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Ting S, Lowe P, Smith A, Fernández-Peñas P. Drug survival of biologics in psoriasis: An Australian multicentre retrospective study. Australas J Dermatol 2024; 65:350-357. [PMID: 38509804 DOI: 10.1111/ajd.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Drug survival, which refers to the time from treatment initiation to discontinuation, provides a surrogate measure of the effectiveness of a biologic in a real-world setting (J Invest Dermatol, 2015, 135, 1). The aim of this study was to determine the drug survival of biologics that are currently available in Australia. We also analysed the treatment efficacy of these biologics and reasons for discontinuation. METHODS Retrospective data from outpatient Dermatology biologic clinics in Westmead Hospital and Royal Prince Alfred Hospital (Sydney, Australia) from April 2006 to December 2020 were collected. Kaplan-Meier analysis was used to calculate drug survival. RESULTS A total of 306 patients who underwent 566 treatment courses were analysed. Guselkumab was observed to have the longest drug survival, with cumulative drug survival rates of 94.2% ± 4.0 at 1- and 5-years. This was followed by ixekizumab which had a 1-year survival rate of 87.2% ± 4.5 and 5-year survival rate of 59.4% ± 9.5. Ixekizumab and guselkumab were also noted to have superior treatment efficacy compared with other biologics, with PASI-75 rates of 94.9% and 93.8%, respectively. The most common reasons for treatment discontinuation were a lack of initial efficacy to treatment and a loss of efficacy over time despite an initial response, respectively. CONCLUSION To our knowledge, this is the first Australian study to report on outcomes of multiple new biologics that are currently in use for the treatment of chronic plaque psoriasis. Overall, this study provides insight into patterns of care from a local experience that may help guide the management of moderate-to-severe psoriasis.
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Affiliation(s)
- Samantha Ting
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Patricia Lowe
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Annika Smith
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Pablo Fernández-Peñas
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
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Tibaduiza MF, Berbeo YK, Ton CM, Aguirre-Acevedo DC, Sanclemente G. Responsiveness of the Colombian Spanish Version of the DLQI in Psoriasis Patients With Biologic Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:316-320. [PMID: 37871895 DOI: 10.1016/j.ad.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- M F Tibaduiza
- Group of Investigative Dermatology (GRID), School of Medicine, University of Antioquia, Medellin, Colombia
| | - Y K Berbeo
- Group of Investigative Dermatology (GRID), School of Medicine, University of Antioquia, Medellin, Colombia
| | - C M Ton
- School of Medicine, University of Antioquia, Medellin, Colombia
| | - D C Aguirre-Acevedo
- Group of Investigative Dermatology (GRID), School of Medicine, University of Antioquia, Medellin, Colombia
| | - G Sanclemente
- Group of Investigative Dermatology (GRID), School of Medicine, University of Antioquia, Medellin, Colombia; Hospital San Vicente Fundación, Medellin, Colombia; Hospital Alma Máter de Antioquia, IPS Universitaria, University of Antioquia, Medellin, Colombia.
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3
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Tibaduiza MF, Berbeo YK, Ton CM, Aguirre-Acevedo DC, Sanclemente G. Responsiveness of the Colombian Spanish Version of the DLQI in Psoriasis Patients With Biologic Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T316-T320. [PMID: 38184102 DOI: 10.1016/j.ad.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 01/08/2024] Open
Affiliation(s)
- M F Tibaduiza
- Grupo de Investigacion Dermatologica (GRID), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Y K Berbeo
- Grupo de Investigacion Dermatologica (GRID), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - C M Ton
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - D C Aguirre-Acevedo
- Grupo de Investigacion Dermatologica (GRID), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - G Sanclemente
- Grupo de Investigacion Dermatologica (GRID), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Hospital San Vicente Fundación, Medellín, Colombia; Hospital Alma Máter de Antioquía, IPS Universitaria, Universidad de Antioquía, Medellín, Colombia.
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Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190:315-339. [PMID: 36971254 DOI: 10.1093/bjd/ljad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. OBJECTIVES To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. METHODS The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. RESULTS Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. CONCLUSIONS This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.
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Affiliation(s)
| | - Jeffrey R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ravinder K Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Madrigal-Cadavid J, Estrada-Acevedo J, Maria Jaramillo A, Jaramillo-Santacoloma L, Guarin S, Londoño A, Rojas-Gualdron D. Rasch analysis of the dermatology life quality index (DLQI) in patients with mild to moderate-severe psoriasis. Indian J Dermatol Venereol Leprol 2024; 0:1-7. [PMID: 38314980 DOI: 10.25259/ijdvl_271_2022] [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: 03/11/2022] [Accepted: 09/12/2023] [Indexed: 02/07/2024]
Abstract
Background The Dermatology Life Quality Index (DLQI) is a valuable tool for assessing the quality of life in adult patients with psoriasis. Aims To analyse the reliability and validity of the DLQI to measure the quality of life in patients with mild to moderate-severe psoriasis. Methods This was a secondary validation study nested in a follow-up study. The Rasch-Andrich model was utilised to perform response function, item and person fit, differential item functioning, dimensionality, and reliability analyses. Results A total of 1439 patients were analysed, 52.1% male, mean age of 48.7 years (SD 16.1). Psoriasis vulgaris was the phenotype in 43.1% of patients, and 86% had a mild Psoriasis Area Severity Index (PASI). Adequate adjustment of the response function and the items was observed in the best-fit sample, except for item 7 (work and study). The measure explained 60.9% of the variance and presented a reliability of 0.86. Differential item functioning was identified by age, with a relevant bias in the estimation for older adults. Item-person maps are provided. Limitations This study was performed at a single centre, with most patients presenting a mild PASI score, limiting generalisation of the findings. Conclusion The validity evidence favours the use of the DLQI in moderate-severe psoriasis. However, the instrument biases the estimate of older adults. This population group should consider a specific version of the instrument.
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Affiliation(s)
| | | | | | | | - Simon Guarin
- School of Medicine, CES University, Medellin-Colombia
| | - Angela Londoño
- Dermatology Research Group, CES University, Medellin-Colombia
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Fink C, Alt C, Schank TE, Sies K, Kilian S, Schäkel K. Multiarm study comparing patient-reported and clinical outcome measures in patients undergoing antipsoriatic therapy with non-biological systemic agents in a real-world setting. J DERMATOL TREAT 2022; 33:2997-3004. [PMID: 35763015 DOI: 10.1080/09546634.2022.2095329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although the inclusion of patients' preferences and needs is essential for therapy adherence, the assessment of patient-reported outcome measures in clinical trials is often neglected. Therefore, the aim of this study was to quantify several patient-reported outcome measures in psoriasis patients undergoing systemic therapy in a real-life clinical setting. METHODS This clinical trial has been designed as a prospective, multiarm study to investigate the treatment satisfaction, adherence to therapy, quality of life (QoL), and clinical response in a real-life clinical setting during the initial 6 months of treatment with apremilast, methotrexate, and fumaric acids in 80 patients suffering from plaque psoriasis. RESULTS The treatment satisfaction for the three systemic therapies was rated 'sufficient' with a mean (±SD) Treatment Satisfaction Questionnaire for Medication (TSQM) score of 275.0 (±62.7). Most potential for improvement was seen in the 'effectiveness' domain (54.3 ± 21.5). The highest treatment satisfaction level in all four domains (convenience, effectiveness, global satisfaction, and side-effects) was seen in the methotrexate group with a mean TSQM score of 306.3 ± 50.9, followed by apremilast (267.1 ± 61.6) and fumaric acids (254.9 ± 65.0; p = 0.005). Analysis of the TSQM revealed a considerable discrepancy between patient-reported clinical response and the actual Psoriasis Area and Severity Index (PASI) reduction. This applies equally to the patient- vs. physician-reported side-effects. CONCLUSIONS This real-life study demonstrates that an adequate assessment of antipsoriatic drugs by PASI-reduction alone is not sufficient and underlines the importance of patient-reported outcome measures not only in clinical trials, but also for improved patient care.
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christina Alt
- Department of Dermatology, University of Essen, Essen, Germany
| | - Timo E Schank
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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7
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Aalemi AK, Hamdard AG, Sobat AS. Correlation of Psoriasis Disability Index and Psoriasis Area and Severity Index: A Study from Afghanistan. Clin Cosmet Investig Dermatol 2022; 15:559-566. [PMID: 35411166 PMCID: PMC8994531 DOI: 10.2147/ccid.s363343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
Background Psoriasis is a common skin disease that affects physical, psychological, and social well-being of patients. Several studies have assessed health-related quality of life of patients with psoriasis in different populations with large variations. Objective To investigate, for the first time, the impact of psoriasis on quality of life of Afghan patients with psoriasis. Methods This is a prospective observational study conducted at the dermatology department of Maiwand Teaching hospital in Kabul City during April 2018 to May 2019. Patients with plaque psoriasis with age ≥16 years were included in the study. Psoriasis Disability Index was used for the assessment of health-related quality of life. Psoriasis Area and Severity Index was used to define the severity of disease. Appropriate tests were performed using Statistical Package for Social Science. Results A total of 174 patients with psoriasis were included in the study, 89 of them were male (51.1%) and 85 of them were female (48.9%). The mean age of the patients was 27.7 years with 13.2 years SD, and the average duration of the disease was 3.2 years with 4.7 years SD. The mean of PASI score was 13.3 with 7.8 SD, while the mean of total PDI was 9.6 with 3.7 SD; there was a strong correlation between total PDI and PASI score (r=0.751, p<0.001). The mean of total PDI was higher among moderate-to-severe psoriasis, female patients, younger age, and those who were single. Conclusion Our study highlighted that psoriasis disability index was highly correlated with psoriasis area and severity index. Furthermore, the quality of life was more affected among female patients, patients younger than 40 years, and those patients who were single.
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Affiliation(s)
- Ahmad Khalid Aalemi
- Department of Oral Medicine, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan.,Department of Dermatology, Maiwand Teaching Hospital, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Maiwand Teaching Hospital, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
| | - Ahmad Shekeb Sobat
- Department of Oral Surgery, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
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Carrascosa J, Puig L, Belinchón Romero I, Salgado-Boquete L, del Alcázar E, Andrés Lencina J, Moreno D, de la Cueva P. [Translated article] Practical Update of the Recommendations Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis with Biologic Therapy. Part 1. Concepts and General Management of Psoriasis With Biologic Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Carrascosa JM, Puig L, Belinchón Romero I, Salgado-Boquete L, Del Alcázar E, Andrés Lencina JJ, Moreno D, de la Cueva P. Practical update of the Recommendations Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPS) on the Treatment of Psoriasis with Biologic Therapy. Part 1. Concepts and General Management of Psoriasis with Biologic Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:261-277. [PMID: 35526919 DOI: 10.1016/j.ad.2021.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A new, updated AEDV Psoriasis Group consensus document on the treatment of moderate to severe psoriasis was needed owing to the approval, in recent years, of a large number of new drugs and changes in the treatment paradigm. METHODOLOGY The consensus document was developed using the nominal group technique and a scoping review. First, a designated coordinator selected a group of Psoriasis Group members for the panel. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. Based on these reviews, the coordinator drew up a set of proposed recommendations, which were then discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted. RESULTS The present guidelines include general principles for the treatment of patients with moderate to severe psoriasis and also define treatment goals and criteria for the indication of biologic therapy and the selection of initial and subsequent therapies. Practical issues, such as treatment failure and maintenance of response, are also addressed.
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Affiliation(s)
- J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, España.
| | - L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - I Belinchón Romero
- Departamento de Dermatología, Hospital General Universitario de Alicante-ISABIAL, Universidad Miguel Hernández de Elche, Alicante, España
| | - L Salgado-Boquete
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - E Del Alcázar
- Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, España
| | - J J Andrés Lencina
- Servicio de Dermatología, Hospital Universitario Vega Baja, Alicante, España
| | - D Moreno
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
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Kawamori J, Itazawa T, Fukushima S, Ito R, Yamauchi H, Sekiguchi K. Effect of Heparinoid Moisturizer on Quality of Life in Patients with Acute Radiation Skin Damage Following Hypofractionated Radiation Therapy After Breast-Conserving Surgery: A Randomized Controlled Study. BREAST CANCER: TARGETS AND THERAPY 2021; 13:743-753. [PMID: 35002315 PMCID: PMC8728094 DOI: 10.2147/bctt.s347136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Background With few research reports on the effects of moisturizer use for dry skin associated with radiotherapy after breast-conserving surgery on patient quality of life (QOL), we conducted a randomized controlled trial to investigate this effect. Methods Patients with breast cancer were randomly assigned to receive either heparinoid moisturizer (Group M) or no treatment (Group C). Group M was instructed to apply heparinoid moisturizer during 3 weeks of hypofractionated whole-breast irradiation with or without boost until 4 weeks after completion of irradiation. Skin-related QOL was assessed using the Dermatology Life Quality Index (DLQI) for 7 weeks. The primary endpoint was total DLQI score at 4 weeks after the start date. Results In total, 35 patients in Group M and 37 patients in Group C were analyzed. The DLQI total score (2.06 ± 2.17: mean ± SD) at 4 weeks in Group M was slightly lower than in Group C (2.16 ± 2.13) but with no significant difference (p = 0.894). The “Symptoms and feelings” subscore indicated significant worsening at 3 weeks and maintained until 7 weeks in Group C. There was no significant change for this subscore during radiotherapy in Group M, and it significantly increased after radiotherapy (4–5 weeks) and returned to baseline in 7 weeks. The period of subscore worsening was shorter in Group M than in Group C. Conclusion Concomitant and extended use of heparinoid moisturizer with radiation therapy may improve the QOL of breast cancer patients impaired by dry skin for patients with breast cancer.
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Affiliation(s)
- Jiro Kawamori
- Department of Radiation Oncology, St. Luke’s International Hospital, Tokyo, Japan
- Correspondence: Jiro Kawamori Department of Radiation Oncology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, JapanTel +81 3 5550 7006Fax +81 3 3544 0649 Email
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke’s International Hospital, Tokyo, Japan
| | | | - Ryoko Ito
- Department of Radiation Oncology, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgery, St Luke’s International Hospital, Tokyo, Japan
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Du Thanh A, Girard C, Morel J, Roubille C. Toward a holistic management of skin and joint disorders in PsA patients. Rheumatology (Oxford) 2021; 61:1310-1311. [PMID: 34850854 DOI: 10.1093/rheumatology/keab889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aurélie Du Thanh
- Department of Dermatology, CHU Montpellier, Montpellier University, France.,Inserm 1058, pathogénèse et contrôle des infections chroniques, Montpellier, France
| | - Céline Girard
- Department of Dermatology, CHU Montpellier, Montpellier University, France
| | - Jacques Morel
- Department of Rheumatology, CHU Montpellier, Montpellier University, France
| | - Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
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12
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Szabó Á, Brodszky V, Rencz F. A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI-Relevant and Skindex-16. Br J Dermatol 2021; 186:485-495. [PMID: 34724199 DOI: 10.1111/bjd.20765] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used dermatology-specific health-related quality-of-life (HRQoL) instruments. DLQI has two common scoring methods, the original and the DLQI-Relevant (DLQI-R) modification. Head-to-head comparisons of the measurement properties of the DLQI, DLQI-R and Skindex-16 are currently lacking. OBJECTIVES We aim to compare the measurement properties of the DLQI, DLQI-R and Skindex-16. METHODS We analysed data from 618 patients with self-reported physician-diagnosed dermatological conditions from a cross-sectional survey carried out in Hungary in early 2020. DLQI, DLQI-R and Skindex-16 were compared in terms of ceiling and floor effects, informativity, convergent validity and known-group validity. RESULTS Mean DLQI, DLQI-R and Skindex-16 total scores were 3·76 ± 5·03, 4·11 ± 5·34 and 29·36 ± 26·62, respectively. Among patients with a DLQI/DLQI-R total score of zero, 64% reported problems on Skindex-16. Overall, 23-38% of patients with 'not relevant' responses on DLQI items 3 (shopping/home/gardening), 7 (working/studying), 8 (interpersonal problems) and 9 (sexual difficulties) reported problems on their corresponding Skindex-16 items. Average relative informativity (Shannon's evenness index) was the highest for Skindex-16 (0·85), followed by DLQI-R (0·66) and DLQI (0·54). DLQI, DLQI-R and Skindex-16 demonstrated similar convergent validity. DLQI was able to better discriminate between known groups of patients based on overall skin-related HRQoL impairment, whereas DLQI-R and Skindex-16 performed better with respect to self-perceived health status. CONCLUSIONS Skindex-16 seems to be more sensitive than DLQI/DLQI-R in capturing mild impairment in HRQoL. Our findings help to provide a fuller understanding of the difference between DLQI, DLQI-R and Skindex-16 and support the informed choice of instrument for clinical and research purposes.
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Affiliation(s)
- Á Szabó
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary.,Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői út, H-1085, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
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Deterioration of Health-Related Quality of Life After Withdrawal of Risankizumab Treatment in Patients with Moderate-to-Severe Plaque Psoriasis: A Machine Learning Predictive Model. Dermatol Ther (Heidelb) 2021; 11:1291-1304. [PMID: 34019229 PMCID: PMC8322223 DOI: 10.1007/s13555-021-00550-8] [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: 03/26/2021] [Accepted: 05/06/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Risankizumab has demonstrated efficacy in treating moderate-to-severe psoriasis. The phase-3 IMMhance trial (NCT02672852) examined the effect of continuing versus withdrawing from risankizumab treatment on psoriasis severity, including the Psoriasis Area and Severity Index (PASI) and static Physician Global Assessment (sPGA). However, the effect of withdrawal on health-related quality of life (HRQL) was not assessed. Therefore, this study was conducted to evaluate the impact of risankizumab withdrawal on HRQL measured by the Dermatology Life Quality Index (DLQI). Because DLQI was not measured beyond week 16 in IMMhance, a machine learning predictive model for DLQI was developed. METHODS A machine learning model for DLQI was fitted using repeated measures data from three phase-3 trials (NCT02684370, NCT02684357, NCT02694523) (pooled N = 1602). An elastic-net algorithm performed automated variable selection among candidate predictors including concurrent PASI and sPGA, demographics, and interaction terms. The machine learning model was used to predict DLQI at weeks 28-104 of IMMhance among patients re-randomized to continue (N = 111) or withdraw from (N = 225) risankizumab after achieving response (sPGA = 0/1) at week 28. RESULTS The machine learning predictive model demonstrated good statistical fit during tenfold cross-validation and external validation against observed DLQI at weeks 0-16 of IMMhance (N = 507). Predicted improvements in DLQI from baseline were lower in the withdrawal versus the continuation cohort (mean DLQI change at week 104, -5.9 versus -11.5, difference [95% CI] = 5.6 [4.1, 7.3]). Predicted DLQI deteriorated more extensively than PASI (49.7% versus 36.4%) after treatment withdrawal. CONCLUSIONS The predicted DLQI score deteriorated more rapidly after risankizumab withdrawal than the PASI score, an objective measure of disease. These findings suggest that the deterioration in HRQL reflects more substantial impacts after risankizumab discontinuation than those measured by PASI only.
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Svoboda SA, Ghamrawi RI, Owusu DA, Feldman SR. Treatment Goals in Psoriasis: Which Outcomes Matter Most? Am J Clin Dermatol 2020; 21:505-511. [PMID: 32424692 DOI: 10.1007/s40257-020-00521-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psoriasis is a chronic immune-mediated inflammatory disease that predominantly affects the skin and joints. Its detrimental effects on the physical, psychosocial, and emotional well-being of patients leads to a significant reduction in quality of life (QoL). The goals of treatment focus on decreasing disease severity and improving QoL for patients; accomplishing these goals requires physicians to understand both the full impact of the disease on a patient's life and the outcomes that matter most to patients. The use of outcome measures, both physician- and patient-reported, can assist clinicians in evaluating the disease burden and its effect on QoL and in identifying patient preferences for treatment, ultimately enhancing quality of care. However, current outcome measures have many limitations and do not adequately capture patients' needs and priorities. Nevertheless, physicians treating patients with psoriasis are encouraged to utilize these instruments while remaining cognizant of each of their limitations. As there is no consensus on an outcome measure that fully encompasses the complexities of psoriasis and its impact on patients, instruments that are appropriate and applicable to dermatologists and their patients should be developed.
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Affiliation(s)
- Steven A Svoboda
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Rima I Ghamrawi
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Dorellie A Owusu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Corazza M, Virgili A, Toni G, Valpiani G, Morotti C, Borghi A. Pictorial Representation of Illness and Self-Measure to assess the perceived burden in patients with chronic inflammatory vulvar diseases: an observational study. J Eur Acad Dermatol Venereol 2020; 34:2645-2651. [PMID: 32597539 DOI: 10.1111/jdv.16637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronic inflammatory vulvar diseases can have a huge detrimental impact on patient welfare. A few studies have addressed this issue so far, mainly measuring patients' quality of life or sexual dysfunction. OBJECTIVE To assess the burden of suffering in patients with chronic inflammatory vulvar diseases using the Pictorial Representation of Illness and Self-Measure (PRISM), a visual, non-verbal instrument. We also assessed (i) the concordance between PRISM and the Dermatology Life Quality Index (DLQI), (ii) whether some variables, both patient-related and disease-related, affect the patient's suffering and quality-of-life impairment. METHODS We evaluated for inclusion in this cross-sectional study all patients who attended our Vulva Unit over a 9-month period with histologically proven lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC), eczema, plasma cell vulvitis and psoriasis (at least five for each disease). Demographics and disease-related subjective and objective scores were recorded. The PRISM and DLQI were administered. RESULTS We included 87 patients affected with LS, 13 with LSC and seven with LP. Median PRISM values (0-273 mm) ranged from 95 to 120 mm, depending on the disease, and median DLQI scores (0-30) were five for all three groups. Neither PRISM nor DLQI scores differed significantly among the three groups. Moderate coherence was found between PRISM and DLQI (ρ = 0.5455, P < 0.001). Global subjective score was the only variable significantly associated with the degree of suffering and quality-of-life impairment. CONCLUSIONS Pictorial Representation of Illness and Self-Measure proved to be a valuable, highly reliable tool for measuring the perceived burden in these patients. In spite of a moderate correlation, PRISM resulted more sensitive in capturing patient distress than DLQI.
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Affiliation(s)
- M Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - A Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - G Toni
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - G Valpiani
- Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - C Morotti
- Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - A Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
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Abstract
BACKGROUND Psoriasis is an inflammatory skin disease that presents with itching, red, scaling plaques; its worsening has been associated with obesity, drinking, smoking, lack of sleep, and a sedentary lifestyle. Lifestyle changes may improve psoriasis. OBJECTIVES To assess the effects of lifestyle changes for psoriasis, including weight reduction, alcohol abstinence, smoking cessation, dietary modification, exercise, and other lifestyle change interventions. SEARCH METHODS We searched the following databases up to July 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched the China National Knowledge Infrastructure, the Airiti Library, and five trials registers up to July 2018. We checked the references of included trials for further relevant trials, and we asked the authors of the included trials if they were aware of any relevant unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) of lifestyle changes (either alone or in combination) for treating psoriasis in people diagnosed by a healthcare professional. Treatment had to be given for at least 12 weeks. Eligible comparisons were no lifestyle changes or another active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Severity of psoriasis' and 'Adherence to the intervention'. Secondary outcomes were 'Quality of life', 'Time to relapse', and 'Reduction in comorbidities'. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS We included 10 RCTs with 1163 participants (mean age: 43 to 61 years; 656 men and 478 women were reported). Six trials examined the effects of dietary intervention (low-calorie diet) in 499 obese participants (mean age: 44.3 to 61 years; where reported, 395 had moderate-to-severe psoriasis). One trial assessed a combined dietary intervention and exercise programme in 303 obese participants with moderate-to-severe psoriasis who had started a systemic therapy for psoriasis and had not achieved clearance after four weeks of continuous treatment (median age: 53 years). Another trial assessed a walking exercise and continuous health education in 200 participants (mean age: 43.1 years, severity not reported). Finally, two trials included education programmes promoting a healthy lifestyle in 161 participants (aged 18 to 78 years), with one trial on mild psoriasis and the other trial not reporting severity.Comparisons included information only; no intervention; medical therapy alone; and usual care (such as continuing healthy eating).All trials were conducted in hospitals and treated participants for between 12 weeks and three years. One trial did not report the treatment period. Seven trials measured the outcomes at the end of treatment and there was no additional follow-up. In two trials, there was follow-up after the treatment ended. Five trials had a high risk of performance bias, and four trials had a high risk of attrition bias.We found no trials assessing interventions for alcohol abstinence or smoking cessation. No trials assessed time to relapse. Only two trials assessed adverse events; in one trial these were caused by the add-on therapy ciclosporin (given in both groups). The trial comparing two dietary interventions to a no-treatment group observed no adverse events.The results presented in this abstract are based on trials of obese participants.Outcomes for dietary interventions versus usual care were measured 24 weeks to six months from baseline. Compared to usual care, dietary intervention (strict caloric restriction) may lead to 75% or greater improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07 to 2.58; 2 trials, 323 participants; low-quality evidence). Adherence to the intervention may be greater with the dietary intervention than usual care, but the 95% CI indicates that the dietary intervention might also make little or no difference (RR 1.26, 95% CI 0.76 to 2.09; 2 trials, 105 participants; low-quality evidence). Dietary intervention probably achieves a greater improvement in dermatology quality-of-life index (DLQI) score compared to usual care (MD -12.20, 95% CI -13.92 to -10.48; 1 trial, 36 participants; moderate-quality evidence), and probably reduces the BMI compared to usual care (MD -4.65, 95% CI -5.93 to -3.36; 2 trials, 78 participants; moderate-quality evidence).Outcomes for dietary interventions plus exercise programme were measured 16 weeks from baseline and are based on one trial (303 participants). Compared to information only (on reducing weight to improve psoriasis), combined dietary intervention and exercise programme (dietetic plan and physical activities) probably improves psoriasis severity, but the 95% CI indicates that the intervention might make little or no difference (PASI 75: RR 1.28, 95% CI 0.83 to 1.98). This combined intervention probably results in a greater reduction in BMI (median change -1.10 kg/m², P = 0.002), but there is probably no difference in adherence (RR 0.95, 95% CI 0.89 to 1.01; 137/151 and 145/152 participants adhered in the treatment and control group, respectively). There were no data on quality of life. These outcomes are based on moderate-quality evidence. AUTHORS' CONCLUSIONS Dietary intervention may reduce the severity of psoriasis (low-quality evidence) and probably improves quality of life and reduces BMI (moderate-quality evidence) in obese people when compared with usual care, while combined dietary intervention and exercise programme probably improves psoriasis severity and BMI when compared with information only (moderate-quality evidence). None of the trials measured quality of life.We did not detect a clear difference in treatment adherence between those in the combined dietary intervention and exercise programme group and those given information only (moderate-quality evidence). Adherence may be improved through dietary intervention compared with usual care (low-quality evidence). Participants generally adhered well to the lifestyle interventions assessed in the review.No trials assessed the time to relapse. Trial limitations included unblinded participants and high dropout rate.Future trials should reduce dropouts and include comprehensive outcome measures; they should examine whether dietary intervention with or without an exercise programme is effective in non-obese people with psoriasis, whether an additional exercise programme is more effective than dietary intervention alone, whether the time to relapse prolongs in people who receive dietary intervention with or without exercise programme, and whether smoking cessation and alcohol abstinence are effective in treating psoriasis.
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Affiliation(s)
- Shu‐Hua Ko
- Wei‐Gong Memorial HospitalDepartment of Nursing128, Shin‐I RdToufenMiaoliTaiwan35159
| | - Ching‐Chi Chi
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
- Chang Gung Memorial Hospital, LinkouDepartment of Dermatology5, Fuxing StGuishan DistTaoyuanTaiwan33305
| | - Mei‐Ling Yeh
- National Taipei University of Nursing and Health SciencesSchool of Nursing365, MingTe RoadTaipeiPeiTouTaiwan112
| | - Shu‐Hui Wang
- Far Eastern Memorial HospitalDepartment of Dermatology21, Sec 2, Nanya S RdBanciao DistrictNew TaipeiTaiwan22060
| | - Yu‐Shiun Tsai
- Chang Gung Memorial Hospital, ChiayiMedical Library6, Sec West, Chia‐Pu RdPuzihChiayiTaiwan61363
| | - Mei‐Ya Hsu
- Chang Gung Memorial Hospital, ChiayiDepartment of Nutrition6, Sec West, Chia‐Pu Rd, PuzihChiayiTaiwan61363
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Azizam NA, Ismail A, Sulong S, Nor NM. Cost-Effectiveness Analysis of Psoriasis Treatment Modalities in Malaysia. Int J Health Policy Manag 2019; 8:394-402. [PMID: 31441276 PMCID: PMC6706977 DOI: 10.15171/ijhpm.2019.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. METHODS This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015's recorded Malaysian Ringgit (RM) currency. RESULTS Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter. CONCLUSION Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options.
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Affiliation(s)
- Nor Azmaniza Azizam
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia.,Faculty of Business and Management, Universiti Teknologi MARA Selangor, Selangor, Malaysia
| | - Aniza Ismail
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Saperi Sulong
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norazirah Md Nor
- Medical Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Arnone M, Takahashi MDF, Carvalho AVED, Bernardo WM, Bressan AL, Ramos AMC, Terena AC, Souza CDS, Nunes DH, Bortoletto MCDC, Oliveira MDFSPD, Neffá JM, Fieri LC, Azulay-Abulafia L, Felix PAO, Magalhaes RF, Romiti R, Jaime TJ. Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:76-107. [PMID: 31166402 PMCID: PMC6544036 DOI: 10.1590/abd1806-4841.2019940211] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian
population. The most common clinical manifestations are erythematous, scaling
lesions that affect both genders and can occur on any anatomical site,
preferentially involving the knees, elbows, scalp and genitals. Besides the
impact on the quality of life, the systemic nature of the disease makes
psoriasis an independent risk factor for cardiovascular disease, especially in
young patients with severe disease. By an initiative of the Brazilian Society of
Dermatology, dermatologists with renowned clinical experience in the management
of psoriasis were invited to form a work group that, in a partnership with the
Brazilian Medical Association, dedicated themselves to create the Plaque
Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the
diagnosis (evaluation of severity and comorbidities) and treatment of plaque
psoriasis were defined. The issues generated a search strategy in the
Medline-PubMed database up to July 2018. Subsequently, the answers to the
questions of the recommendations were devised, and each reference selected
presented the respective level of recommendation and strength of scientific
evidence. The final recommendations for making up the final text were worded by
the coordinators.
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Affiliation(s)
- Marcelo Arnone
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Wanderley Marques Bernardo
- Center of Development of Medical Education, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aline Lopes Bressan
- Service of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andrea Machado Coelho Ramos
- Service of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Cacilda da Silva Souza
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Holthausen Nunes
- Service of Dermatology, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | - Jane Marcy Neffá
- Department of Medicine, Dermatology Clinic, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | - Luna Azulay-Abulafia
- Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Renata Ferreira Magalhaes
- Department of Internal Medicine, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ricardo Romiti
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Takeshita J, Eriksen WT, Raziano VT, Bocage C, Hur L, Shah RV, Gelfand JM, Barg FK. Racial Differences in Perceptions of Psoriasis Therapies: Implications for Racial Disparities in Psoriasis Treatment. J Invest Dermatol 2019; 139:1672-1679.e1. [PMID: 30738054 DOI: 10.1016/j.jid.2018.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/05/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
In the United States, black patients are less likely than white patients to receive biologic treatment for their psoriasis. We conducted a qualitative free-listing study to identify patient-generated factors that may explain this apparent racial disparity in psoriasis treatment by comparing the perceptions of biologics and other psoriasis therapies between white and black adults with psoriasis. Participants included 68 white and black adults with moderate to severe psoriasis who had and had not received biologic treatment. Each participant was asked to list words in response to verbal probes querying five psoriasis treatments: self-injectable biologics, infliximab, methotrexate, apremilast, and phototherapy. Salience scores indicating the relative importance of each word were calculated, and salient words were compared across each race/treatment group. Participants who had experience with biologics generally associated positive words with self-injectable biologics. Among biologic-naïve participants, "apprehension," "side effects," and "immune suppression" were most salient. "Unfamiliar" and "dislike needles" were salient only among black participants who were biologic naïve. Participants were generally unfamiliar with the other psoriasis therapies except phototherapy. Unfamiliarity with biologics, particularly among black, biologic-naïve patients, may partly explain the existing racial disparity in biologic treatment for psoriasis and might stem from lack of exposure to or poor understanding of biologics.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Whitney T Eriksen
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie T Raziano
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claire Bocage
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynn Hur
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ruchi V Shah
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Armstrong AW, Reich K, Foley P, Han C, Song M, Shen YK, You Y, Papp KA. Improvement in Patient-Reported Outcomes (Dermatology Life Quality Index and the Psoriasis Symptoms and Signs Diary) with Guselkumab in Moderate-to-Severe Plaque Psoriasis: Results from the Phase III VOYAGE 1 and VOYAGE 2 Studies. Am J Clin Dermatol 2019; 20:155-164. [PMID: 30417277 PMCID: PMC6513809 DOI: 10.1007/s40257-018-0396-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) may be markedly impaired in patients with moderate-to-severe psoriasis. OBJECTIVES Our objectives were to compare improvements in Dermatology Life Quality Index (DLQI) and Psoriasis Symptoms and Signs Diary (PSSD) scores between patients receiving guselkumab compared with placebo or adalimumab and to correlate these improvements with skin clearance. METHODS Pooled phase III VOYAGE 1 and VOYAGE 2 data were evaluated through week 24. At baseline, patients were randomized to guselkumab 100 mg, placebo, or adalimumab 40 mg. At week 16, patients receiving placebo switched to guselkumab. Assessment measures included DLQI percent change from baseline, DLQI 0/1, DLQI minimal clinically important difference (MCID), individual domain scores, PSSD symptoms and signs score = 0, DLQI association with PSSD, Investigator's Global Assessment (IGA), and Psoriasis Area and Severity Index (PASI). RESULTS Significantly greater improvements from baseline DLQI were observed with guselkumab versus placebo (weeks 8 and 16) and versus adalimumab (week 24; p < 0.001). The proportion of patients achieving DLQI 0/1 ("no impact") at week 24 was higher with guselkumab than with adalimumab (58.9 vs. 40.2%; p < 0.001), and more patients attained a ≥ 4-point reduction in DLQI (MCID) at this timepoint (p < 0.001). Changes in individual DLQI domains were significantly greater for patients receiving guselkumab than for those receiving adalimumab, and among patients with individual baseline domain scores = 3 or 6 (severest impact), more guselkumab recipients than those receiving adalimumab achieved a score = 0 across all domains at week 24. DLQI 0/1 scores were associated with a PSSD symptom or sign score = 0 (no impact) and greater improvement of PASI and IGA (week 24). CONCLUSIONS Pooled VOYAGE 1/VOYAGE 2 data demonstrated that guselkumab was superior to adalimumab in improving HRQoL, which was associated with greater skin clearance. CLINICAL TRIAL REGISTRATION NCT02207231 and NCT02207244.
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Affiliation(s)
- April W Armstrong
- Keck School of Medicine of USC, University of Southern California, 1975 Zonal Avenue, Keith Administration Building, Room 510, Los Angeles, CA, 90089, USA.
| | - Kristian Reich
- Dermatologikum Berlin, Berlin, Germany
- SCIderm Research Institute, Hamburg, Germany
| | - Peter Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy and Probity Medical Research Inc., and Skin & Cancer Foundation Inc., Carlton, VIC, Australia
| | - Chenglong Han
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Michael Song
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Yin You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
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Ali FM, Johns N, Salek S, Finlay AY. Correlating the Dermatology Life Quality Index with psychiatric measures: A systematic review. Clin Dermatol 2018; 36:691-697. [DOI: 10.1016/j.clindermatol.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wechter T, Heath M, Aung-Din D, Sahni D, Cline A, Feldman SR. Current Psoriasis Efficacy Outcome Measures in Clinical Trials. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Rencz F, Gulácsi L, Péntek M, Poór AK, Sárdy M, Holló P, Szegedi A, Remenyik É, Brodszky V. Proposal of a new scoring formula for the Dermatology Life Quality Index in psoriasis. Br J Dermatol 2018; 179:1102-1108. [PMID: 29968311 DOI: 10.1111/bjd.16927] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND 'Not relevant' responses (NRRs) on the Dermatology Life Quality Index (DLQI) may occur in up to 40% of patients with psoriasis. As these responses are scored as the item of the questionnaire having no impact on the patients' lives at all, it is more difficult for these patients to fulfil the DLQI > 10 criterion required by clinical guidelines to become candidates for systemic treatment including biologics. OBJECTIVES We propose a new scoring system for the DLQI that corrects for the bias in the NRR option and test its construct validity in a sample of patients with psoriasis. METHODS Data from 242 patients (104 of whom marked at least one NRR) from two earlier cross-sectional surveys were reanalysed. For each patient, the DLQI score was calculated in two ways: (i) according to the original scoring and (ii) by applying a new scoring formula (DLQI-R) that adjusts the total score for the number of NRRs. The construct validity of the DLQI-R was tested against the Psoriasis Area and Severity Index (PASI) and EQ-5D-3L. RESULTS The mean DLQI and DLQI-R scores were 9·99 ± 7·52 and 11·0 ± 8·02, respectively. The DLQI-R allowed eight more patients (3·3%) to achieve the 'PASI > 10 and DLQI > 10' threshold. The results were robust when limiting the maximum number of NRRs allowed to two or three. Compared with the DLQI, DLQI-R correlated slightly better with PASI (rs = 0·59 vs. 0·57) and EQ-5D-3L index scores (rs = -0·58 vs. -0·54). CONCLUSIONS The DLQI-R seems to be a valid scoring system for avoiding the bias in the NRR option and can help to improve patients' access to biologics.
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Affiliation(s)
- F Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary.,Hungarian Academy of Sciences, Premium Postdoctoral Research Programme, Nádor u. 7, H-1051, Budapest, Hungary
| | - L Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
| | - M Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
| | - A K Poór
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - P Holló
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - A Szegedi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary.,Department of Dermatological Allergology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
| | - É Remenyik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
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Affiliation(s)
- P. Gisondi
- Section of Dermatology and Venereology; Department of Medicine; University of Verona; Piazzale A. Stefani 1 37126 Verona Italy
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Youn SW, Lee JH, Yu DY, Kim Y, Kim BS, Seo SJ, Choe YB, Yun SK, Park J, Kim NI, Choi CW, Youn JI, Lee SJ, Lee MG, Kim KJ, Park CJ, Ro YS, Song HJ, Shin BS, Ahn SK, Lee JY, Won YH, Jang MS, Kim KH, Kim MH, Kim TY, Choi JH. The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study). J Eur Acad Dermatol Venereol 2018; 32:1499-1506. [PMID: 29430733 DOI: 10.1111/jdv.14865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/25/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.
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Affiliation(s)
- S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J-H Lee
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - D Y Yu
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - Y Kim
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - B S Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Y B Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - S-K Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - J Park
- Department of Dermatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - N I Kim
- Department of Dermatology, KyungHee University Medical center, Seoul, Korea
| | - C W Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J I Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - S-J Lee
- Department of Dermatology, Kyungpook National University Hospital, Daegu, Korea
| | - M-G Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - K J Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - C J Park
- Department of Dermatology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Y S Ro
- Department of Dermatology, Hanyang University Medical Center, Seoul, Korea
| | - H J Song
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
| | - B S Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - S K Ahn
- Department of Dermatology, Wonju Severance Christian Hospital, Wonju, Korea
| | - J Y Lee
- Department of Dermatology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Y H Won
- Department of Dermatology, Chonnam National University Hospital, Gwangju, Korea
| | - M S Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - K H Kim
- Department of Dermatology, Dong-A University Hospital, Busan, Korea
| | - M H Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - T Y Kim
- Department of Dermatology, Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - J-H Choi
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Tzaneva S, Geroldinger A, Trattner H, Tanew A. Fumaric acid esters in combination with a 6-week course of narrowband ultraviolet B provides an accelerated response compared with fumaric acid esters monotherapy in patients with moderate-to-severe plaque psoriasis: a randomized prospective clinical stud. Br J Dermatol 2018; 178:682-688. [DOI: 10.1111/bjd.16106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
- S. Tzaneva
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Geroldinger
- Center for Medical Statistics, Informatics and Intelligent Systems; Section for Clinical Biometrics; Medical University of Vienna; Vienna Austria
| | - H. Trattner
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Tanew
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
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Frieder J, Kivelevitch D, Fiore CT, Saad S, Menter A. The impact of biologic agents on health-related quality of life outcomes in patients with psoriasis. Expert Rev Clin Immunol 2017; 14:1-19. [PMID: 29110556 DOI: 10.1080/1744666x.2018.1401468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements. Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-α (TNF-α) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents. Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population.
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Affiliation(s)
- Jillian Frieder
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Dario Kivelevitch
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Connie Tran Fiore
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Saadeddine Saad
- b Texas A&M Health Science Center College of Medicine , Bryan , TX , USA
| | - Alan Menter
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
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28
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Kivelevitch D, Michel P, Menter A. Quality of life instruments in psoriasis clinical trials. Br J Dermatol 2017; 176:563. [PMID: 28300302 DOI: 10.1111/bjd.15102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - P Michel
- Baylor Institute for Immunology Research, Dallas, TX, U.S.A
| | - A Menter
- Baylor University Medical Center, Dallas, TX, U.S.A
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29
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Ali F, Johns N, Finlay A, Salek M, Piguet V. Comparison of the paper‐based and electronic versions of the Dermatology Life Quality Index: evidence of equivalence. Br J Dermatol 2017; 177:1306-1315. [DOI: 10.1111/bjd.15314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 12/30/2022]
Affiliation(s)
- F.M. Ali
- Department of Dermatology and Wound Healing Division of Infection and Immunity School of Medicine Cardiff University Cardiff U.K
| | - N. Johns
- Department of Dermatology and Wound Healing Division of Infection and Immunity School of Medicine Cardiff University Cardiff U.K
- Faculty of Pharmaceutical Sciences and Melatonin Research Group Khon Kaen University Khon Kaen Thailand
| | - A.Y. Finlay
- Department of Dermatology and Wound Healing Division of Infection and Immunity School of Medicine Cardiff University Cardiff U.K
| | - M.S. Salek
- School of Life and Medical Sciences University of Hertfordshire Hatfield U.K
- Institute for Medicines Development Cardiff U.K
| | - V. Piguet
- Department of Dermatology and Wound Healing Division of Infection and Immunity School of Medicine Cardiff University Cardiff U.K
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30
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Puig L, van de Kerkhof PCM, Reich K, Bachelez H, Barker J, Girolomoni G, Paul C. A European subset analysis from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis shows country-specific features: results from psoriasis patients in Spain. J Eur Acad Dermatol Venereol 2017; 31:1176-1182. [PMID: 28271561 PMCID: PMC5574026 DOI: 10.1111/jdv.14195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
Background The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey data were not analysed to account for cultural and healthcare system differences across European countries (EC). Objective To utilize MAPP data to characterize psoriasis in Spanish patients, including severity assessment and Dermatology Life Quality Index (DLQI). Methods The MAPP survey was conducted between June and August 2012. This analysis included 1700 patients with self‐reported psoriasis (without psoriatic arthritis) from France (n = 349), Germany (n = 311), Italy (n = 359), Spain (n = 354) and the United Kingdom (n = 327). Results Patients from Spain vs. other EC self‐reported higher mean body mass index (26.9 vs. 25.6, P ≤ 0.001), lower prevalence of depression (6% vs. 12%, P = 0.002) and higher mean self‐perceived psoriasis severity at its worst (5.92 vs. 5.33, P < 0.001) despite lower estimated body‐surface‐area involvement. Overall, patients from Spain vs. other EC had lower mean global DLQI scores (4.70 vs. 6.06, P = 0.001) and lower mean scores for each DLQI dimension [all P < 0.001, except leisure (P = 0.002), treatment (P = 0.002), and work and school (P = 0.005)]. Higher DLQI values were inversely associated with age and directly correlated with perceived severity. Palmoplantar, nail and scalp psoriasis were reported less frequently in Spanish patients (P = 0.026) and were associated with higher DLQI values (P < 0.01). Spanish patients were more likely to have seen multiple healthcare providers (HCPs; P < 0.001) and achieve therapeutic goals (P < 0.001), but current treatments were similar to patients in other EC. Conclusions In the MAPP survey, Spanish patients differed from other EC in several characteristics, including comorbidities, extent and distribution of psoriasis lesions, perception of severity and impact on quality of life. Their perception of psoriasis severity was higher despite a lower estimated extent, and DLQI scores were significantly lower. Spanish patients had more HCP visits and a higher rate of therapeutic goal achievement. These differences might be attributed to cultural factors, phenotypical variation and differences in HCP access.
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Affiliation(s)
- L Puig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - K Reich
- Sclderm Research Institute and Dermatologikum Hamburg, Hamburg, Germany
| | - H Bachelez
- Department of Dermatology, APHP Saint-Louis Hospital, Sorbonne Paris Cité Université Paris Diderot, Paris, France
| | - J Barker
- Division of Genetics and Molecular Medicine, St. John's Institute of Dermatology, King's College, London, UK
| | | | - C Paul
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
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31
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Connor CJ. Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines. Clin Cosmet Investig Dermatol 2017; 10:117-132. [PMID: 28458571 PMCID: PMC5404497 DOI: 10.2147/ccid.s111041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient's quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.
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Affiliation(s)
- Cody J Connor
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Ohtsuki M, Okubo Y, Komine M, Imafuku S, Day RM, Chen P, Petric R, Maroli A, Nemoto O. Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of Japanese patients with moderate to severe plaque psoriasis: Efficacy, safety and tolerability results from a phase 2b randomized controlled trial. J Dermatol 2017; 44:873-884. [PMID: 28391657 PMCID: PMC5573969 DOI: 10.1111/1346-8138.13829] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 01/15/2023]
Abstract
Apremilast, an oral, small‐molecule phosphodiesterase 4 inhibitor, works intracellularly within immune cells to regulate inflammatory mediators. This phase 2b randomized, placebo‐controlled study evaluated efficacy and safety of apremilast among Japanese patients with moderate to severe plaque psoriasis. In total, 254 patients were randomized to placebo, apremilast 20 mg b.i.d. (apremilast 20) or apremilast 30 mg b.i.d. (apremilast 30) through week 16; thereafter, all placebo patients were re‐randomized to apremilast 20 or 30 through week 68. Efficacy assessments included achievement of 75% or more reduction from baseline in Psoriasis Area and Severity Index score (PASI‐75; primary) and achievement of static Physician Global Assessment (sPGA; secondary) score of 0 (clear) or 1 (minimal) at week 16. Safety was assessed through week 68. At week 16, PASI‐75 response rates were 7.1% (placebo), 23.5% (apremilast 20; P = 0.0032 vs placebo) and 28.2% (apremilast 30; P = 0.0003 vs placebo); sPGA response rates (score of 0 or 1) were 8.8% (placebo), 23.9% (apremilast 20; P = 0.0165 vs placebo) and 29.6% (apremilast 30; P = 0.0020 vs placebo). Responses were maintained with apremilast through week 68. Most common adverse events (AEs) with placebo, apremilast 20 and apremilast 30 (0–16 weeks) were nasopharyngitis (8.3%, 11.8%, 11.8%), diarrhea (1.2%, 8.2%, 9.4%), and abdominal discomfort (1.2%, 1.2%, 7.1%), respectively. Exposure‐adjusted incidence of these AEs did not increase with continued apremilast treatment (up to 68 weeks). Apremilast demonstrated efficacy and safety in Japanese patients with moderate to severe plaque psoriasis through 68 weeks that was generally consistent with prior studies.
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Affiliation(s)
| | | | | | | | | | - Peng Chen
- Celgene Corporation, Summit, New Jersey, USA
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Gladman DD, Poulin Y, Adams K, Bourcier M, Barac S, Barber K, Chandran V, Dutz J, Flanagan C, Gooderham MJ, Gulliver WP, Ho VC, Hong CH, Karsh J, Khraishi MM, Lynde CW, Papp KA, Rahman P, Rohekar S, Rosen CF, Russell AS, Vender RB, Yeung J, Ziouzina O, Zummer M. Treating Psoriasis and Psoriatic Arthritis: Position Paper on Applying the Treat-to-target Concept to Canadian Daily Practice. J Rheumatol 2017; 44:519-534. [DOI: 10.3899/jrheum.161473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective.To develop preliminary treat-to-target (T2T) recommendations for psoriasis and psoriatic arthritis (PsA) for Canadian daily practice.Methods.A task force composed of expert Canadian dermatologists and rheumatologists performed a needs assessment among Canadian clinicians treating these diseases as well as an extensive literature search on the outcome measures used in clinical trials and practice.Results.Based on results from the needs assessment and literature search, the task force established 5 overarching principles and developed 8 preliminary T2T recommendations.Conclusion.The proposed recommendations should improve management of psoriasis and PsA in Canadian daily practice. However, these recommendations must be further validated in a real-world observational study to ensure that their use leads to better longterm outcomes.
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Pickard AS, Gooderham M, Hartz S, Nicolay C. EQ-5D health utilities: exploring ways to improve upon responsiveness in psoriasis. J Med Econ 2017; 20:19-27. [PMID: 27471948 DOI: 10.1080/13696998.2016.1219359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To determine if EuroQoL 5-Dimension Health Questionnaire (EQ-5D) health utility scores were able to discriminate among different levels of improvement in psoriasis severity following therapy. MATERIALS AND METHODS Data were from three placebo-controlled phase 3 ixekizumab studies (UNCOVER-1, UNCOVER-2, and UNCOVER-3) with patients who had baseline Dermatology Life Quality Index scores >10 (DLQI >10). Psoriasis severity (Psoriasis Area and Severity Index [PASI]), general health utility (EQ-5D), and psoriasis-specific utility (EQ-PSO, UNCOVER-3 only) were assessed. EQ-5D-5L utility scores were generated using the England EQ-5D-5L value set, a crosswalk applied to the EQ-5D-3L United States (US) and United Kingdom (UK) value sets, and a regression-based exploratory scoring function for the EQ-PSO (UK). Analysis of variance was used to estimate change in EQ-5D-5L from baseline to Week 12 per PASI improvement level: PASI <50, PASI 50 to <75, PASI 75 to <90, PASI 90 to <100, and PASI 100. Missing data were imputed using the last observation carried forward method. Value sets for the UK, England, and the US were applied. RESULTS In total, 2085 patients across UNCOVER-1, UNCOVER-2, and UNCOVER-3 had baseline DLQI >10 and available utility scores. At Week 12, mean EQ-5D utility scores increased with increasing PASI improvement levels (p < 0.001, all analyses). Mean health utilities for PASI 90 to <100 and PASI 100 were similar when based on the generic classifier, whereas a clear differentiation between PASI 90 to <100 and PASI 100 was observed for EQ-PSO mean scores (UNCOVER-3 only, n = 645; PASI 90 to <100: 0.141, PASI 100: 0.200; adjusted p = 0.043). LIMITATIONS EQ-5D-5L index-based scores have limited ability to differentiate among psoriasis patients at the highest PASI improvement levels. ConclusionsL Adding psoriasis-specific EQ-PSO dimensions to the EQ-5D may enhance responsiveness to improvement in skin clarity at the highest PASI levels, and, therefore, generate utility scores that better reflect treatment benefit in cost-utility models.
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Affiliation(s)
- A Simon Pickard
- a Second City Outcomes Research , Chicago , IL , USA
- b Department of Medical Research , China Medical University Hospital, China Medical University , Taichung , Taiwan
| | | | - Susanne Hartz
- d Eli Lilly and Company Ltd. , Windlesham , Surrey , UK
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35
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Greb JE, Goldminz AM, Elder JT, Lebwohl MG, Gladman DD, Wu JJ, Mehta NN, Finlay AY, Gottlieb AB. Psoriasis. Nat Rev Dis Primers 2016; 2:16082. [PMID: 27883001 DOI: 10.1038/nrdp.2016.82] [Citation(s) in RCA: 530] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations and substantial negative effects on patient quality of life. Psoriasis has a strong, albeit polygenic, genetic basis. Whereas approximately half of the accountable genetic effect of psoriasis maps to the major histocompatibility complex, >70 other loci have been identified, many of which implicate nuclear factor-κB, interferon signalling and the IL-23-IL-23 receptor axis. Psoriasis pathophysiology is characterized by abnormal keratinocyte proliferation and immune cell infiltration in the dermis and epidermis involving the innate and adaptive immune systems, with important roles for dendritic cells and T cells, among other cells. Frequent comorbidities are rheumatological and cardiovascular in nature, in particular, psoriatic arthritis. Current treatments for psoriasis include topical agents, photo-based therapies, traditional systemic drugs and biologic agents. Treatments can be used in combination or as monotherapy. Biologic therapies that target specific disease mediators have become a mainstay in the treatment of moderate-to-severe disease, whereas advances in the treatment of mild-to-moderate disease have been limited.
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Affiliation(s)
- Jacqueline E Greb
- Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Department of Dermatology, Boston, Massachusetts, USA
| | - Ari M Goldminz
- Tufts Medical Center, Department of Dermatology, Boston, Massachusetts, USA
| | - James T Elder
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dafna D Gladman
- University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Alice B Gottlieb
- Department of Dermatology, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, New York 10595, USA
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36
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Daudén E, Puig L, Ferrándiz C, Sánchez-Carazo JL, Hernanz-Hermosa JM. Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol 2016; 30 Suppl 2:1-18. [PMID: 26812550 DOI: 10.1111/jdv.13542] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
Psoriasis is a highly prevalent disease with a major impact on quality of life; therefore, appropriate patient management is mandatory. Given that many issues in psoriasis are controversial and not clearly defined by evidence-based medicine, management of psoriasis is very variable. Expert consensus can generate practical guidelines for optimization of patient care. Much has changed since 2009, when the Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis was published by the Spanish Psoriasis Group (GEP) of the Spanish Academy of Dermatology and Venereology (AEDV). The objective of the present consensus document is to provide the dermatologist with updated recommendations for the evaluation and treatment of patients with moderate-to-severe plaque psoriasis. All active members of the GEP of the AEDV were invited to participate in the survey. The final group comprised 46 members from various areas of Spain and with substantial experience in managing psoriasis. A 3-round Delphi process was used to reach consensus. Consistent agreement and consistent disagreement (consensus) required the achievement of at least two of the following three criteria: Criterion 1, which was based on the position occupied by the mean on a scale of 1-9 and an SD <2; Criterion 2, which was based on the median and interquartile range (IQR) on a scale of 1-9; Criterion 3, which considered the percentage of the voting experts on a scale of 1-9. The items studied were definition of severity, therapeutic objectives, indications for systemic treatment and biologic therapy, induction and maintenance periods, therapeutic failure, loss of response, relapse and rebound, continuous and intermittent therapy, screening of patients before treatment, adherence to therapy, follow-up of treatment outcome, combination of drugs, transitioning and associated comorbidities. Consistent agreement or disagreement (consensus) was achieved for 198 items (agreement, 3 criteria 146 items, 2 criteria 43 items; disagreement, 3 criteria 9 items, 2 criteria 0 items) based on the criteria described above. Completion of the Delphi consensus process enabled a broad and experienced group of Spanish psoriasis experts to provide useful and practical guidelines for the management and treatment of patients with moderate-to-severe psoriasis, particularly in areas where evidence is lacking.
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Affiliation(s)
- E Daudén
- Dermatology Department, IIS-IP, Hospital Universitario La Princesa, Madrid, Spain
| | - L Puig
- Dermatology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - C Ferrándiz
- Dermatology Department, Hospital Germans Trías i Pujol, Barcelona, Spain
| | - J L Sánchez-Carazo
- Dermatology Department, Hospital General Universitario de Valencia, Valencia, Spain
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37
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Mermin D, Boursault L, Milpied B, Taieb A, Ezzedine K, Seneschal J. DLQI as a major criterion for introduction of systemic agents in patients with mild psoriasis. J Eur Acad Dermatol Venereol 2016; 30:1961-1964. [DOI: 10.1111/jdv.13803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D. Mermin
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
| | - L. Boursault
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
| | - B. Milpied
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
| | - A. Taieb
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
| | - K. Ezzedine
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
| | - J. Seneschal
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin disorders; Hôpital Saint-André; Bordeaux France
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38
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Radtke MA, Spehr C, Reich K, Rustenbach SJ, Feuerhahn J, Augustin M. Treatment Satisfaction in Psoriasis: Development and Use of the PsoSat Patient Questionnaire in a Cross-Sectional Study. Dermatology 2016; 232:334-43. [DOI: 10.1159/000444635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
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39
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Kwon HH, Kim MW, Park GH, Bae YI, Kuk SK, Suh DH, Youn JI, Kwon IH. Facial Psoriasis Log-based Area and Severity Index: A valid and reliable severity measurement method detecting improvement of facial psoriasis in clinical practice settings. J Dermatol 2016; 43:894-9. [PMID: 26992293 DOI: 10.1111/1346-8138.13283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/01/2015] [Indexed: 01/10/2023]
Abstract
Facial psoriasis is often observed in moderate to severe degrees of psoriasis. While we previously demonstrated construct validity of the facial Psoriasis Log-based Area and Severity Index (fPLASI) system for the cross-sectional evaluation of facial psoriasis, its reliability and accuracy to detect clinical improvement has not been confirmed yet. The aim of this study is to analyze whether the fPLASI properly represents the range of improvement for facial psoriasis compared with the existing facial Psoriasis Area and Severity Index (fPASI) after receiving systemic treatments in clinical practice settings. The changing severity of facial psoriasis for 118 patients was calculated by the scales of fPASI and fPLASI between two time points after systemic treatments. Then, percentage changes (ΔfPASI and ΔfPLASI) were analyzed from the perspective of both the Physician's Global Assessment of effectiveness (PGA) and patients' Subjective Global Assessment (SGA). As a result, the distribution of the fPASI was more heavily clustered around the low score range compared with the fPLASI at both first and second visits. Linear regression analysis between ΔfPASI and ΔfPLASI shows that the correlation coefficient was 0.94, and ΔfPLASI represented greater percentage changes than ΔfPASI. Remarkably, degrees of clinical improvement measured by the PGA matched better with ΔfPLASI, while ΔfPASI underestimated clinical improvements compared with ΔfPLASI from treatment-responding groups by the PGA and SGA. In conclusion, the fPLASI represented clinical improvement of facial psoriasis with more sensitivity and reliability compared with the fPASI. Therefore, the PLASI system would be a viable severity measurement method for facial psoriasis in clinical practice.
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Affiliation(s)
- Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Woo Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - You In Bae
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Su Kyung Kuk
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
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40
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Fitzpatrick SE, Srivorakiat L, Wink LK, Pedapati EV, Erickson CA. Aggression in autism spectrum disorder: presentation and treatment options. Neuropsychiatr Dis Treat 2016; 12:1525-38. [PMID: 27382295 PMCID: PMC4922773 DOI: 10.2147/ndt.s84585] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder.
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Affiliation(s)
- Sarah E Fitzpatrick
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Laura Srivorakiat
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan K Wink
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig A Erickson
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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41
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Petraškienė R, Valiukevičienė S, Macijauskienė J. Associations of the quality of life and psychoemotional state with sociodemographic factors in patients with psoriasis. Medicina (B Aires) 2016; 52:238-243. [DOI: 10.1016/j.medici.2016.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 07/09/2016] [Indexed: 11/25/2022] Open
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42
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Dogra S, Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Indian Dermatol Online J 2016; 7:471-480. [PMID: 27990381 PMCID: PMC5134160 DOI: 10.4103/2229-5178.193906] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
On the basis of current evidence derived from hospital-based studies, mostly from North India, the prevalence of psoriasis in adults varies from 0.44 to 2.8%, with a much lower prevalence in children. The peak age at onset in adults is in the third and fourth decade of life, with a slight male preponderance. It is recommended that population-based large epidemiologic studies should be undertaken in different parts of the country for estimating the correct prevalence of psoriasis in general population. Chronic plaque-type psoriasis is the most common morphologic presentation of psoriasis, accounting for more than 90% of all cases. Other morphologic variants that deserve special mention include palmoplantar psoriasis, pustular psoriasis, and recalcitrant psoriasis. For epidemiologic purposes, psoriasis can be classified into early and late onset psoriasis. Psoriasis can be classified on the basis of morphology and extent of involvement into localized and widespread disease. For the purpose of clinical trials, psoriasis may be classified as mild psoriasis, moderate psoriasis, and severe psoriasis. The literature shows that there is a significant risk of psoriatic arthritis (7-48%) in patients with plaque-type psoriasis. Hence, it is recommended to evaluate for its presence by detailed history taking and clinical examination, and if necessary, by appropriate radiological investigations. Evidence on the association between plaque-type psoriasis and cardiovascular disease risk factors and ischemic heart disease isinconsistent. On the basis ofavailable evidence, it is prudent to proactively look for metabolic syndrome, dyslipidemia, and obesity, especially in patientswith severe psoriasis (Level 1+ evidence based on systematic reviews and meta-analysis). Based on the current evidence, the psoriasis area severity index appears to be the most valid and reproducible clinical severity score in the management of adult patients with plaque-type psoriasis.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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43
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Register-Based Evaluation of Relative Effectiveness of New Therapies: Biologics Versus Conventional Agents in Treatment of Psoriasis in Sweden. BioDrugs 2015; 29:389-98. [DOI: 10.1007/s40259-015-0151-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Affiliation(s)
- Ching-Chi Chi
- Chang Gung Memorial Hospital; Department of Dermatology and Centre for Evidence-Based Medicine; 6, Sec West, Chia-Pu Road Puzih Chiayi Taiwan 61363
- Chang Gung University; College of Medicine; Taoyuan Taiwan
| | - Shu-Hua Ko
- Wei-Gong Memorial Hospital; Department of Nursing; 128, Shin-I Rd Toufen Miaoli Taiwan 35159
| | - Mei-Ling Yeh
- National Taipei University of Nursing and Health Sciences; School of Nursing; 365, MingTe Road Taipei PeiTou Taiwan 112
| | - Shu-Hui Wang
- Far Eastern Memorial Hospital; Department of Dermatology; 21, Sec 2, Nanya S Rd Banciao District New Taipei City Taiwan 220
| | - Yu-Shiun Tsai
- Chang Gung Memorial Hospital, Chiayi; Medical Library; 6.WEST SEC. CHIAPU ROAD, PUTZU CITY Chiayi Taiwan 61363
| | - Mei-Ya Hsu
- Chang Gung Memorial Hospital, Chiayi; Department of Nutrition; 6, Sec West, Chia-Pu Rd, Puzih Chiayi Taiwan 61363
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45
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Fotiou K, Hofmann M, Kaufmann R, Thaci D. Pictorial representation of illness and self measure (PRISM): an effective tool to assess the burden of psoriasis. J Eur Acad Dermatol Venereol 2015; 29:2356-62. [DOI: 10.1111/jdv.13232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/21/2015] [Indexed: 12/31/2022]
Affiliation(s)
- K. Fotiou
- Department of Dermatology, Venereology and Allergology; Goethe University Frankfurt; Frankfurt Germany
| | - M. Hofmann
- Department of Dermatology, Venereology and Allergology; Goethe University Frankfurt; Frankfurt Germany
| | - R. Kaufmann
- Department of Dermatology, Venereology and Allergology; Goethe University Frankfurt; Frankfurt Germany
| | - D. Thaci
- Comprehensive Center for Inflammation Medicine; University Medical Center Schleswig-Holstein; University of Lübeck; Lübeck Germany
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46
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Tennvall GR, Norlin JM, Malmberg I, Erlendsson AM, Hædersdal M. Health related quality of life in patients with actinic keratosis--an observational study of patients treated in dermatology specialist care in Denmark. Health Qual Life Outcomes 2015. [PMID: 26220553 PMCID: PMC4518856 DOI: 10.1186/s12955-015-0295-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Actinic keratosis (AK) is a common skin condition that may progress to non-melanoma skin cancer (NMSC). The disease may influence Health Related Quality of Life (HRQoL), but studies of HRQoL in patients with AK are limited. The purpose of the study was to analyze HRQoL in patients with different severity levels of AK treated in dermatology specialist care using generic and disease-specific HRQoL instruments and to analyze their relationship. Methods AK patients who visited dermatological clinics in Denmark were included in an observational, cross-sectional, study in a multi-center setting. Dermatologists assessed AK severity and patients completed: Actinic Keratosis Quality of Life Questionnaire (AKQoL), Dermatology Life Quality Index (DLQI), and EQ-5D-5 L including EQ-VAS. Differences between categorical subgroups were tested with Wilcoxon rank-sum test. The relationship between instruments was analyzed with the Spearman correlation test. Results A total of 312 patients were included in the analyses. Patients reported impairment in the disease specific HRQoL instrument AKQoL (mean AKQoL 6.7, DLQI 2, EQ-5D-5 L 0.88, and EQ-VAS 79). HRQoL was least affected in patients with mild actinic disease, whereas patients with severe actinic damage suffered from further impaired HRQoL (mean AKQoL 10.1 and DLQI 4.6). Correlations between DLQI and AKQoL were moderate, whereas the correlations between DLQI and EQ-5D-5 L and between AKQoL and EQ-5D-5 L were weak. Conclusions Patients with severe actinic damage showed more impairment in HRQoL than those with mild disease. Correlations between instruments suggest that they are complementary as they measure different aspects of HRQoL and are used for different purposes.
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Affiliation(s)
| | - J M Norlin
- IHE, The Swedish Institute for Health Economics, P.O. Box 2127, SE-220 02, Lund, Sweden.
| | | | - A M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - M Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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47
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Measuring psoriatic disease in clinical practice. An expert opinion position paper. Autoimmun Rev 2015; 14:864-74. [PMID: 26025585 DOI: 10.1016/j.autrev.2015.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/22/2015] [Indexed: 02/08/2023]
Abstract
Psoriasis is a common, immune-mediated chronic inflammatory disease with a primary involvement of skin and joints, affecting approximately 2% of the population worldwide. Up to one third of patients with psoriasis are diagnosed with psoriatic arthritis (PsA). Psoriasis and PsA are heterogeneous diseases whose severity depends on a number of clinical factors, such as areas affected and pattern of involvement, and are associated with a range of comorbid diseases and risk factors, including obesity, metabolic syndrome, cardiovascular disease and liver disease. Thus measuring the severity of psoriatic disease needs to take into account the multidimensional aspects of the disease. Subjective measures including the impairment in quality of life or in daily living activities as well as the presence of cardio-metabolic comorbidities, are important for the outcome and add further levels of complexity that, to a certain extent, need to be assessed. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented for a most effective managing of psoriasis patients. A joint dermatologist-rheumatologist roundtable discussion was convened to share evidence on the real-life use of methods for measuring psoriasis severity comprehensively. Our objective was to provide an expert position on which clinical variables are to be taken into account when considering patients affected by psoriasis and/or PsA globally and on the assessment tools more suitable for measuring disease activity and/or severity in clinical practice.
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48
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Simpson M, Chow C, Morgenstern H, Luger T, Ellis C. Comparison of three methods for measuring psoriasis severity in clinical studies (Part 2 of 2): use of quality of life to assess construct validity of the Lattice System Physician's Global Assessment, Psoriasis Area and Severity Index and Static Physician. J Eur Acad Dermatol Venereol 2015; 29:1415-20. [DOI: 10.1111/jdv.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/20/2014] [Indexed: 12/21/2022]
Affiliation(s)
- M.J. Simpson
- Department of Dermatology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Epidemiology; School of Public Health; University of Michigan; Ann Arbor Michigan USA
| | - C. Chow
- Department of Dermatology; University of Michigan Medical School; Ann Arbor Michigan USA
| | - H. Morgenstern
- Department of Epidemiology; School of Public Health; University of Michigan; Ann Arbor Michigan USA
- Department of Environmental Health Sciences; School of Public Health; University of Michigan; Ann Arbor Michigan USA
- Department of Urology; University of Michigan Medical School; Ann Arbor Michigan USA
| | - T.A. Luger
- Department of Dermatology; University of Münster; Münster Germany
| | - C.N. Ellis
- Department of Dermatology; University of Michigan Medical School; Ann Arbor Michigan USA
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49
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Kitchen H, Cordingley L, Young H, Griffiths CEM, Bundy C. Patient-reported outcome measures in psoriasis: the good, the bad and the missing! Br J Dermatol 2015; 172:1210-21. [PMID: 25677764 DOI: 10.1111/bjd.13691] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 01/22/2023]
Abstract
As a long-term condition, psoriasis demands significant personal and professional input for optimal self-management. Low levels of well-being and high levels of psychological distress in patients with psoriasis are associated with reduced resources for self-care. Patient-reported outcome (PRO) measures can be used to assess physical, social and psychological functioning in order to guide treatment. In this article, we systematically reviewed the development and validation of existing PRO measures. PubMed (Medline), PsycINFO and CINAHL were searched systematically using predefined search terms. The search was limited to articles in the English language relating to human subjects. Articles were selected for full review through explicit inclusion/exclusion criteria. PRO measures were critically reviewed in accordance with the published guidelines and theory on the development and validation of PROs. The search identified 967 abstracts; 71 of these articles met the criteria for full review. In these 71 articles, 45 PRO measures were found: 16 were specific to psoriasis, 21 assessed other dermatological conditions and eight were developed for generic nondermatological health conditions. The review revealed several limitations of the existing measures, including: (i) a composite structure assessing multiple, poorly-defined concepts; (ii) a lack of evidence for face and content validity; (iii) a failure to include both patient and clinician perspectives and requirements and (iv) a lack of evidence regarding the feasibility and acceptability for patients and physicians. No single PRO measure with adequate evidence of validity, reliability and sensitivity to change captures patient well-being in psoriasis. A valid, sensitive, specific and acceptable PRO that assesses the full impact of psoriasis on well-being is needed for the comprehensive clinical management of psoriasis.
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Affiliation(s)
- H Kitchen
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - L Cordingley
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - H Young
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - C E M Griffiths
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - C Bundy
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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50
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Molina-Leyva A, Caparros-delMoral I, Ruiz-Carrascosa J, Naranjo-Sintes R, Jimenez-Moleon J. Elevated prevalence of Type D (distressed) personality in moderate to severe psoriasis is associated with mood status and quality of life impairment: a comparative pilot study. J Eur Acad Dermatol Venereol 2015; 29:1710-7. [DOI: 10.1111/jdv.12960] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/09/2014] [Indexed: 01/09/2023]
Affiliation(s)
- A. Molina-Leyva
- Department of Dermatology; Hospital Torrecardenas; Almería Spain
| | | | | | | | - J.J. Jimenez-Moleon
- CIBER de Epidemiología y Salud Pública (CIBERESP); Granada Spain
- Dpto. de Medicina Preventiva y Salud Pública; Instituto de Investigación Biosanitaria ibs; Hospitales Universitarios de Granada/Universidad de Granada; Granada Spain
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