCM01 plus topical calcipotriol 0.005% or oral YXBCM01 placebo plus topical calcipotriol 0.005% treatment for 12 weeks, with a 12-week follow-up phase. The Chinese herbal medicine or placebo will be administered orally as dissolvable granules. The primary outcome measure will be PASI change (%) from baseline to the end of treatment phase. Secondary outcomes will include safety, key psoriasis-related cytokine changes (for example, IL12, IL17 and IL 23) during the entire trial and symptom relapse rates at the end of the follow-up phase. Discussion The study will evaluate the feasibility of a randomized controlled trial investigating combined conventional and Chinese herbal medicine therapy for psoriasis vulgaris. The ingredients of YXBCM01 were selected based on literature, the expert opinion on herbal medicine and pre-clinical evidence, for instance Chinese herbal medicine possesses anti-inflammatory or antiproliferative properties. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12614000493640.
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Affiliation(s)
| | | | | | | | | | - Chuanjian Lu
- School of Health Sciences, RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia.
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Do YK, Lakhani N, Malhotra R, Halstater B, Theng C, Østbye T. Association between psoriasis and leisure-time physical activity: findings from the National Health and Nutrition Examination Survey. J Dermatol 2014; 42:148-53. [PMID: 25491719 DOI: 10.1111/1346-8138.12721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/08/2014] [Indexed: 01/21/2023]
Abstract
Despite evidence that physical activity can reduce the cardiometabolic risk of patients with psoriasis, these patients may engage in less physical activity than those without psoriasis. The aim of this study was to examine the association of the extent of psoriatic skin lesions with the likelihood of participating in leisure-time moderate to vigorous physical activity (MVPA) and metabolic equivalent task (MET)-minutes of MVPA amongst those who participated. The National Health and Nutrition Examination Survey (NHANES) is a population-based survey among U.S. adults. A total of 6549 persons aged 20-59 years responded to the 2003-2006 NHANES dermatology questionnaires, which asked about participation in leisure-time MVPA and MET-minutes of MVPA amongst those who participated. Compared with individuals without psoriasis, those with psoriasis were less likely to have engaged in leisure MVPA in the past 30 days, although this association was not statistically significant. Amongst those who participated in leisure-time MVPA, MET-minutes of leisure-time MVPA were lower on average for patients currently having few to extensive cutaneous lesions (but not for those currently having little or no psoriatic patches), relative to individuals never diagnosed with psoriasis by approximately 30%. Clinicians should encourage patients with psoriasis, especially those with more severe disease, to be more physically active; they should help identify and address possible psychological and physical barriers to their patients' physical activity.
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Affiliation(s)
- Young Kyung Do
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea; Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
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Akçali C, Guven EH, Kirtak N, Inaloz HS, Ozgoztasi O, Guvenc U. Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis. J Int Med Res 2014; 42:1118-22. [DOI: 10.1177/0300060514539280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. Methods Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3 mg/kg per day cyclosporine or 0.3–0.5 mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. Results PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine ( n = 21) or acitretin ( n = 25). There were no statistically significant between-group differences in any parameter. Conclusions Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.
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Affiliation(s)
- Cenk Akçali
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ebru Homurlu Guven
- Department of Dermatology, Avukat Cengiz Gokcek State Hospital, Gaziantep, Turkey
| | - Necmettin Kirtak
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - H Serhat Inaloz
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Orhan Ozgoztasi
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ulas Guvenc
- Dermatology Clinic, Medical Park Hospital, Tarsus, Turkey
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Feldman SR, Levi E, Pathak P, Kakatkar S, Balkrishnan R. Using a single product (calcipotriene/betamethasone topical suspension) vs multiple products to manage body and scalp psoriasis: comparisons in resource utilization and costs. J Med Econ 2013; 16:1405-13. [PMID: 24063352 DOI: 10.3111/13696998.2013.848209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare resource utilization and costs among patients who used calcipotriene/betamethasone dipropionate topical suspension (Taclonex Scalp Topical Suspension, Leo Pharma A/S) vs those who used multiple body and scalp formulations for psoriasis. RESEARCH DESIGN AND METHODS A retrospective study using Truven Health MarketScan Commercial Database from 2006-2011 was performed to identify patients with psoriasis (ICD code 696.1x). Two study cohorts analyzed were cohort A (used body-only formulations for psoriasis and switched on the index date to using calcipotriene/betamethasone dipropionate topical suspension alone) and cohort B (used multiple body and scalp formulations for psoriasis). Patients were required to be continuously enrolled during 180-days pre- and post-index periods. Multiple regression analyses adjusting for baseline demographic and clinical covariates were performed. MAIN OUTCOMES MEASURES Number of psoriasis-related outpatient visits, total healthcare costs, psoriasis-related costs, and use of systemic agents during post-index period. RESULTS A total of 1923 patients were identified with at least one prescription for calcipotriene/betamethasone dipropionate scalp topical suspension (cohort A = 367, cohort B = 1556). Patients using multiple medications (cohort B) were associated with 48% higher number of outpatient visits as compared with those who used a single formulation (cohort A) after controlling for baseline covariates (p < 0.001). A generalized linear model adjusting for baseline covariates showed significantly higher post-index total and psoriasis-related healthcare costs for cohort B as compared with cohort A (both p < 0.001). Patients in Cohort B also had twice the odds of using systemic agents as compared to patients in Cohort A (p < 0.001). CONCLUSIONS Patients with body and scalp psoriasis using a single product had significantly lower overall and psoriasis-related healthcare costs, needed fewer psoriasis-related outpatient visits, and used less systemic agents during the post-index period. A lack of robust clinical measures to define the disease severity may have limited the interpretations from this study.
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Zhuang XM, Zhong YH, Xiao WB, Li H, Lu C. Identification and Characterization of Psoralen and Isopsoralen as Potent CYP1A2 Reversible and Time-Dependent Inhibitors in Human and Rat Preclinical Studies. Drug Metab Dispos 2013; 41:1914-22. [DOI: 10.1124/dmd.113.053199] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Lara-Corrales I, Corrales IL, Ramnarine S, Lansang P. Treatment of childhood psoriasis with phototherapy and photochemotherapy. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2013; 7:25-33. [PMID: 23966809 PMCID: PMC3735876 DOI: 10.4137/cmped.s8045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Phototherapy and photochemotherapy are well-described treatment modalities for psoriasis in adults. Like many other treatments, the experience and long-term safety of their use in children is limited. We conducted a literature search and identified publications reporting the use of phototherapy and photochemotherapy in pediatric populations. This article summarizes the existing literature on this topic. Although many studies report good improvement with these treatment modalities, long-term safety data on their use is lacking for pediatric patients.
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Affiliation(s)
| | - Irene Lara Corrales
- Assistant Professor of Pediatrics, University of Toronto, Staff Physician Pediatric Dermatology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8
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12
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Feldman SR, Matheson R, Bruce S, Grande K, Markowitz O, Kempers S, Brundage T, Wyres M. Efficacy and safety of calcipotriene 0.005% foam for the treatment of plaque-type psoriasis: results of two multicenter, randomized, double-blind, vehicle-controlled, phase III clinical trials. Am J Clin Dermatol 2012; 13:261-71. [PMID: 22587791 DOI: 10.2165/11630710-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Topical calcipotriene is frequently prescribed for the treatment of plaque-type psoriasis. Calcipotriene is currently available in the US as an ointment, a solution, a cream, and in a fixed-dose combination ointment with betamethasone dipropionate. Calcipotriene 0.005% has recently been formulated as a foam using a novel aqueous-based formulation to provide a new topical treatment option for patients with psoriasis. OBJECTIVE The objective of this study was to evaluate the efficacy and safety of topical calcipotriene 0.005% foam for the treatment of mild to moderate plaque-type psoriasis. DESIGN Two identical, randomized, double-blind, vehicle-controlled, 8-week phase III clinical trials. INTERVENTION Subjects with plaque-type psoriasis affecting 2-20% of the body surface area, with an identifiable target lesion affecting the trunk or extremities, were randomized in a 2:1 ratio to calcipotriene foam (n = 437) or vehicle foam (n = 222). Study medication was applied twice daily for 8 weeks. OUTCOME MEASURES Treatment success was defined as a score of 0 or 1 (clear or almost clear) on the Investigator's Static Global Assessment (ISGA) psoriasis rating scale and a minimum improvement of ISGA score of at least 2 grades from baseline. Predefined target lesions were assessed for erythema, scaling, and plaque thickness. Primary endpoint was the proportion of subjects in each treatment group who achieved treatment success after 8 weeks, analyzed on an intent-to-treat (ITT) basis. In the primary endpoint analysis, subjects missing 8-week outcomes data were classified as treatment failures regardless of their outcomes at earlier evaluations. As part of the sensitivity analysis, a last-observation-carried-forward (LOCF) approach to impute missing 8-week efficacy outcomes also examined treatment. Secondary endpoints included treatment success as a function of baseline ISGA score (mild or moderate), ISGA score of 0 or 1 (clear or almost clear), and effects of treatment on target lesion. Adverse events (AEs) were recorded throughout the study. RESULTS In the ITT population of Study 1, treatment success after 8 weeks was achieved by 14% of subjects in the calcipotriene foam group versus 7% of subjects in the vehicle foam group (p = 0.058). In the LOCF analysis, treatment success was achieved by more subjects with calcipotriene foam than with vehicle foam (15% vs 7%; p = 0.034). In Study 2, treatment success was achieved by more subjects in the calcipotriene foam group for the primary endpoint (27% vs 16%; p = 0.016) and the LOCF analysis (28% vs 16%; p = 0.010). Subjects in the calcipotriene foam group exhibited better response rates than did the vehicle foam group for most of the secondary outcomes. Calcipotriene foam was safe with an overall incidence of AEs similar to those experienced in the vehicle foam group. Application-site reactions were noted in approximately 1-2% of subjects in each group. No AE was reported in more than 2% of subjects in the calcipotriene foam group. Treatment was discontinued because of AEs in approximately 2% of subjects in both groups. CONCLUSIONS In two identically designed, phase III clinical trials, calcipotriene 0.005% foam was safe and effective for the treatment of mild to moderate plaque-type psoriasis for up to 8 weeks. CLINICAL TRIAL REGISTRATION Registered at clinicaltrials.gov: NCT00688519 and NCT00689481.
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Affiliation(s)
- Steven R Feldman
- Wake Forest University Health Sciences, Winston-Salem, NC 27104, USA.
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KHLEBNIKOVA AN. Current approaches to the external therapy of psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2012. [DOI: 10.25208/vdv654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Topical glucocorticosteroids rank first among drugs for the external therapy of psoriasis. When selecting a drug, it is necessary to take into account the disease sensitivity to different classes of topical steroids. Dermovate (clobetasol propionate) is the most efficient drug for the external therapy of moderate to severe psoriasis. When this drug was used as a part of the complex treatment of psoriasis, regression of eruptions was observed within three weeks in 97.4% of patients, and in 91.5% of patients if the process was localized in the area of palms and soles. Major indications for its use are torpidity with regard to the previous therapy, localization in the field of palms and soles, and substantial reduction in the life quality.
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Prizment AE, Alonso A, Folsom AR, Ahmed RL, Virnig BA, Warshaw EM, Anderson KE. Association between psoriasis and incident cancer: the Iowa's Women's Health Study. Cancer Causes Control 2011; 22:1003-10. [PMID: 21553077 DOI: 10.1007/s10552-011-9773-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 04/23/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Studies have reported higher cancer risk in individuals with psoriasis, a chronic inflammatory autoimmune disease; however, adjustment for potential confounders was lacking. METHODS We examined the association of psoriasis with cancer incidence in 32,910 women after age 65 in the IWHS cohort linked to Medicare. Psoriasis was defined as: 2+ psoriasis claims from any Medicare file during 1991-2004 or 1+ psoriasis claim from a dermatologist (n = 719). Severe psoriasis was defined as 4+ psoriasis claims from a dermatologist in any year (n = 121). Cox proportional hazards regression, with psoriasis as a time-dependent variable was conducted to calculate hazard ratios (HR) and 95% confidence intervals (CI) of total (n = 6,488), breast (n = 2,066), lung (n = 742), and colon cancers (n = 947). RESULTS With age-adjustment, psoriasis (yes vs. no) was associated with increased risk of lung 1.9 (95% CI: 1.2-3.0), colon 1.6 (95% CI: 1.1-2.5), and total cancer 1.2 (95% CI, 1.0-1.4). After further adjustment for smoking, body mass index, education, physical activity, and hormone therapy use, only the association for colon cancer remained statistically significant (HR = 1.6, 95% CI: 1.0-2.4) and was stronger for severe psoriasis. CONCLUSION The observed association between psoriasis and colon cancer may reflect inflammatory or unidentified processes.
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Affiliation(s)
- Anna E Prizment
- Division of Epidemiology and Community Health, University of Minnesota, 1300 2nd Street South, Suite 300, Minneapolis, MN 55455, USA.
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Daudén E, Conejo J, García-Calvo C. Percepción del médico y paciente de la gravedad de la psoriasis, su impacto en la calidad de vida y satisfacción con la atención y el tratamiento recibido. Estudio observacional en España. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:270-6. [DOI: 10.1016/j.ad.2010.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/21/2010] [Indexed: 12/01/2022] Open
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Lin HC, Lucas PT, Feldman SR, Balkrishnan R. Medication use and associated health care outcomes and costs for patients with psoriasis in the United States. J DERMATOL TREAT 2011; 23:196-202. [DOI: 10.3109/09546634.2010.544708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Daudén E, Conejo J, García-Calvo C. Physician and Patient Perception of Disease Severity, Quality of Life, and Treatment Satisfaction in Psoriasis: An Observational Study in Spain. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70802-2] [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] Open
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Khlebnikova AN. Clobetasol propionate (Dermovate) gives new opportunities in the treatment ofdermatoses. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The author provides a review of literature covering studies of the efficacy and safety of a very powerful topical corticosteroid -
clobetasol propionate (Dermovate). It surpasses most topical glucocorticoids by its action and efficacy for steroid-responsive
dermatoses. The drug has several forms convenient for use for different localizations. It is a drug of choice for medium and severe
psoriasis. It is efficient in treatment of a wide range of torpid dermatoses as well as dermatoses resistant to other topical drugs.
This drug is safe under the condition of its reasonable administration. The development of serious complications is possible only
in case of long-term administration of extremely high doses.
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Duarte I, Cunha JAJD, Bedrikow RB, Lazzarini R. Qual é o tipo de fototerapia mais comumente indicada no tratamento da psoríase?: UVB banda estreita e PUVA: comportamento da prescrição. An Bras Dermatol 2009; 84:244-8. [DOI: 10.1590/s0365-05962009000300005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/04/2009] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Formas moderada e grave de psoríase requerem fototerapia e/ou medicações sistêmicas. Tanto UVB banda estreita quanto fototerapia UVA com psoralênicos (PUVA) podem ser utilizadas no tratamento dessas formas de psoríase, sendo comprovada a efetividade de ambas as terapias. OBJETIVOS: Avaliar as indicações de dois tipos de fototerapia no tratamento da psoríase refratária à terapia tópica: UVB banda estreita e PUVA. MÉTODOS: Entre janeiro de 2006 e dezembro de 2007, os pacientes encaminhados a dois serviços de fototerapia foram incluídos neste estudo. Dados sobre os casos e tipos de prescrição foram coletados de maneira retrospectiva. RESULTADOS: Dentre os 67 pacientes estudados, 51 (76%) foram tratados com UVB banda estreita. As razões para sua indicação foram presença de psoríase em gotas (22%), presença de finas placas (15%), uso de drogas fotossensibilizantes (15%), idade abaixo de 20 anos (9%), fototipo I (9%) e doença hepática (6%). Os 16 (24%) restantes foram tratados com PUVA. A principal indicação dessa terapia foi gravidade da doença (15%), seguida de fototipo IV (9%). CONCLUSÕES: As prescrições de UVB banda estreita excederam as de PUVA devido ao menor número de contraindicações, menor possibilidade de efeitos colaterais, e ainda por ser uma opção mais prática.
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Affiliation(s)
- Ida Duarte
- Faculdade de Medicina da Santa Casa de São Paulo
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Horn EJ, Fox KM, Patel V, Chiou CF, Dann F, Lebwohl M. Are patients with psoriasis undertreated? Results of National Psoriasis Foundation survey. J Am Acad Dermatol 2007; 57:957-62. [PMID: 17706322 DOI: 10.1016/j.jaad.2007.06.042] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 05/31/2007] [Accepted: 06/17/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to assess whether patients with psoriasis with moderate or severe disease are being treated with systemic therapy. METHODS Participants were identified from a random sample of the National Psoriasis Foundation contact database who were 18 years and older, with severe psoriasis (>10% body surface area) and moderate psoriasis (3%-10% body surface area); respondents with psoriatic arthritis were excluded. RESULTS In all, 1657 respondents with psoriasis completed the survey (28% severe, 41% moderate). A total of 39% of respondents with severe psoriasis and 37% with moderate psoriasis were not currently receiving any treatment. Among respondents currently receiving therapy, only 43% of respondents with severe psoriasis received either traditional systemic therapy, biologic therapy, or phototherapy. LIMITATIONS Respondents were from the National Psoriasis Foundation contact database and reported their current severity, which may be affected by their treatment. Body surface area as a measure of patient-reported severity has not been validated but has been used in several published studies. CONCLUSIONS Almost 40% of respondents with psoriasis were currently not receiving treatment. For respondents with severe psoriasis, 26% were treated with systemic therapy, phototherapy, or both; 39% were not in treatment; and 35% were treated with topical therapy alone.
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Pearce DJ, Camacho F, Balkrishnan R, Fleischer AB, Feldman SR. Trends in on and off-label calcipotriene use. J DERMATOL TREAT 2007; 17:308-13. [PMID: 17092863 DOI: 10.1080/09546630600813659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Following its introduction in 1994, calcipotriene quickly became the single most prescribed medication for psoriasis according to National Ambulatory Medical Care Survey (NAMCS) data. Primarily through regulation of cellular differentiation, calcipotriene may be effective in dermatoses other than psoriasis. We characterize the clinical trends in the utilization of calcipotriene by analyzing a representative sample of visits to US physicians. Demographic characteristics, specialty of the provider, and off-label uses are reported. Calcipotriene was mentioned at 5.8 million of all NAMCS visits during the study period. Nearly 57% of mentions of calcipotriene were not linked to a diagnosis of psoriasis. Adjusted use for gender and race were relatively stable; there was a rise in non-psoriasis uses and use among non-dermatologists in 1997. Our findings support previous reports of the utility of calcipotriene in treating other dermatoses as witnessed by the numerous conditions for which its use was observed. Physicians and policy-makers should be aware of the role that this medication plays in the delivery of dermatologic care.
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Affiliation(s)
- Daniel J Pearce
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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