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Costache DO, Bejan H, Poenaru M, Costache RS. Skin Cancer Correlations in Psoriatic Patients. Cancers (Basel) 2023; 15:cancers15092451. [PMID: 37173917 PMCID: PMC10177598 DOI: 10.3390/cancers15092451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Psoriasis is a common chronic, immune-mediated, inflammatory disease with associated comorbidities. Common psoriasis-associated comorbidities include psoriatic arthritis, cardiovascular disease, metabolic syndrome, inflammatory digestive syndromes, and depression. A less studied association is between psoriasis and specific-site cancers. A key cell in the pathophysiology of psoriasis is the myeloid dendritic cell, which links the innate and adaptive immune systems, and therefore is involved in the control of cancer-prevention mechanisms. The relationship between cancer and inflammation is not new, with inflammation being recognized as a key element in the development of neoplastic foci. Infection leads to the development of local chronic inflammation, which further leads to the accumulation of inflammatory cells. Various phagocytes produce reactive oxygen species that cause mutations in cellular DNA and lead to the perpetuation of cells with altered genomes. Therefore, in inflammatory sites, there will be a multiplication of cells with damaged DNA, leading to tumor cells. Over the years, scientists have tried to assess the extent to which psoriasis can increase the risk of developing skin cancer. Our aim is to review the available data and present some information that might help both the patients and the care providers in properly managing psoriatic patients to prevent skin cancer development.
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Affiliation(s)
- Daniel Octavian Costache
- II Dermatology Discipline, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Bejan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Marcela Poenaru
- Dermatology Department, Carol Davila University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Raluca Simona Costache
- Internal Medicine and Gastroenterology Discipline, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Eun Y, Hwang J, Seo GH, Ahn JK. Risk of cancer in Korean patients with psoriatic arthritis: a nationwide population-based cohort study. RMD Open 2023; 9:rmdopen-2022-002874. [PMID: 36958767 PMCID: PMC10040019 DOI: 10.1136/rmdopen-2022-002874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE While many studies on the increased risk of cancer in patients with psoriasis are available, data on the risk of cancer in patients with psoriatic arthritis (PsA) are still scarce. We assessed the risk of cancer in patients with PsA in a nationwide population-based cohort in Korea. METHODS From 2010 to June 2021, patients newly diagnosed with PsA and 1:10 age-matched and sex-matched controls were included in this study. The outcome was the incidence of overall and specific cancers. RESULTS Total 162 cancers occurred in 4688 PsA patients (incidence rate 83.2 (95% CI 70.8 to 97.0) per 10 000 person-years) and 1307 cancers occurred in 46 880 controls (incidence rate 66.9 (95% CI 63.3 to 70.6) per 10 000 person-years). The adjusted HR (aHR) of overall cancer in PsA patients was 1.20 (95% CI 1.02 to 1.41). However, this significance disappeared when non-melanoma skin cancer (NMSC) was excluded (aHR 1.16, 95% CI 0.98 to 1.37). Among specific cancers, the risk of NMSC (aHR 3.64 (95% CI 1.61 to 8.23)), lymphoma (aHR 2.63 (95% CI 1.30 to 5.30)) and thyroid cancer (aHR 1.83 (95% CI 1.18 to 2.85)) was higher in patients with PsA than in controls. CONCLUSION The risk of overall cancer was higher in patients with PsA than in the general population. Patients with PsA had increased risks of NMSC, lymphoma and thyroid cancer compared with the general population. Our findings suggest a need to conduct cancer screening by a detailed history and comprehensive clinical examination in patients with PsA.
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Affiliation(s)
- Yeonghee Eun
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jiwon Hwang
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Gi Hyeon Seo
- Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Joong Kyong Ahn
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Bellinato F, Gisondi P, Girolomoni G. Risk of lymphohematologic malignancies in patients with chronic plaque psoriasis: A systematic review with meta-analysis. J Am Acad Dermatol 2021; 86:86-96. [PMID: 34363908 DOI: 10.1016/j.jaad.2021.07.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The association between chronic plaque psoriasis and lymphohematologic malignancies (LHMs) remains controversial. OBJECTIVE To investigate the risk of LHMs in patients with psoriasis according to the best evidence. METHODS A systematic review and meta-analysis of observational cohort studies was undertaken to assess the association of psoriasis with different LHMs. A literature search for relevant studies was performed on February 28, 2021. The random-effects model in conducting meta-analyses was applied. To evaluate the risk of bias, the Newcastle-Ottawa Scale was employed. RESULTS A total of 25 observational studies were selected, comprising collectively 2,501,652 subjects. A significantly increased risk for LHM (hazard ratio [HR], 1.55; 1.24-2.94) and lymphoma (HR, 1.27; 1.08-1.50) in patients with moderate-to-severe plaque psoriasis compared to the general population was found. In detail, increased risks for Hodgkin lymphoma (HR, 1.71; 1.27-2.30), non-Hodgkin lymphoma (HR, 1.27; 1.08-1.50), multiple myeloma (HR, 1.32; 1.03-1.69), and leukemia (HR, 1.28; 1.00-1.65) were found. The risk of cutaneous T-cell lymphoma was markedly augmented in patients with psoriasis (HR, 6.22; 3.39-11.42). LIMITATIONS Possible ascertainment bias related to the diagnosis of LHMs. CONCLUSION The increased risk of LHMs, particularly cutaneous T-cell lymphoma, in patients with psoriasis could be related to exposure to systemic immunosuppressive therapies, comorbidities, and sustained immune activation, particularly in the skin.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ. Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review. Am J Clin Dermatol 2021; 22:425-442. [PMID: 33861409 PMCID: PMC8051287 DOI: 10.1007/s40257-021-00603-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2021] [Indexed: 02/06/2023]
Abstract
The emergence of data from clinical trials of biologics, the approval of new biologics, and our improved understanding of psoriasis pathogenesis have increased the therapeutic possibilities for the treatment of moderate-to-severe psoriasis. Biologics currently approved for the treatment of psoriasis include tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, ustekinumab (an IL-12/23 inhibitor), and IL-23 inhibitors. Data from clinical trials and studies of the safety and efficacy of biologics provide essential information for the personalization of patient care. We discuss the benefits and disadvantages of biologics as a first-line treatment choice, update treatment recommendations according to current evidence, and propose psoriasis treatment algorithms. Our discussion includes the following comorbid conditions: psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, nonmelanoma skin cancer, lymphoma, and latent tuberculosis. We make evidence-based treatment recommendations for special populations, including pediatric patients, patients with coronavirus 2019 (COVID-19), and pregnant and breastfeeding patients with psoriasis. Ultimately, individualized recommendations that consider patient preferences, disease severity, comorbid conditions, and additional risk factors should be offered to patients and updated as new trial data emerges.
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Charakopoulos E, Spyrou I, Viniou NA, Giannakopoulou N, Hatzidavid S, Diamantopoulos PT. A case report of Hodgkin lymphoma in a patient treated with ustekinumab for psoriasis. Medicine (Baltimore) 2020; 99:e20048. [PMID: 32481271 PMCID: PMC7249998 DOI: 10.1097/md.0000000000020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/08/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ustekinumab is a biological agent that inhibits interleukin 12 and 23 and has been approved for the treatment of moderate and severe plaque psoriasis. There have been case reports that raise concerns about its oncogenic potential. We are the first authors to report a case of Hodgkin lymphoma in a psoriatic patient receiving ustekinumab. PATIENT CONCERNS A 22-year-old asymptomatic female patient presented to our department to investigate an enlarged cervical lymph node. Her past history was unremarkable, except for psoriasis since age 13. Two months before presentation the decision to administer Ustekinumab was taken and the patient had already received 3 doses. DIAGNOSES During workup a Stage IV Hodgkin lymphoma was discovered. INTERVENTIONS Ustekinumab administration was discontinued. The patient received treatment with the ABVD regimen. OUTCOMES The patient's disease was refractory to the above-mentioned treatment. Therefore, a more aggressive regimen (BEACOPP escalated) was administered. LESSONS Growing postmarketing surveillance data and case reports indicate that further research is warranted in order to elucidate a potential association between Ustekinumab and malignancy.
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Vaengebjerg S, Skov L, Egeberg A, Loft ND. Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:421-429. [PMID: 32074260 PMCID: PMC7042857 DOI: 10.1001/jamadermatol.2020.0024] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Importance The association between psoriasis and risk of cancer remains debatable. Objective To evaluate the association and risk of cancer in patients with psoriasis or psoriatic arthritis, including risk of specific cancer subtypes. Data Sources Two databases (PubMed and Embase) were screened from inception to January 1, 2019, using the search string psoriasis or psoriatic and neoplasms or malignancy or cancer. The search was filtered to only include human participants and publications in English. Study Selection Observational cohort studies with a population of patients with psoriasis or psoriatic arthritis were included. Studies had to be original and report the incidence or prevalence of cancer within this population. Studies evaluating pediatric populations and cancer types not included in the protocol were excluded. Data Extraction and Synthesis This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search string, objectives, and study protocol methods were defined before the study was initiated. A total of 365 studies were included for full-text assessment. Owing to the heterogeneity of the included studies, a random-effects model was used. Main Outcomes and Measures Main outcome was cancer (overall and specific subtypes) and measures were prevalence, incidence, and risk estimate for cancer in patients with psoriasis or psoriatic arthritis. Results Of the 365 studies assessed, 112 were included in the analysis (N = 2 053 932 patients). The overall prevalence of cancer in patients with psoriasis was 4.78% (95% CI, 4.02%-5.59%), with an incidence rate of 11.75 per 1000 person-years (95% CI, 8.66-15.31) and a risk ratio (RR) of 1.21 (95% CI, 1.11-1.33). There was an increased risk of several cancers, including keratinocyte cancer (RR, 2.28; 95% CI, 1.73-3.01), lymphomas (RR, 1.56; 95% CI, 1.37-1.78), lung cancer (RR, 1.26; 95% CI, 1.13-1.40), and bladder cancer (RR, 1.12; 95% CI, 1.04-1.19). No increased risk of cancer for patients with psoriasis treated with biologic agents was found (RR, 0.97; 95% CI, 0.85-1.10). Psoriatic arthritis was not associated with increased risk of cancer overall (RR, 1.02; 95% CI, 0.97-1.08). Conclusions and Relevance Patients with psoriasis appear to have a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas. Data on treatment with biologic agents did not show an increased risk of cancer. Data on cancer in patients with psoriatic arthritis remain scarce, and further research is warranted in this area.
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Affiliation(s)
- Sofie Vaengebjerg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Dyrberg Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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7
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Wang X, Liu Q, Wu L, Nie Z, Mei Z. Risk of non-melanoma skin cancer in patients with psoriasis: An updated evidence from systematic review with meta-analysis. J Cancer 2020; 11:1047-1055. [PMID: 31956351 PMCID: PMC6959083 DOI: 10.7150/jca.37015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/20/2019] [Indexed: 12/21/2022] Open
Abstract
BackgroundPsoriasis is a chronic inflammatory skin disorder which may result in an increased cancer risk due to defects of immune surveillance. The relationship between psoriasis and risk of non-melanoma skin cancer (NMSC) has not yet been fully determined. The aim of this study was to update the evidence on the association between psoriasis and risk of NMSC. MethodsWe conducted an extensive literature search of publications in Pubmed, EMBASE, and Cochrane Library without restrictions on language from inception through August 2019 using predefined keywords. Eligible observational studies were selected if they assessed the risk ratio of NMSC in patients with psoriasis. Data from included studies were extracted, and meta-analysis was performed using random-effects models. ResultsSixteen cohort studies involving 16,023,503 participants published between 1999 and 2019 met inclusion criteria and were included in this systematic review. Meta-analysis demonstrated that compared with patients without psoriasis, patients with psoriasis had 1.72 times higher risk of developing NMSC (RR, 1.72, 95% CI 1.46 to 2.02). Patients with moderate to severe psoriasis had higher risk of NMSC (RR, 1.82, 95% CI 1.38 to 2.41) than those had mild psoriasis (RR, 1.61, 95% CI 1.25 to 2.09) (P for interaction<0.001). Moreover, patients with psoriasis had significantly higher risk of squamous cell carcinoma (RR, 2.08, 95% CI 1.53 to 2.83) than that of basal cell carcinoma (RR, 1.28, 95% CI 0.81 to 2.00) (P for interaction<0.001). ConclusionsCurrent evidence suggests that patients with psoriasis may have a higher risk of NMSC than psoriasis-free patients. Periodic screening for specific cancer risk is warranted in patients with psoriasis.
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Affiliation(s)
- Xiujuan Wang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, People's Republic of China
| | - Qiang Liu
- Department of Medical Acupuncture, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.,National Clinical Research Center for Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Lingling Wu
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, People's Republic of China
| | - Zhenhua Nie
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, People's Republic of China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
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8
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Systematic analysis of genes and diseases using PheWAS-Associated networks. Comput Biol Med 2019; 109:311-321. [DOI: 10.1016/j.compbiomed.2019.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 02/08/2023]
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9
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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10
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Rademaker M, Rubel DM, Agnew K, Andrews M, Armour KS, Baker C, Foley P, Gebauer K, Goh MS, Gupta M, Marshman G, Prince HM, Sullivan J. Psoriasis and cancer. An Australian/New Zealand narrative. Australas J Dermatol 2018; 60:12-18. [PMID: 29992535 DOI: 10.1111/ajd.12889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 12/16/2022]
Abstract
Patients with psoriasis have an increased risk of cancer, which may be due to impaired immune surveillance, immune modulatory treatments, chronic inflammation and/or co-risk factors such as obesity. The increase in treatment-independent solid cancers, including urinary/bladder cancers, oropharynx/larynx, liver/gallbladder and colon/rectal cancers, seem to be linked to alcohol and smoking. Lung cancer and nonmelanoma skin cancer are also increased in patients with psoriasis. The risk of nonmelanoma skin cancer increases with age and severity of psoriasis. It is also higher in men, particularly for squamous cell carcinoma, which may reflect previous exposure to PUVA and/or ciclosporin. The risk of cutaneous T-cell lymphoma is substantially higher in patients with moderate-to-severe psoriasis. Biologic therapies are independently associated with a slight increase risk of cancer, but this is less than ciclosporin, with the risk confounded by disease severity and other co-risk factors. The risk of cancer from low-dose methotrexate is likely minimal. In contrast, acitretin is likely protective against a variety of solid and haematological malignancies. The data on small molecule therapies such as apremilast are too immature for comment, although no signal has yet been identified. The decision whether to stop psoriasis immune modulatory treatments following a diagnosis of cancer, and when to resume, needs to be considered in the context of the patients' specific cancer. However, there is no absolute need to stop any treatment other than possibly ciclosporin, unless there is a concern over an increased risk of serious infection or drug-drug interaction with cancer-directed therapies, including radiotherapy.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical School, Auckland University Medical School, Hamilton, New Zealand
| | - Diana M Rubel
- Woden Dermatology, Phillip, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Agnew
- Dermatology Department, Greenlane Clinical Centre & Starship Children's Hospital, Auckland, New Zealand
| | | | | | - Christopher Baker
- Skin & Cancer Foundation Inc., Carlton, Victoria, Australia.,St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Fitzroy and Probity Medical Research, Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Michelle Sy Goh
- Skin & Cancer Foundation Inc., Carlton, Victoria, Australia.,St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Flinders University Medical School, Adelaide, South Australia, Australia
| | - H Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - John Sullivan
- Kingsway Dermatology, Miranda, New South Wales, Australia
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11
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Adult sepsis - A nationwide study of trends and outcomes in a population of 23 million people. J Infect 2017; 75:409-419. [PMID: 28851532 DOI: 10.1016/j.jinf.2017.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine the trend of incidence and outcome of sepsis based on a nationwide administrative database. METHODS We analyzed the incidence and mortality of both emergency department treated and hospital treated sepsis from 2002 through 2012 using the entire health insurance claims data of Taiwan. The national health insurance covers 99% of residents in Taiwan. Sepsis patients were identified using a set of validated ICD-9CM codes conforming to the sepsis-3 definition. The 30-day all-cause mortality was verified by linked death certificate database. RESULTS During the 11-year study period, a total of 1,259,578 episodes of sepsis was identified. The mean incidence rate was 639 per 100,000 person-years, increasing from 637.8/100,000 persons in 2002 to 772.1/100,000 persons in 2012 (annual increase: 1.9%). The mortality rate, however, has decreased from 27.8% in 2002 to 22.8% in 2012 (annual decrease: 0.45%). The trend of incidence and mortality did not change after standardization by age and gender using 2002 as the reference standard. CONCLUSION We showed that the incidence of sepsis has increased while the mortality has decreased in Taiwan. Despite the decreasing trend in sepsis mortality, the total number of sepsis mortality remains increasing due to the rapid increase in sepsis incidence.
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13
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Wu CW, Wu JY, Lee MTG, Lai CC, Wu IL, Tsai YW, Chang SS, Lee CC. Risk of incident active tuberculosis disease in patients treated with non-steroidal anti-inflammatory drugs: a population-based study. BMC Pulm Med 2017; 17:82. [PMID: 28472944 PMCID: PMC5418697 DOI: 10.1186/s12890-017-0425-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 04/27/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mycobacterium tuberculosis (TB) is one of the world's most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease. METHODS We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan's national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs ≧ 7 days that ended between 31 and 90 days prior to the index date. RESULTS A total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95% [CI], 1.24 - 1.57 and DRS adjusted analysis ([ARR], 1.30; 95% [CI], 1.15- 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95% [CI], 0.89 - 1.70). CONCLUSIONS In this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.
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Affiliation(s)
- Chun-Wei Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jiunn-Yih Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Meng-Tse Gabriel Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - I-Lin Wu
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yi-Wen Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital and School of Medicine, Taipei Medical University, Taipei, 110, Taiwan. .,Department of Family Medicine, Taipei Medical University Hospital, No.252, Wuxing St, Xinyi District, Taipei, Taiwan.
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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14
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Saleem MD, Kesty C, Feldman SR. Relative versus absolute risk of comorbidities in patients with psoriasis. J Am Acad Dermatol 2016; 76:531-537. [PMID: 27986396 DOI: 10.1016/j.jaad.2016.11.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/03/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psoriasis is associated with numerous comorbidities, often reported in terms of relative risk. Both doctors and the general population tend to overestimate the effects of exposures when presented in relative terms, leading to anxiety and potentially poor treatment decisions. Absolute risks might provide a better basis for risk assessment. OBJECTIVE To characterize and compare relative and absolute risks of comorbidities in patients with psoriasis. METHODS A systematic review using Medline identified comorbidities associated with psoriasis, their relative risks, and information for calculating absolute risks. RESULTS The comorbidities associated with psoriasis with the highest relative risk were nonmelanoma skin cancer, melanoma, and lymphoma, with relative risks of 7.5, 6.12, and 3.61, respectively; the attributable risk for these 3 conditions were 0.64, 0.05, and 0.17 per 1000 person-years, respectively. To attribute 1 event of these conditions to psoriasis would require seeing 1551; 20,135; and 5823 patients, respectively. LIMITATIONS Database studies might not fully account for confounders, resulting in overestimates of the risk impact of comorbidities. CONCLUSIONS Presenting attributable risk in the form of the number needed to harm provides a clearer picture of the magnitude of risk and a basis for wiser medical decision making and patient education.
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Affiliation(s)
- Mohammed D Saleem
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Chelsea Kesty
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Public Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Dai H, Li WQ, Qureshi AA, Han J. Personal history of psoriasis and risk of nonmelanoma skin cancer (NMSC) among women in the United States: A population-based cohort study. J Am Acad Dermatol 2016; 75:731-735. [DOI: 10.1016/j.jaad.2016.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 02/08/2023]
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Wu JY, Lee MTG, Lee SH, Lee SH, Tsai YW, Hsu SC, Chang SS, Lee CC. Angiotensin-Converting Enzyme Inhibitors and Active Tuberculosis: A Population-Based Study. Medicine (Baltimore) 2016; 95:e3579. [PMID: 27175655 PMCID: PMC4902497 DOI: 10.1097/md.0000000000003579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Numerous epidemiological data suggest that the use of angiotensin-converting enzyme inhibitors (ACEis) can improve the clinical outcomes of pneumonia. Tuberculosis (TB) is an airborne bacteria like pneumonia, and we aimed to find out whether the use of ACEis can decrease the risk of active TB.We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan national health insurance research database. The rate ratios (RRs) for TB were estimated by conditional logistic regression, and adjusted using a TB-specific disease risk score (DRS) with 71 TB-related covariates.From January, 1997 to December, 2011, a total of 75,536 users of ACEis, and 7720 cases of new active TB were identified. Current use (DRS adjusted RR, 0.87 [95% CI, 0.78-0.97]), but not recent and past use of ACEis, was associated with a decrease in risk of active TB. Interestingly, it was found that chronic use (>90 days) of ACEis was associated with a further decrease in the risk of TB (aRR, 0.74, [95% CI, 0.66-0.83]). There was also a duration response effect, correlating decrease in TB risk with longer duration of ACEis use. The decrease in TB risk was also consistent across all patient subgroups (age, sex, heart failure, cerebrovascular diseases, myocardial infraction, renal diseases, and diabetes) and patients receiving other cardiovascular medicine.In this large population-based study, we found that subjects with recent and chronic use of ACEis were associated with decrease in TB risk.
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Affiliation(s)
- Jiunn-Yih Wu
- From the Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan (J-YW, S-CH); Department of Emergency Medicine, National Taiwan University Hospital (M-TGL, S-HL, C-CL); Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital (S-HL); Department of Medicine, College of Medicine, National Yang Ming University, Taipei (S-HL); Department of Family Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine (Y-WT, S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan (S-SC); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yun-lin Branch, Douliou (C-CL), Taiwan
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Bhushan R, Lebwohl MG, Gottlieb AB, Boyer K, Hamarstrom E, Korman NJ, Kirsner RS, Sober AJ, Menter A. Translating psoriasis guidelines into practice: Important gaps revealed. J Am Acad Dermatol 2016; 74:544-51. [DOI: 10.1016/j.jaad.2015.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 01/18/2023]
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Li WQ, Han J, Cho E, Wu S, Dai H, Weinstock MA, Qureshi AA. Personal history of psoriasis and risk of incident cancer among women: a population-based cohort study. Br J Dermatol 2016; 174:1108-11. [PMID: 26582001 DOI: 10.1111/bjd.14301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- W-Q Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A..
| | - J Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, U.S.A.,Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, U.S.A
| | - E Cho
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - S Wu
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - H Dai
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, U.S.A.,Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, U.S.A
| | - M A Weinstock
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Center for Dermatoepidemiology, VA Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A
| | - A A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A
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Bhattacharya T, Nardone B, Rademaker A, Martini M, Amin A, Al-Mudaimeagh HM, Kiguradze T, Schneider D, West DP. Co-existence of psoriasis and melanoma in a large urban academic centre population: a cross-sectional retrospective study. J Eur Acad Dermatol Venereol 2016; 30:83-5. [PMID: 25627163 DOI: 10.1111/jdv.12949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/04/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psoriasis has been linked to increased malignancy risk, particularly lympho-haematopoietic and non-melanoma skin cancers; however, its association with cutaneous melanoma remains unclear. OBJECTIVE The aim of this study was to determine if there is an association between melanoma and psoriasis in a large, urban academic population through an electronic medical record database. METHODS We searched our institution's electronic medical record database (EDW-Electronic Data Warehouse) from 1/2001 to 11/2013. Subjects were identified by ICD-9 codes. Melanoma diagnosis was included only if documented at least 1 month after the psoriasis diagnosis was documented. Odds ratio (OR) was obtained for association between cutaneous melanoma and psoriasis. The OR was then adjusted for phototherapy and age. To minimize detection bias, we also obtained the OR for association between cutaneous melanoma and atopic dermatitis. RESULTS We identified 10 947 patients with psoriasis, 64 of whom had a subsequent diagnosis of cutaneous melanoma. We detected a significant association between melanoma and psoriasis (OR = 1.77; 95%CI 1.38-2.26; P < 0.0001; total n = 1 525 252). After adjusting for phototherapy and age, a statistically significant association between melanoma and psoriasis remained detectable (OR = 1.9; 95%CI 1.55-2.55; P < 0.0001 and OR = 1.64; 95%CI 1.17-2.26; P = 0.003 respectively). The OR for melanoma with atopic dermatitis in the same patient database showed a statistically significant inverse association between the two diseases (OR = 0.35; 95%CI 0.16-0.73; P = 0.005). CONCLUSION Our findings show a statistically significant association between psoriasis and melanoma. After adjusting the OR for phototherapy and age, a statistically significant association remained. Further investigations exploring these associations are warranted in order to establish the relative risk for melanoma in psoriasis patients.
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Affiliation(s)
- T Bhattacharya
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - B Nardone
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - A Rademaker
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - M Martini
- Department of Dermatology, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - A Amin
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - H M Al-Mudaimeagh
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - T Kiguradze
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - D Schneider
- Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Northwestern University, Chicago, IL, USA
| | - D P West
- Department of Dermatology, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Lee MTG, Lee SH, Chang SS, Chan YL, Pang L, Hsu SM, Lee CC. Comparative Treatment Failure Rates of Respiratory Fluoroquinolones or β-Lactam + Macrolide Versus β-Lactam Alone in the Treatment for Community-Acquired Pneumonia in Adult Outpatients: An Analysis of a Nationally Representative Claims Database. Medicine (Baltimore) 2015; 94:e1662. [PMID: 26426664 PMCID: PMC4616833 DOI: 10.1097/md.0000000000001662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory fluoroquinolones, β-lactam, and β-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide + β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines.
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Affiliation(s)
- Meng-Tse Gabriel Lee
- From the Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan (M-TGL, S-HL, C-CL); Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (S-SC); Department of International Business, Asia University, 500, Lioufeng Rd., Wufeng, Taichung City, Taiwan (Y-LC); Loyola University New Orleans College of Law 6363 St Charles Ave, New Orleans, LA (LP); Department of Business Administration, Tunghai University, Tunghai University, Taichung City, Taiwan (S-MH); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (C-CL)
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Use of nicorandil is Associated with Increased Risk for Gastrointestinal Ulceration and Perforation- A Nationally Representative Population-based study. Sci Rep 2015; 5:11495. [PMID: 26118431 PMCID: PMC4483775 DOI: 10.1038/srep11495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/07/2015] [Indexed: 02/08/2023] Open
Abstract
Nicorandil is a vasodilatory drug used to relieve angina symptoms. Several healthcare products regulatory agencies have issued a warning associating the use of nicorandil and gastrointestinal (GI) ulceration. We aimed to evaluate the association between use of nicorandil and GI ulceration/perforation. A population-based cohort study involving 1 million randomly sampled participants in Taiwan’s National Health Insurance Research Database was carried out. We estimated the association between use of nicorandil and GI ulceration/perforation by a Cox proportional hazards regression model. A nicorandil-specific propensity score (PS) was also created for adjustment of 75 covariates and matching. 25.8% (183/710) of nicorandil-treated patients developed new GI ulcer events and 1.6% (20/1254) developed new GI perforation events in the three-year follow-up period, as compared to 9.3% (61,281/659,081) and 0.3% (2,488/770,537) in the general population comparator cohort. Patients treated with nicorandil were at significantly increased risk of GI ulcer (PS adjusted hazard ratio 1.43, 95% CI, 1.23 to 1.65, 6848 excess cases per 100,000 person years) or GI perforation (aHR 1.60, 95% CI 1.02–2.51, 315 excess cases per 100,000 person years) compared with the nicorandil unexposed population. Our finding may warn the clinicians to weigh the overall risk-benefit balance of nicorandil treatment in patients.
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Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis. J Am Acad Dermatol 2015; 72:516-23. [PMID: 25575687 DOI: 10.1016/j.jaad.2014.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Performance Improvement (PI) CME format improves physician performance in other specialties but data are lacking in dermatology. OBJECTIVE We sought to assess the impact of a PI CME activity on physician practice patterns for patients with psoriasis, which was developed, implemented, and evaluated by the American Academy of Dermatology (AAD), in part to assist dermatologists in fulfilling Part IV of their Maintenance of Certification requirements. METHODS In this PI CME activity, participants: (1) self-audited patient charts, which met inclusion criteria in stage A, and reflected on their results, benchmarked against peers; (2) reviewed educational materials in stage B and developed an improvement plan; and (3) self-audited a different set of patient charts following the plan's implementation. Aggregate stage A and C data were analyzed using χ(2) tests. RESULTS We found a statistically significant improvement in the advisement of patients with psoriasis regarding their increased risk for cardiovascular disease, to contact their primary care provider for cardiovascular risk assessment, and in shared decision making regarding the treatment plan. We also found an overall statistically significant improvement in history taking per the guidelines. LIMITATIONS Learner chart selection bias, self-reporting of chart data, and lack of a control group are limitations. CONCLUSIONS The AAD psoriasis PI CME activity demonstrated significantly improved dermatologists' documentation of patient's history, counseling of patients for lifestyle behaviors, and shared decision making.
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Lee MTG, Lee SH, Chang SS, Lee SH, Lee M, Fang CC, Chen SC, Lee CC. Comparative effectiveness of different oral antibiotics regimens for treatment of urinary tract infection in outpatients: an analysis of national representative claims database. Medicine (Baltimore) 2014; 93:e304. [PMID: 25526477 PMCID: PMC4603088 DOI: 10.1097/md.0000000000000304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There are very limited data on the postmarketing outcome comparison of different guideline antibiotic regimens for patients with urinary tract infections (UTIs). We carried out a population-based comparative effectiveness study from year 2000 through 2009, using the administrative data of 2 million patients from the National Health Informatics Project of Taiwan. Treatment failure was defined as either hospitalization or emergency department visits for UTI. Odd ratios were computed using conditional logistic regression models matched on propensity score. We identified 73,675 individuals with UTI, of whom 54,796 (74.4%) received trimethoprim-sulfamethoxazole (TMP-SMX), 4184 (5.7%) received ciprofloxacin, 3142 (4.3%) received levofloxacin, 5984 (8.1%) received ofloxacin, and 5569 (7.6%) received norfloxacin. Compared with TMP-SMX, the composite treatment failure was significantly lowered for norfloxacin in propensity score (PS) matching analyses (OR, 0.73; 95% CI, 0.54-0.99). Both norfloxacin (PS-matched OR, 0.68; 95% CI, 0.47-0.98) and ofloxacin (PS-matched OR, 0.70; 95% CI, 0.49-0.99) had significantly lowered composite treatment failure rate when compared with ciprofloxacin. Subgroup analysis suggested that both norfloxacin and ofloxacin were more effective in female patients without complications (W/O indwelling catheters, W/O bedridden status and W/O spinal cord injury), when compared with either TMP-SMX or ciprofloxacin. Among outpatients receiving oral fluoroquinolone therapy for UTIs, there was evidence of superiority of norfloxacin or ofloxacin over ciprofloxacin or TMP-SMX in terms of treatment failure. Given the observational nature of this study and regional difference in antibiotic resistance patterns, more studies are required to validate our results.
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Affiliation(s)
- Meng-Tse Gabriel Lee
- From the Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan (M-TGL, Sh-HL, C-CF, S-CC, C-CL); Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (S-SC); Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital (Si-HL); Department of Rehabilitation and Physical Medicine, National Yang-Ming University, Taipei, Taiwan (Si-HL); Medical Wisdom Inc, US (ML); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (C-CL)
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Colombo D, Cassano N, Bellia G, Vena GA. Gender medicine and psoriasis. World J Dermatol 2014; 3:36-44. [DOI: 10.5314/wjd.v3.i3.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/24/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The study of specific differences between women and men is arousing huge interests in various fields of medicine, including dermatology. The available data on gender medicine applied to common skin diseases are unfortunately still scanty. Psoriasis is a chronic immune-mediated skin disease which affects 1%-3% of most populations worldwide and can involve also the joints and entheses. The pathogenesis of the disease is very complex, resulting from the interaction between genetic predisposition and several environmental triggers. The pathogenic role of sex hormones has also been hypothesized. The analysis of gender-specific differences in psoriasis seems to suggest some interesting findings, such as an earlier age of disease onset in females, a higher probability of severe disease in men, or different tendencies in care utilization, adherence to treatment, development of psychological distress, and coping strategies. Moreover, sex-related differences have been recently described in some epidemiological and clinical features among patients with psoriatic arthritis. The objective of this article is to review briefly the available evidence regarding gender differences in various aspects of psoriasis, such as epidemiology, genetics, risk factors, associated conditions, quality of life, clinical and therapeutic aspects.
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Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
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Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
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Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Lee MS, Lin RY, Lai MS. Increased risk of diabetes mellitus in relation to the severity of psoriasis, concomitant medication, and comorbidity: A nationwide population-based cohort study. J Am Acad Dermatol 2014; 70:691-698. [DOI: 10.1016/j.jaad.2013.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 02/08/2023]
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Maleszka R, Paszkowska-Szczur K, Soczawa E, Boer M, Różewicka-Czabańska M, Wiśniewska J, Mirecka A, Krysztoforska L, Adamski Z, Lubinski J, Dębniak T. Psoriasis vulgaris and familial cancer risk- a population-based study. Hered Cancer Clin Pract 2013; 11:6. [PMID: 23805825 PMCID: PMC3702451 DOI: 10.1186/1897-4287-11-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/29/2013] [Indexed: 02/08/2023] Open
Abstract
Background Follow-up studies of psoriasis patients indicate an increased risk in the occurrence of malignancies at different sites of origin. Population stratification and/or complicated interpretation of evidence on the risk of cancer (due to the small number of patients included in most series) lead to inconsistent data. Herein we investigated the risk of occurrence of malignancies at different sites of origin in a series of 517 psoriasis patients and their 1st degree relatives. Methods We evaluated the tumour spectrum as well as the age of the patient at diagnosis of cancers in psoriasis families along with the observed and expected frequencies of malignancies. The distribution of 17 common mutations/polymorphisms in 10 known cancer susceptibility genes among psoriasis patients and 517 matched healthy controls were examined. No such study has been published to date. Results The statistical comparison of the observed and expected frequencies of cancers revealed a higher than expected occurrence of Hodgkin’s lymphoma among males in psoriasis families when compared to the general population (OR=1.8, 95%CI 1.6-2.1, p=0.002). There was a non-significant tendency towards a younger age of onset and overrepresentation of laryngeal cancer and leukaemia in psoriasis families. We found no major differences in the distribution of cancer susceptibility mutations among our cases and the healthy controls. Conclusions The results of our study suggest an increased risk of Hodgkin’s lymphoma for male members of psoriasis families. Further studies are needed to confirm the findings and to evaluate whether or not the application of cancer surveillance protocols for Hodgkin’s lymphoma, leukaemia and laryngeal cancer are justified in these families.
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Affiliation(s)
- Romuald Maleszka
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Połabska 4, 70-115 Szczecin, Poland.
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