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Youn SW, Jo SJ, Park CJ, Kim DH, Shin BS, Jeong KH, Bang CH, Cross N, Thirlwell J, Hoepken B. Bimekizumab efficacy and safety in Korean patients with moderate to severe plaque psoriasis: A phase 3, randomized, placebo-controlled, double-blinded study. J Dermatol 2024. [PMID: 39328126 DOI: 10.1111/1346-8138.17446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/08/2024] [Accepted: 08/18/2024] [Indexed: 09/28/2024]
Abstract
Bimekizumab treatment has demonstrated significant improvements in clinical outcomes in patients with moderate to severe plaque psoriasis; however, studies so far have focused on predominantly White patient populations from North America and Europe, with one smaller study in a Japanese population. Here, clinical responses, safety, and tolerability of bimekizumab treatment in Korean patients are reported. Korean patients with moderate to severe plaque psoriasis were randomized to bimekizumab 320 mg every 4 weeks (Q4W) or placebo Q4W to week 16. Co-primary efficacy end points were achievement of ≥90% improvement from baseline in the Psoriasis Area and Severity Index (PASI 90) and Investigator's Global Assessment score of 0/1 (clear/almost clear) at week 16. Secondary efficacy end points included achievement of PASI 75 at week 4 and Dermatology Life Quality Index 0/1 at week 16. Safety outcomes were also assessed. Statistical analysis of the co-primary efficacy end points was performed using a type I error rate, at a two-sided α level of 0.05. Overall, 47 Korean patients were randomized to treatment (bimekizumab: 32, placebo: 15). At week 16, bimekizumab-treated patients had significantly higher clinical responses versus placebo-treated patients (PASI 90: 81.3% vs. 0%; IGA 0/1: 87.5% vs. 0%, p < 0.001 for both). Bimekizumab showed a rapid onset of clinical response, with 75.0% of patients achieving PASI 75 by week 4 (0% in placebo patients [nominal p < 0.001]). A higher proportion of bimekizumab-treated patients achieved DLQI 0/1 at week 16 (46.9% vs. 6.7% in placebo patients, nominal p = 0.007), indicating greater improvements in health-related quality of life (HRQoL) following bimekizumab treatment. Bimekizumab was well-tolerated in Korean patients, with no new safety signals identified. Treatment with bimekizumab led to rapid improvements in clinical responses and HRQoL versus placebo in Korean patients, consistent with responses in global populations. These findings suggest that bimekizumab is an effective and well-tolerated treatment option in Korean patients with psoriasis.
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Affiliation(s)
- Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chul Jong Park
- Department of Dermatology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - Ki Heon Jeong
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nancy Cross
- UCB Pharma, Morrisville, North Carolina, USA
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Wang T, Wu W, Zhang X, Gan B, Zhou Y, Cheng X. Tofacitinib treatment for plaque psoriasis and psoriatic arthritis: A meta-analysis of randomised controlled trials. Indian J Dermatol Venereol Leprol 2024; 0:1-8. [PMID: 39361844 DOI: 10.25259/ijdvl_14_2024] [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: 01/04/2024] [Accepted: 06/26/2024] [Indexed: 10/05/2024]
Abstract
Objectives Tofacitinib is used as an oral Janus-associated kinase (JAK) inhibitor acting on JAK1 and JAK3, in treating psoriatic disease. However, there is still no consensus on the optimal dosage and duration of tofacitinib. In this study, we aimed to evaluate the effects of tofacitinib in treating psoriatic disease. Methods and Materials A literature search was done utilising Cochrane library, Medline, EMBASE, Wiley Online library, Web of Science and BIOSIS Previews through December 18, 2022. We performed a meta-analysis of published original studies to assess the impact of tofacitinib in plaque psoriasis or psoriatic arthritis therapy based on seven randomised controlled trials (RCTs) involving 2,672 patients (receiving tofacitinib) and 853 controls (receiving placebo). Results Compared with placebo, the treatment of 5 mg twice-daily (BID) tofacitinib for 12 weeks is sufficient to significantly alleviate the main clinical manifestations of psoriasis [≥75% decrease in Psoriasis Area and Severity Index score (PASI 75): Risk ratio (RR)=4.38 (95% Confidence interval (CI) 2.51 to 7.64); ≥90% decrease in PASI score (PASI 90): RR=21.68 (95% CI 4.20 to 111.85); Physician's Global Assessment of 'clear' or 'almost clear' (PGA 0/1): RR=3.93 (95%CI 3.03 to 5.09)]. Interestingly, there was no significant difference in improvement in PGA 0/1 with 5 mg BID tofacitinib given for 16 weeks when compared with 5 mg BID tofacitinib for 12 weeks [RR=1.11 (95%CI 0.98 to 1.25)]. Additionally, the 5 mg BID tofacitinib for 16 weeks treatment schedule significantly increased the incidence of upper respiratory tract infection (URTI) [RR=1.89 (95%CI 1.06 to 3.38)] as compared to 5 mg BID tofacitinib for 12 weeks treatment schedule [RR=1.15 (95%CI 0.60 to 2.20)]. Conclusion The 5 mg BID tofacitinib for 12 weeks treatment significantly improved psoriasis without causing too many specific adverse events. This indicated that tofacitinib is an effective treatment plan for psoriatic disease by reasonably controlling dosage and dosing time.
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Affiliation(s)
- Tao Wang
- Department of Sexual Medicine/Traditional Chinese Medicine, Fifth People's Hospital of Shunde District (Longjiang Hospital of Shunde District), Foshan, Guangdong, China
| | - Wei Wu
- Department of Medical Science, Shunde Polytechnic, Foshan, Guangdong, China
| | - Xiaoqing Zhang
- Department of Basic Medical Sciences, Guangdong Medical University, Dongguan, Guangdong, China
| | - Bin Gan
- Department of Respiratory Medicine, Fifth People's Hospital of Shunde District (Longjiang Hospital of Shunde District), Foshan, Guangdong, China
| | - Yanfang Zhou
- Department of Basic Medical Sciences, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xiaoyan Cheng
- Department of Traditional Chinese Medicine, The Second Clinical Medical College, Guangdong Medical University, Dongguan, Guangdong, China
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Yan X, Varghese KJ, Bourgeois JA. Prevalence of Substance Use Disorders Among Patients with Psoriasis and Co-Morbid Major Depressive Disorder. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00090-9. [PMID: 39236788 DOI: 10.1016/j.jaclp.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Xiaofeng Yan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA.
| | - Kevin J Varghese
- Department of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - James Alan Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
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Armstrong AW, Foley P, Liu Y, Miller M, Teneralli RE, Bewley A, Gordon KB, Papp KA, Han C. Direct and Indirect Effect of Guselkumab on Anxiety, Depression, and Quality of Life in Patients with Moderate-to-Severe Plaque Psoriasis: A Mediation Analysis. Dermatol Ther (Heidelb) 2024; 14:2577-2589. [PMID: 39177870 PMCID: PMC11393263 DOI: 10.1007/s13555-024-01250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Treating plaque psoriasis (PsO) with guselkumab (GUS) promotes skin clearance and is associated with improvements in health-related quality of life (HRQoL), anxiety, and depression. It is unclear whether improvements in patient-reported outcomes are due to resolution of skin symptoms or the direct result of GUS treatment. METHODS Two phase 3, placebo- and active-comparator-controlled studies randomized patients with moderate-to-severe PsO to GUS, placebo (crossing over to GUS at week 16), or adalimumab. Post hoc mediation analyses examined direct and indirect effects of GUS, versus adalimumab, on Dermatology Life Quality Index (DLQI) or Hospital Anxiety and Depression Scale (HADS) after adjusting for indirect effects mediated by skin clearance, evaluated via Psoriasis Area and Severity Index (PASI), to determine the direct effect of GUS on dermatology HRQoL, depression, and anxiety. RESULTS Compared with adalimumab, the natural direct effect (NDE) of GUS on change in DLQI from baseline was - 2.04 (P < 0.001), using PASI improvement as a mediator, indicating 89.2% of the total treatment effect was due to direct effects of GUS; using PASI 90 as a mediator, NDE of GUS was - 1.43 (P < 0.001), with 62.2% of the total treatment effect attributed to direct effects of GUS. Compared with adalimumab, 25.5% of change in HADS anxiety score was mediated through PASI improvement (NDE - 0.74; P = 0.002), indicating 74.5% of the total effect was independent of PASI improvement. Similarly, 24% of treatment effect was mediated through PASI 90 (NDE - 0.76; P = 0.002). Comparable proportions of the total improvement in HADS depression scores were due to direct and indirect effects of GUS mediated through PASI improvement (direct, 50.2%; indirect, 49.8%) or PASI 90 (direct, 59.5%; indirect, 40.5%). CONCLUSIONS GUS-mediated improvements in anxiety, depression, and overall HRQoL are not solely mediated by resolution of PsO signs, suggesting GUS use has a potential direct effect on anxiety and depression.
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Affiliation(s)
| | - Peter Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, Carlton, VIC, Australia
| | - Yan Liu
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA
| | - Megan Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Rachel E Teneralli
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA
| | | | | | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research Inc, Waterloo, ON, Canada
| | - Chenglong Han
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA.
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Cipolla S, Catapano P, Bonamico AF, De Santis V, Murolo R, Romano F, Volpicelli A, Perris F, Lo Schiavo A, Fabrazzo M, Catapano F. Factors Associated with Anxiety, Depression, and Quality of Life in Patients with Psoriasis: A Cross-Sectional Study. Brain Sci 2024; 14:865. [PMID: 39335361 PMCID: PMC11430425 DOI: 10.3390/brainsci14090865] [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: 08/03/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Psoriasis is a chronic skin disorder affecting 2-3% of the global population, and is associated with several comorbidities, including psychiatric disorders. This study aimed to identify factors influencing anxiety, depression, and quality of life (QoL) in patients with psoriasis. METHODS This observational study included 112 patients diagnosed with psoriasis. Dermatological and psychiatric assessments were conducted using Psodisk, the Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Symptom Checklist-90-Revised (SCL-90-R), and 36-Item Short Form Health Survey (SF-36). Descriptive statistics, correlation analyses, and multivariate regression models were employed. RESULTS The sample was predominantly middle-aged males (mean age 48.91 years). Females (p < 0.001), patients with arthritis (p < 0.05), and those with a sedentary lifestyle (p < 0.05) showed higher anxiety and depression scores. Psodisk subscales significantly correlated with psychiatric symptoms and QoL measures (p < 0.001). Pain (B: 0.63, p < 0.05; B: -2.03, p < 0.01) and sleep disturbances (B: 0.68, p < 0.01; B: 0.60, p < 0.01; B: -1.46, p < 0.01; B: -1.57, p < 0.05; B: 3.91, p < 0.05) emerged as major predictors of poor mental health and reduced QoL. CONCLUSIONS The study underscores the complex relationship between psoriasis, psychiatric comorbidities, and QoL. Key factors exacerbating anxiety and depression include female gender, arthritis, and sedentary lifestyle. Comprehensive management of psoriasis should address both dermatological and psychological aspects, with a focus on pain relief and improving sleep quality to enhance overall patient well-being.
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Affiliation(s)
- Salvatore Cipolla
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Pierluigi Catapano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Antonio Fiorino Bonamico
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Valeria De Santis
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Roberta Murolo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Francesca Romano
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Volpicelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Ada Lo Schiavo
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131 Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
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Kotewicz M, Krajewski PK, Jaworek AK, Szepietowski JC. Psychological Aspects of Cutaneous Pain in Psoriasis. J Clin Med 2024; 13:4890. [PMID: 39201033 PMCID: PMC11355655 DOI: 10.3390/jcm13164890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: Psoriasis is a chronic inflammatory disease that negatively impacts patients' quality of life (QoL) and mental health. Itch and pain are prevalent symptoms of psoriasis and contribute to the psychosocial burden of this disease. This study aimed to evaluate the impact of skin pain on the prevalence and severity of symptoms of anxiety and depression and on the QoL in psoriasis patients. Methods: The studied population comprised 106 adults with psoriasis (34% female; mean age 42.1 ± 13.0 years). Disease severity was measured with the Psoriasis Area and Severity Index (PASI). The intensity of skin pain was assessed with the NRS and the Short Form McGill Pain Questionnaire (SF-MPQ). The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires were used to estimate the severity of depression and anxiety, respectively, as was the Hospital Anxiety and Depression Scale (HADS). Quality of life (QoL) was studied using the Dermatology Life Quality Index (DLQI). Results: Regarding anxiety assessment, females reported significantly higher scores with the HADS-A (8.42 ± 4.85 points vs. 5.14 ± 3.9 points; p < 0.001) and the GAD-7 compared to men (7.50 ± 5.58 points vs. 5.24 ± 4.79 points; p = 0.036). Similarly, the severity of depression was significantly higher in women, as measured with the PHQ-9 (7.50 ± 5.58 points vs. 5.24 ± 4.79 points, p = 0.021). Psoriasis patients with skin pain scored significantly higher in HADS Total score (p = 0.043), HADS-A (p = 0.022), PHQ-9 (p = 0.035), and DLQI (p < 0.001) than the rest of the studied group. The intensity of skin pain measured with the SF-MPQ correlated significantly with HADS Total score (p = 0.021), HADS-A (p < 0.001), HADS-D (p = 0.038), and PHQ-9 (p < 0.001). Additionally, there was a significant correlation between the intensity of cutaneous pain assessed using the VAS and the PHQ-9 (p = 0.022). Conclusions: Skin pain significantly influences the well-being of patients with psoriasis as well as the symptoms of anxiety and depression. In particular, women with psoriasis are at increased risk of developing anxiety and depression. Our findings underline the necessity for a multidisciplinary approach to the management of this dermatosis.
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Affiliation(s)
- Magdalena Kotewicz
- University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.K.); (P.K.K.)
| | - Piotr K. Krajewski
- University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.K.); (P.K.K.)
| | - Andrzej K. Jaworek
- Department of Dermatology, Jagiellonian University, 31-008 Kraków, Poland;
| | - Jacek C. Szepietowski
- University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.K.); (P.K.K.)
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Otten M, Djamei V, Augustin M. Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study. JMIR DERMATOLOGY 2024; 7:e54762. [PMID: 39121470 PMCID: PMC11344180 DOI: 10.2196/54762] [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: 11/21/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians' decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients' views and may be relevant for regular documentation and shared decision-making. OBJECTIVE This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. METHODS We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. RESULTS A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. CONCLUSIONS The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients' needs, barriers, and facilitators but also physicians' attitudes and requirements from the health care system.
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Affiliation(s)
- Marina Otten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Brandi SL, Skov L, Strandberg-Larsen K, Zachariae C, Cederkvist L, Groot J, Nybo Andersen AM. Psoriasis and mental health in adolescents: A cross-sectional study within the Danish National Birth Cohort. J Affect Disord 2024; 358:318-325. [PMID: 38703911 DOI: 10.1016/j.jad.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Psoriasis is a chronic skin disease associated with lower quality of life and higher risk of anxiety and depression in adults. We investigate whether adolescents with psoriasis also experience poorer mental health than their peers. METHODS In this cross-sectional study, we included questionnaire data on psoriasis and mental health from the 18-year follow-up of the Danish National Birth Cohort. We estimated odds ratios (OR) and 95 % confidence intervals (CI) using a logistic regression with inverse probability weighting to account for potential selection bias, adjusted for potential confounders identified a priori. We estimated associations between self-reported psoriasis and multiple aspects of mental health (self-rated health, life satisfaction, mental well-being, loneliness, overall and internalizing behavioral difficulties, depressive symptoms, and anxiety symptoms). In sensitivity analyses, we examined doctor-diagnosed psoriasis and psoriasis with and without joint pain. RESULTS Of the 44,838 included in this study, 1147 (2.6 %) reported psoriasis. Adolescents with psoriasis had a higher risk of nearly all outcomes, including depressive symptoms (OR 1.38; 1.19-1.58) and panic/agoraphobia among both males (OR 1.72; 1.33-2.19) and females (OR 1.60; 1.33-1.92). Associations attenuated when restricted to doctor-diagnosed psoriasis. Associations with poor mental health were mainly observed for adolescents with psoriasis also reporting joint pain. LIMITATIONS We could not establish temporality and lacked data on joint pain in referents. CONCLUSION Psoriasis is associated with poor mental health in adolescents. This appears to be driven by adolescents with psoriasis also reporting joint pain and is less evident in those with a doctor-confirmed diagnosis.
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Affiliation(s)
- Sandra L Brandi
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Luise Cederkvist
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Jonathan Groot
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
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Kotewicz M, Krajewski PK, Jaworek AK, Szepietowski JC. Clinical Characteristics of Cutaneous Pain in Psoriasis. J Clin Med 2024; 13:3610. [PMID: 38930137 PMCID: PMC11204389 DOI: 10.3390/jcm13123610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation.
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Affiliation(s)
- Magdalena Kotewicz
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland (P.K.K.)
| | - Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland (P.K.K.)
| | - Andrzej K. Jaworek
- Department of Dermatology, Jagiellonian University, 31-008 Kraków, Poland;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland (P.K.K.)
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Ramessur R, Dand N, Langan SM, Saklatvala J, Fritzsche MC, Holland S, Arents BWM, McAteer H, Proctor A, McMahon D, Greenwood M, Buyx AM, Messer T, Weiler N, Hicks A, Hecht P, Weidinger S, Ndlovu MN, Chengliang D, Hübenthal M, Egeberg A, Paternoster L, Skov L, De Jong EMGJ, Middelkamp-Hup MA, Mahil SK, Barker JN, Flohr C, Brown SJ, Smith CH. Defining disease severity in atopic dermatitis and psoriasis for the application to biomarker research: an interdisciplinary perspective. Br J Dermatol 2024; 191:14-23. [PMID: 38419411 PMCID: PMC11188926 DOI: 10.1093/bjd/ljae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
More severe atopic dermatitis and psoriasis are associated with a higher cumulative impact on quality of life, multimorbidity and healthcare costs. Proactive, early intervention in those most at risk of severe disease may reduce this cumulative burden and modify the disease trajectory to limit progression. The lack of reliable biomarkers for this at-risk group represents a barrier to such a paradigm shift in practice. To expedite discovery and validation, the BIOMarkers in Atopic Dermatitis and Psoriasis (BIOMAP) consortium (a large-scale European, interdisciplinary research initiative) has curated clinical and molecular data across diverse study designs and sources including cross-sectional and cohort studies (small-scale studies through to large multicentre registries), clinical trials, electronic health records and large-scale population-based biobanks. We map all dataset disease severity instruments and measures to three key domains (symptoms, inflammatory activity and disease course), and describe important codependencies and relationships across variables and domains. We prioritize definitions for more severe disease with reference to international consensus, reference standards and/or expert opinion. Key factors to consider when analysing datasets across these diverse study types include explicit early consideration of biomarker purpose and clinical context, candidate biomarkers associated with disease severity at a particular point in time and over time and how they are related, taking the stage of biomarker development into account when selecting disease severity measures for analyses, and validating biomarker associations with disease severity outcomes using both physician- and patient-reported measures and across domains. The outputs from this exercise will ensure coherence and focus across the BIOMAP consortium so that mechanistic insights and biomarkers are clinically relevant, patient-centric and more generalizable to current and future research efforts.
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Affiliation(s)
- Ravi Ramessur
- St John’s Institute of Dermatology
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | | | - Jake Saklatvala
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Marie-Christine Fritzsche
- Institute of History and Ethics in Medicine, TUM School of Medicine
- Department of Science, Technology and Society, School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | | | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | | | | | | | | | - Alena M Buyx
- Institute of History and Ethics in Medicine, TUM School of Medicine
- Department of Science, Technology and Society, School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - Tamara Messer
- EURICE – European Research and Project Office GmbH, St. Ingbert, Germany
| | - Nina Weiler
- EURICE – European Research and Project Office GmbH, St. Ingbert, Germany
| | - Alexandra Hicks
- Immunology & Inflammation Research Therapeutic Area, Sanofi, Cambridge, MA, USA
| | - Peter Hecht
- Public Private Partnerships, Sanofi Partnering, Frankfurt, Germany
| | - Stephan Weidinger
- Department of Dermatology, Venerology and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Matthias Hübenthal
- Department of Dermatology, Quincke Research Center, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Lone Skov
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark
| | - Elke M G J De Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maritza A Middelkamp-Hup
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Satveer K Mahil
- St John’s Institute of Dermatology
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Jonathan N Barker
- St John’s Institute of Dermatology
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Sara J Brown
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
- Department of Dermatology, NHS Lothian, Edinburgh, UK
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11
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Biazus Soares G, Mahmoud O, Yosipovitch G, Mochizuki H. The mind-skin connection: A narrative review exploring the link between inflammatory skin diseases and psychological stress. J Eur Acad Dermatol Venereol 2024; 38:821-834. [PMID: 38311707 DOI: 10.1111/jdv.19813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/16/2023] [Indexed: 02/06/2024]
Abstract
Inflammatory skin diseases are known to negatively impact patient psychology, with individuals experiencing higher rates of stress and subsequent diminished quality of life, as well as mental health issues including anxiety and depression. Moreover, increased psychological stress has been found to exacerbate existing inflammatory skin diseases. The association between inflammatory skin diseases and psychological stress is a timely topic, and a framework to better understand the relationship between the two that integrates available literature is needed. In this narrative review article, we discuss potential neurobiological mechanisms behind psychological stress due to inflammatory skin diseases, focusing mainly on proinflammatory cytokines in the circulating system (the brain-gut-skin communications) and the default mode network in the brain. We also discuss potential descending pathways from the brain that lead to aggravation of inflammatory skin diseases due to psychological stress, including the central and peripheral hypothalamic-pituitary-adrenal axes, peripheral nerves and the skin barrier function.
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Affiliation(s)
- G Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - O Mahmoud
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - H Mochizuki
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Shah SFH, Merchant SA, Shah SA. Female sexual dysfunction in psoriasis: a systematic review and meta-analysis using the Female Sexual Function Index. Int J Impot Res 2024; 36:232-241. [PMID: 36456639 DOI: 10.1038/s41443-022-00650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
Psoriasis is an inflammatory skin condition that can negatively affect numerous domains for quality of life, including sexual function. We aimed to systematically compare sexual function between women with and without psoriasis through meta-analysis. Databases were searched for studies assessing sexual function in women with and without psoriasis using the Female Sexual Function Index (FSFI). Meta-analyses were conducted in R (v4.1.2) to determine: (i) the odds ratio (OR) of sexual dysfunction and (ii) the mean difference (MD) for FSFI scores and sub-scores. Eight studies (five case-control, three cross-sectional) were eligible for review, encompassing 563 women with psoriasis and 525 controls. Risk of bias for included studies was considered as low to moderate. Psoriasis was associated with greater odds of female sexual dysfunction (OR 2.67, 95% CI 1.93,3.69; p < 0.0001). Compared to controls, women with psoriasis had significantly lower mean scores for desire (p < 0.0001), arousal (p = 0.002), lubrication (p = 0.003), orgasm (p < 0.0001), satisfaction (p < 0.0001) and total scores (p < 0.0001). Mean pain scores did not significantly differ between psoriasis patients and controls (p = 0.051). We identified significantly impaired sexual function in women with psoriasis compared to controls, suggesting that routine assessment of sexual health may be beneficial. Prospective studies of larger sample size are required in order to explore the underlying mechanisms and risk factors.
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13
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Mitrić MM. Bimekizumab-bkzx. Clin Ther 2024; 46:379-380. [PMID: 38705824 DOI: 10.1016/j.clinthera.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Miodrag M Mitrić
- Clinical Therapeutics Science Editor, Elsevier, STMJ, Health and Medical Sciences, Radarweg 29, 1043 NX Amsterdam, The Netherlands.
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14
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Burshtein J, Shah M, Zakria D, Lockshin B, Crowley J, Merola JF, Gordon K, Shahriari M, Korman NJ, Chovatiya R, Kalb R, Lebwohl M. The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel. Dermatol Ther (Heidelb) 2024; 14:323-339. [PMID: 38340237 PMCID: PMC10891030 DOI: 10.1007/s13555-024-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. RESULTS The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of "A", one of which was given a strength of "B", and one of which was given a strength of "C". CONCLUSION Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Milaan Shah
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danny Zakria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Lockshin
- US Dermatology Partners, Rockville, MD, USA
- Department of Dermatology, Georgetown University Medical Center, Washington, DC, USA
| | - Jeff Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Joseph F Merola
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ken Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Robert Kalb
- SUNY at Buffalo School of Medicine and Biomedical Sciences, Department of Dermatology, Buffalo Medical Group, Buffalo, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Prignano F, Argenziano G, Bardazzi F, Borroni RG, Brunasso AMG, Burlando M, Cagni AE, Campione E, Cinotti E, Colonna F, Cuccia A, Dastoli S, De Pasquale R, De Simone C, Di Lernia V, Dini V, Fabbrocini G, Galluzzi C, Giacchetti A, Giofrè C, Lasagni C, Lembo S, Loconsole F, Montesu MA, Pella P, Piaserico S, Pigatto P, Richetta AG, Scuotto A, Stroppiana E, Venturini M, Vinci AS, Zichichi L, Fargnoli MC. Understanding Barriers Impacting upon Patient Wellbeing: A Nationwide Italian Survey and Expert Opinion of Dermatologists Treating Patients with Moderate-to-Severe Psoriasis. J Clin Med 2023; 13:101. [PMID: 38202108 PMCID: PMC10779771 DOI: 10.3390/jcm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists' perspectives on the impact of psoriasis and its treatment on patients' daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| | | | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Riccardo G. Borroni
- Department of Biomedical Sciences, Humanitas University, 20089 Milan, Italy;
- Dermatology Unit, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy
| | | | - Martina Burlando
- Dermatologic Clinic, DISSAL, San Martino Policlinico San Martino Hospital, 16132 Genova, Italy;
| | - Anna Elisabetta Cagni
- Unità Operativa Dipartimentale di Dermatologia e Venereologia, IRCCS San Gerardo, 20900 Milan, Italy;
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Fabrizio Colonna
- Dipartimento di Psicologia, Università di Torino, 10124 Turin, Italy;
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, 52100 Arezzo, Italy;
| | - Stefano Dastoli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Clara De Simone
- Institute of Dermatology, Catholic University, 00185 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy;
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Claudia Galluzzi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | | | - Claudia Giofrè
- Dermatology Complex Operative Unit, Papardo Hospital, 98158 Messina, Italy;
| | - Claudia Lasagni
- AOU Policlinico di Modena, Department of Specialized Medicine, University of Modena, 41121 Modena, Italy;
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy;
| | - Francesco Loconsole
- Clinica Dermatologica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Maria Antonia Montesu
- Department of Surgical, Microsurgical and Medical Sciences, Dermatology, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Pella
- Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, 35122 Padova, Italy;
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, Istituto Ortopedico Galezzi, University of Milan, 20122 Milan, Italy;
| | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Rome, Italy;
| | - Adriana Scuotto
- Department of Advanced Biomedical Science, Legal Medicine Section, University of Naples Federico II, 80131 Naples, Italy;
| | - Elena Stroppiana
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili, 25121 Brescia, Italy;
| | | | - Leonardo Zichichi
- Unit of Dermatology, San Antonio Abate Hospital, 80057 Trapani, Italy;
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Luna PC, Chu CY, Fatani M, Borlenghi C, Adora A, Llamado LQ, Wee J. Psychosocial Burden of Psoriasis: A Systematic Literature Review of Depression Among Patients with Psoriasis. Dermatol Ther (Heidelb) 2023; 13:3043-3055. [PMID: 37995052 PMCID: PMC10689612 DOI: 10.1007/s13555-023-01060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
Psoriasis is associated with various comorbidities with a notable psychosocial burden. This systematic literature review explores the burden of depression in patients with psoriasis, comparing it with that experienced by patients with other chronic medical conditions. Embase via Ovid, PubMed, and Cochrane Database of Systematic Reviews via Ovid were searched for peer-reviewed studies published in English between January 1, 2016 and December 6, 2021 that reported real-world evidence or observational studies involving at least 100 adults (age ≥ 18 years) with general (unspecified) or plaque psoriasis experiencing symptoms of depression (but not restricted to patients with a clinical diagnosis). Any report of depression or suicidality was eligible for inclusion. Systematic literature reviews reporting depression/suicidality in other chronic medical conditions were also included. Statistical analysis was not performed; the study was descriptive only. A total of 1744 records were identified, and after several defined screenings by two independent reviewers for publication year, relevance, and sample size, 82 publications were included. Psoriasis was significantly associated with depression. The prevalence of depression in patients with psoriasis ranged from 0.2% to 74.6%, with incidence from 4.83 to 91.9 per 1000 person-years. The prevalence of depression was generally higher among patients with more severe psoriasis than those with less severe disease (as determined by Psoriasis Area Severity Index [PASI] scoring system) and was more prevalent among women than men with psoriasis. Depression in psoriasis significantly reduced quality of life, including factors such as sexual dysfunction, sleep difficulties, subjective well-being, and addictions. Comorbid hypertension, hyperlipidemia, psoriatic arthritis, obesity, inflammatory bowel disease, diabetes, and statin use were all associated with increased depression risk in patients with psoriasis. This systematic literature review found that the burden of depression in psoriasis is no lower than in other chronic medical conditions. Greater awareness of the psychological impact of psoriasis would improve care and management, which should incorporate psychological interventions.
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Affiliation(s)
- Paula C Luna
- Hospital Aleman, Arenales 2557 1a ZC 1425, Buenos Aires, Argentina.
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mohammad Fatani
- Dermatology Department, Hera General Hospital, Makkah, Saudi Arabia
| | | | - Anna Adora
- Department of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines
- Department of Adult Cardiology, Philippine Heart Center, Quezon City, Metro Manila, Philippines
| | | | - James Wee
- Pfizer Inc., Makati City, Philippines
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17
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Papp KA, Blauvelt A, Puig L, Ohtsuki M, Beissert S, Gooderham M, Amin AZ, Liu J, Wu T, Azam T, Stakias V, Espaillat R, Sinvhal R, Soliman AM, Pang Y, Chen MM, Lebwohl MG. Long-term safety and efficacy of risankizumab for the treatment of moderate-to-severe plaque psoriasis: Interim analysis of the LIMMitless open-label extension trial up to 5 years of follow-up. J Am Acad Dermatol 2023; 89:1149-1158. [PMID: 37553030 DOI: 10.1016/j.jaad.2023.07.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Psoriasis is a chronic, inflammatory skin disease often requiring long-term therapy. OBJECTIVE To evaluate the long-term safety and efficacy of risankizumab in patients with psoriasis. METHODS LIMMitless is an ongoing phase 3, open-label extension study evaluating the long-term safety and efficacy of continuous risankizumab 150 mg every 12 weeks for adults with moderate-to-severe plaque psoriasis following multiple phase 2/3 base studies. This interim analysis assessed safety (ie, monitored treatment-emergent adverse events [TEAEs]) through 304 weeks. Efficacy assessments included determining the proportion of patients who achieved ≥90% or 100% improvement in Psoriasis Area and Severity Index (PASI 90/100), static Physician's Global Assessment of clear/almost clear (sPGA 0/1), and Dermatology Life Quality Index of no effect on patient's life (DLQI 0/1) through 256 weeks. RESULTS Among 897 patients randomized to risankizumab in the base studies, 706 were still ongoing at data cutoff. Rates of TEAEs, TEAEs leading to discontinuation, and TEAEs of safety interest were low. At week 256, 85.1%/52.3% of patients achieved PASI 90/100, respectively, 85.8% achieved sPGA 0/1, and 76.4% achieved DLQI 0/1. LIMITATIONS Open-label study with no placebo or active-comparator group. CONCLUSIONS Long-term continuous risankizumab treatment for up to 5 years was well tolerated and demonstrated high and durable efficacy.
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Affiliation(s)
- Kim A Papp
- Alliance Clinical Research and Probity Medical Research, Waterloo.
| | | | - Lluís Puig
- Department of Dermatology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona
| | | | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Probity Medical Research, and Department of Medicine, Queen's University, Ontario
| | | | | | | | | | | | | | | | | | | | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York
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18
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Ding Y, Li W, Guan X, Liu N, Zhou Y, Li G, Wang X, Wang Z, Xiao X, Yang B, Lv C, Zhang C, Shi Y. Treatment outcomes of secukinumab in adult patients with moderate-to-severe plaque psoriasis in China: A real-world multicenter retrospective study. Clin Transl Sci 2023; 16:1803-1814. [PMID: 37644777 PMCID: PMC10582683 DOI: 10.1111/cts.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 08/31/2023] Open
Abstract
Secukinumab is effective in treating patients with moderate-to-severe plaque psoriasis. However, most studies assessing its effectiveness in routine clinical settings in China are mostly single-center studies with a limited sample size. The objective of this study was to assess secukinumab's efficacy, treatment patterns, and characteristics in patients with moderate-to-severe plaque psoriasis. This 24-week, multicenter (n = 5) retrospective study analyzed the data of Chinese adult patients with moderate-to-severe plaque psoriasis who initiated secukinumab treatment between May 2019 and March 2020. The Psoriasis Area and Severity Index (PASI), body surface area (BSA), Investigator's Global Assessment Modified 2011 (IGA mod 2011), and Dermatology Life Quality Index (DLQI) were assessed. Dermatologists documented the treatment dosage and modification reasons. Of the 244 secukinumab-naïve patients, most were men (73.4%, 179/244) and weighed 60-90 kg (72.8%, 177/243). The mean (SD) age at secukinumab initiation was 38.1 (11.6) years, and the disease duration was 13.5 (7.9) years. Most patients (97.1%, 237/244) received secukinumab 300 mg. At weeks 4, 12, 16, and 24, the proportion of patients achieving PASI 75 (≥75% reduction from baseline) was 40.0%, 92.1%, 88.4%, and 88.9%, respectively; PASI 90 was 15.0%, 73.7%, 81.4%, and 68.3%, respectively; and PASI 100 was 8.7%, 40.8%, 58.1%, and 41.3%, respectively. During the same periods, BSA and IGA mod 2011 showed similar improvement trends. An increasing proportion of patients achieved DLQI of 0-1 (21.6%, 65.7%, 75.0%, and 80.3%, respectively). Treatment modification was highest at week 12. The average interval between two administrations after week 4 was 62.95 days. Secukinumab was highly effective in improving the PASI, IGA, BSA, and DLQI in Chinese patients with moderate-to-severe plaque psoriasis throughout the first 24 weeks. The treatment pattern for Chinese patients differs from that in the clinical guidelines.
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Affiliation(s)
- Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease HospitalTongji University School of MedicineShanghaiChina
| | - Wei Li
- Department of Dermatology & Rare Disease CenterWest China Hospital of Sichuan University37# Guoxue Alley, Wuhou DistrictChengduChina
| | - Xin Guan
- Peking University Third HospitalBeijingChina
| | - Na Liu
- Shanghai Sixth People's HospitalShanghaiChina
| | - Ying Zhou
- Dalian Dermatology HospitalDalianChina
| | - Gaojie Li
- Department of Dermatology & Rare Disease CenterWest China Hospital of Sichuan University37# Guoxue Alley, Wuhou DistrictChengduChina
| | - Xiaohua Wang
- Dermatology Hospital, Southern Medical UniversityGuangzhouChina
| | | | - Xiao Xiao
- Beijing Novartis Pharma Co., Ltd.BeijingChina
| | - Bin Yang
- Dermatology Hospital, Southern Medical UniversityGuangzhouChina
| | | | | | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease HospitalTongji University School of MedicineShanghaiChina
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Haberman RH, Um S, Catron S, Chen A, Lydon E, Attur M, Neimann AL, Reddy S, Troxel A, Adhikari S, Scher JU. Paradoxical Effects of Depression on Psoriatic Arthritis Outcomes in a Combined Psoriasis-Psoriatic Arthritis Center. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2023; 8:134-140. [PMID: 38188536 PMCID: PMC10768813 DOI: 10.1177/24755303231186405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Backgroud Psoriatic arthritis (PsA) is a chronic, inflammatory arthritis that, when left untreated, can lead to erosions, deformities and decrease in quality of life. PsA is known to be associated with multiple comorbidities, including cardiovascular, metabolic and mental health syndromes, all of which can increase its overall morbidity and mortality. Objective To characterize a cohort of patients with PsA and understand the impact of depression on PsA outcome measures. Methods 527 consecutive patients with PsA were enrolled in an observational, longitudinal registry that followed them prospectively at standard of care visits. Demographics, medical history, medication use, and clinical exam were all recorded. Results Depression was reported in 22.8% of the population, anxiety in 18%, and attention deficit hyperactivity disorder in 4%. Depression was more common in female participants (P < .001). At baseline, individuals with PsA and concomitant depression had similar tender and swollen joint counts and RAPID3 compared to those without depression, and had lower body surface area affected by psoriasis (P = .04). At year one, all patients had improvement in clinical outcomes. However, patients with depression had a significantly higher tender joint count compared to those without depression (P = .001), despite similar swollen joint count and body surface area. Conclusion In patients with depression, there is a discrepancy between improvement in physician assessed measures and patient reported outcomes. These observations underscore the importance of addressing depression and psychological distress as part of PsA treatment outcomes and points towards the need to address residual pain through co-adjuvant approaches.
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Affiliation(s)
- Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Seungha Um
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Sydney Catron
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Alan Chen
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Eileen Lydon
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Malavikalakshmi Attur
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Soumya Reddy
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
- Colton Center of Autoimmunity, NYU Langone Health, New York, NY, USA
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Zheng M, Chen X, Wang F, Chen J, Jackson K, Yang F, Payne C, Li H, Wang Y, Xiao Z, Zheng J. Pharmacokinetics, Safety, and Efficacy of Ixekizumab in Chinese Patients with Moderate-to-Severe Plaque Psoriasis: A Phase 1, Single- and Multiple-Dose Study. Adv Ther 2023; 40:3804-3816. [PMID: 37356077 DOI: 10.1007/s12325-023-02575-1] [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: 04/14/2023] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION We evaluated the pharmacokinetics (PK), safety, and efficacy of ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A, in Chinese patients with moderate-to-severe psoriasis. METHODS In this phase 1, multicenter, open-label study, adults (≥ 18 years) diagnosed with moderate-to-severe plaque psoriasis for ≥ 6 months involving ≥ 10% of their body surface area received ixekizumab 80 mg by subcutaneous injection and were observed for 20 weeks (single-dose phase) and then an initial dose of 160 mg followed by randomization (1:1) to 80 mg ixekizumab every 2 weeks (IXE Q2W) or every 4 weeks (IXE Q4W) for an 8-week treatment period (multiple-dose phase). RESULTS The median time to maximum observed ixekizumab concentrations occurred 2-4 days after dosing and the geometric mean half-life was 15-16 days, after single (n = 12) and multiple (n = 29) doses. Approximately linear pharmacokinetics were observed between the 80 and 160 mg single doses. Steady-state systemic exposure to ixekizumab during a dosing interval was similar with the IXE Q2W and IXE Q4W regimens, with estimates of 224 µg·day/mL and 213 µg·day/mL for the area under the concentration-time curve from time 0 to 14 days post-dose and 0 to 28 days post-dose, respectively. Safety was consistent with the established safety profile of ixekizumab. At week 12 after multiple doses, the proportions of patients achieving a 75% or 90% improvement in Psoriasis Area and Severity Index score were 100% and 86% for IXE Q2W, respectively, and 93% and 80% for IXE Q4W, respectively. A Static Physician's Global Assessment score of 0 or 1 was achieved in 100% and 87% with IXE Q2W and IXE Q4W, respectively. CONCLUSIONS The PK of ixekizumab in Chinese patients with moderate-to-severe plaque psoriasis was comparable to findings in global populations. After IXE Q2W or IXE Q4W for 12 weeks, clinically relevant treatment responses and an acceptable safety profile were observed. TRIAL REGISTRATION Clinicaltrials.gov (NCT03073213).
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Affiliation(s)
- Min Zheng
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Wang
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Jisu Chen
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Fan Yang
- Eli Lilly and Company, Indianapolis, USA
| | | | - HongYing Li
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - YiHui Wang
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - ZiPei Xiao
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, School of Medicine, Rui Jin Hospital, Shanghai Jiao Tong University, 197, Rui Jin Er Road, Shanghai, 200025, China.
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Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic. Dermatol Ther (Heidelb) 2023; 13:1973-1984. [PMID: 37392261 PMCID: PMC10442297 DOI: 10.1007/s13555-023-00967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION Limited access to healthcare during the COVID-19 pandemic prompted patients to seek care using telehealth. In this study, we assessed whether treatment patterns differed for patients with psoriasis (PsO) or psoriatic arthritis (PsA) initiating apremilast by either a telehealth or an in-person visit. METHODS We estimated adherence and persistence among US patients in the Merative© MarketScan© Commercial and Supplemental Medicare Databases who newly initiated apremilast between April and June 2020, categorized by the type of visit (telehealth or in-person) when apremilast was first prescribed. Adherence was defined as the proportion of days covered (PDC), with PDC ≥ 0.80 considered to indicate high adherence. Persistence was defined as having apremilast available to take without a 60-day gap during follow-up. Factors associated with high adherence and persistence were estimated with logistic and Cox regression. RESULTS Among apremilast initiators (n = 505), the mean age was 47.6 years, 57.8% were female, and the majority had PsO (79.6%). Telehealth index visits were more likely among patients residing in Northeast USA (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.63-6.71) and Western USA (OR 2.52, 95% CI 1.07-5.93]), those with a prescribing rheumatologist (OR 2.27, 95% CI 1.10-4.68), and those with any baseline telehealth visit (OR 1.91, 85% CI 1.20-3.04). Those initiating apremilast with a telehealth visit (n = 141) had similar mean PDC to those initiating apremilast with an in-person visit (n = 364) (0.695 vs. 0.728; p = 0.272). At the end of the 6-month follow-up, 54.3% of the overall population had high adherence (PDC ≥ 0.80) and 65.1% were persistent. After adjusting for potential confounders, patients initiating apremilast via telehealth had similar full adherence (OR 0.80, 95% CI 0.52-1.21) and persistence as those initiating apremilast in-person. CONCLUSION Patients with PsO and patients with PsA initiating apremilast via telehealth or in-person during the COVID-19 pandemic had similar medication adherence and persistence during the 6-month follow-up period. These data suggest that patients initiating apremilast can be as effectively managed with telehealth visits as with in-person visits.
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Affiliation(s)
- Ashis K. Das
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Caleb Paydar
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Michael S. Broder
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
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Reich A, Pinter A, Maul JT, Vender RB, Torres T, Brnabic A, Haustrup N, Reed C, Schuster C, Riedl E. Speed of clinical improvement in the real-world setting from patient-reported Psoriasis Symptoms and Signs Diary: Secondary outcomes from the Psoriasis Study of Health Outcomes through 12 weeks. J Eur Acad Dermatol Venereol 2023; 37:1825-1840. [PMID: 37147855 DOI: 10.1111/jdv.19161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Rapid skin improvement is a key treatment goal of patients with moderate-to-severe psoriasis (PsO). OBJECTIVES To compare the speed of clinical improvement of approved biologics on the symptoms and signs of psoriasis assessed by patients using the validated Psoriasis Symptoms and Signs Diary (PSSD) through 12 weeks. METHODS Psoriasis Study of Health Outcomes (PSoHO) is an international, prospective, non-interventional study that compares the effectiveness of anti-interleukin (IL)-17A biologics versus other biologics, together with pairwise comparisons of ixekizumab versus five individual biologics in patients with PsO. Using the PSSD 7-day recall period, patients assessed the symptoms (itch, skin tightness, burning, stinging and pain) and signs (dryness, cracking, scaling, shedding/flaking, redness and bleeding) of their psoriasis (0-10). Symptom and sign summary scores (0-100) are derived from the average of individual scores. Percentage change in summary scores and proportion of patients with clinically meaningful improvements (CMI) in PSSD summary and individual scores are evaluated weekly. Longitudinal PSSD data are reported as observed with treatment comparisons analysed using mixed model for repeated measures (MMRM) and generalized linear mixed models (GLMM). RESULTS Across cohorts and treatments, eligible patients (n = 1654) had comparable baseline PSSD scores. From Week 1, the anti-IL-17A cohort achieved significantly larger score improvements in PSSD summary scores and a higher proportion of patients showed CMIs compared to the other biologics cohort through 12 weeks. Lower PSSD scores were associated with a greater proportion of patients reporting their psoriasis as no longer impacting their quality-of-life (DLQI 0,1) and a high level of clinical response (PASI100). Results also indicate a relationship between an early CMI in PSSD score at Week 2 and PASI100 score at Week 12. CONCLUSIONS Treatment with anti-IL-17A biologics, particularly ixekizumab, resulted in rapid and sustained patient-reported improvements in psoriasis symptoms and signs compared with other biologics in a real-world setting.
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Affiliation(s)
- A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - A Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J-T Maul
- Department of Dermatology and Venereology, University Hospital of Zürich and Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - R B Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - T Torres
- Department of Dermatology and Dermatology Research Unit, Centro Hospitalar Universitário do Porto, University of Porto, Porto, Portugal
| | - A Brnabic
- Eli Lilly and Company, Indiana, Indianapolis, USA
| | - N Haustrup
- Eli Lilly and Company, Indiana, Indianapolis, USA
| | - C Reed
- Eli Lilly and Company, Indiana, Indianapolis, USA
| | - C Schuster
- Eli Lilly and Company, Indiana, Indianapolis, USA
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - E Riedl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Strober B, Paul C, Blauvelt A, Thaçi D, Puig L, Lebwohl M, White K, Vanvoorden V, Deherder D, Gomez NN, Eyerich K. Bimekizumab efficacy and safety in patients with moderate to severe plaque psoriasis: Two-year interim results from the open-label extension of the randomized BE RADIANT phase 3b trial. J Am Acad Dermatol 2023; 89:486-495. [PMID: 37182701 DOI: 10.1016/j.jaad.2023.04.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Bimekizumab is a monoclonal IgG1 antibody that inhibits interleukin-17A/F. Bimekizumab is more efficacious than secukinumab over 1 year in the treatment of psoriasis. OBJECTIVE Evaluate the safety and efficacy of bimekizumab through 2 years in patients with moderate to severe plaque psoriasis. METHODS The BE RADIANT phase 3b randomized controlled trial consisted of a 48-week double-blinded period, where patients received bimekizumab (320 mg every 4 or 8 weeks) or secukinumab (300 mg weekly to Week 4, then every 4 weeks), and an open-label extension (OLE). From Week 48, all patients received bimekizumab in the OLE. RESULTS At Week 48, more patients achieved complete skin clearance (PASI 100; modified non-responder imputation) with bimekizumab than secukinumab (74.8% vs 52.8%). PASI 100 responses were maintained to Week 96 in continuous bimekizumab patients (70.8%); patients who switched from secukinumab to bimekizumab had increased rates at Week 96 (76.6%). The most common adverse events were: nasopharyngitis, oral candidiasis, and urinary tract infection. Safety data were consistent with the known safety profile of bimekizumab. LIMITATIONS Limited racial diversity; overlap with the COVID-19 pandemic. CONCLUSIONS High PASI 100 responses achieved with bimekizumab over 48 weeks were sustained through Week 96; secukinumab patients who switched to bimekizumab achieved similar responses by Week 96.
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Affiliation(s)
- Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut.
| | - Carle Paul
- Toulouse University and INSERM Infinity, Toulouse, France
| | | | - Diamant Thaçi
- Insititute and Centre for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Luis Puig
- Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Kilian Eyerich
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
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Sbidian E, Chaimani A, Guelimi R, Garcia-Doval I, Hua C, Hughes C, Naldi L, Kinberger M, Afach S, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2023; 7:CD011535. [PMID: 37436070 PMCID: PMC10337265 DOI: 10.1002/14651858.cd011535.pub6] [Citation(s) in RCA: 2] [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: 07/13/2023]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease with either skin or joints manifestations, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. The relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the benefits and harms of non-biological systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis using a network meta-analysis, and to provide a ranking of these treatments according to their benefits and harms. SEARCH METHODS For this update of the living systematic review, we updated our searches of the following databases monthly to October 2022: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults over 18 years with moderate-to-severe plaque psoriasis, at any stage of treatment, compared to placebo or another active agent. The primary outcomes were: proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90; proportion of participants with serious adverse events (SAEs) at induction phase (8 to 24 weeks after randomisation). DATA COLLECTION AND ANALYSIS We conducted duplicate study selection, data extraction, risk of bias assessment, and analyses. We synthesised data using pairwise and network meta-analysis (NMA) to compare treatments and rank them according to effectiveness (PASI 90 score) and acceptability (inverse of SAEs). We assessed the certainty of NMA evidence for the two primary outcomes and all comparisons using CINeMA, as very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer treatment hierarchy, from 0% (worst for effectiveness or safety) to 100% (best for effectiveness or safety). MAIN RESULTS This update includes an additional 12 studies, taking the total number of included studies to 179, and randomised participants to 62,339, 67.1% men, mainly recruited from hospitals. Average age was 44.6 years, mean PASI score at baseline was 20.4 (range: 9.5 to 39). Most studies were placebo-controlled (56%). We assessed a total of 20 treatments. Most (152) trials were multicentric (two to 231 centres). One-third of the studies (65/179) had high risk of bias, 24 unclear risk, and most (90) low risk. Most studies (138/179) declared funding by a pharmaceutical company, and 24 studies did not report a funding source. Network meta-analysis at class level showed that all interventions (non-biological systemic agents, small molecules, and biological treatments) showed a higher proportion of patients reaching PASI 90 than placebo. Anti-IL17 treatment showed a higher proportion of patients reaching PASI 90 compared to all the interventions. Biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha showed a higher proportion of patients reaching PASI 90 than the non-biological systemic agents. For reaching PASI 90, the most effective drugs when compared to placebo were (SUCRA rank order, all high-certainty evidence): infliximab (risk ratio (RR) 49.16, 95% CI 20.49 to 117.95), bimekizumab (RR 27.86, 95% CI 23.56 to 32.94), ixekizumab (RR 27.35, 95% CI 23.15 to 32.29), risankizumab (RR 26.16, 95% CI 22.03 to 31.07). Clinical effectiveness of these drugs was similar when compared against each other. Bimekizumab and ixekizumab were significantly more likely to reach PASI 90 than secukinumab. Bimekizumab, ixekizumab, and risankizumab were significantly more likely to reach PASI 90 than brodalumab and guselkumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab, and brodalumab), and anti-IL23 drugs except tildrakizumab were significantly more likely to reach PASI 90 than ustekinumab, three anti-TNF alpha agents, and deucravacitinib. Ustekinumab was superior to certolizumab. Adalimumab, tildrakizumab, and ustekinumab were superior to etanercept. No significant difference was shown between apremilast and two non-biological drugs: ciclosporin and methotrexate. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. The risk of SAEs was significantly lower for participants on methotrexate compared with most of the interventions. Nevertheless, the SAE analyses were based on a very low number of events with very low- to moderate-certainty evidence for all the comparisons. The findings therefore have to be viewed with caution. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1), the results were similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that, compared to placebo, the biologics infliximab, bimekizumab, ixekizumab, and risankizumab were the most effective treatments for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of high-certainty evidence. This NMA evidence is limited to induction therapy (outcomes measured from 8 to 24 weeks after randomisation), and is not sufficient for evaluating longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean 44.6 years) and high level of disease severity (PASI 20.4 at baseline) may not be typical of patients seen in daily clinical practice. We found no significant difference in the assessed interventions and placebo in terms of SAEs, and the safety evidence for most interventions was very low to moderate quality. More randomised trials directly comparing active agents are needed, and these should include systematic subgroup analyses (sex, age, ethnicity, comorbidities, psoriatic arthritis). To provide long-term information on the safety of treatments included in this review, an evaluation of non-randomised studies is needed. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Anna Chaimani
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Robin Guelimi
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Ignacio Garcia-Doval
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Camille Hua
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Carolyn Hughes
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Luigi Naldi
- Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - Maria Kinberger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sivem Afach
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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Stadtmüller LR, Eckardt MA, Zick C, Kupfer J, Schut C. Interest in a short psychological intervention in patients with psoriasis: a cross-sectional observational study at a German clinic. Front Med (Lausanne) 2023; 10:1074632. [PMID: 37396886 PMCID: PMC10310526 DOI: 10.3389/fmed.2023.1074632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/24/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Utilization of health services is not only associated with the kind of illness one has, but also with patient characteristics like age, sex or psychological variables. Psoriasis (PS) is a chronic inflammatory skin condition, in which psychological interventions were shown to be beneficial regarding not only psychological variables, but also regarding the skin status. The present study investigated with regard to which patient characteristics PS-patients with interest in participation in a short psychological intervention differ from PS-patients without interest. Methods This cross-sectional questionnaire study was conducted at a German rehabilitation clinic. At the beginning of their stay at the clinic, 127 PS-patients filled in questionnaires to assess the severity of their PS, stress, illness perceptions, mindfulness, anxiety, and depression. Interest in taking part in a short psychological intervention was assessed using a dichotomous item. The statistical analysis comprised group comparisons using t-tests of patients with and without interest to take part in a short psychological intervention. Results Sixty-four of the participants were male (50.4%). Participants were 50.7 ± 10 years on average (range: 25-65). 50.4% of them had a mild, 37.0% a moderate, and 12.6% a severe PS. Results indicated that patients with interest in a short psychological intervention were younger, reported to have more skin symptoms due to their PS (higher skin-related illness identity), were more anxious and depressed, but less stressed and less mindful than patients without interest. Conclusion This study shows that in PS-patients with certain characteristics, it might help to raise awareness on the relationship between psychological factors and symptoms of the skin disease in order to motivate this group of patients to take part in psychological interventions to improve their skin condition. Further studies are needed to investigate whether patients who show interest in a psychological intervention also actually take part in the intervention and profit from it.Clinical Trial Registration: DRKS00017426.
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Affiliation(s)
| | - Markus A. Eckardt
- Institute of Medical Psychology, University of Giessen, Giessen, Germany
| | - Christoph Zick
- Department of Dermatology, Rehabilitation Clinic Borkum Riff, Borkum, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, University of Giessen, Giessen, Germany
| | - Christina Schut
- Institute of Medical Psychology, University of Giessen, Giessen, Germany
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Timis TL, Beni L, Mocan T, Florian IA, Orasan RI. Biologic Therapies Decrease Disease Severity and Improve Depression and Anxiety Symptoms in Psoriasis Patients. Life (Basel) 2023; 13:life13051219. [PMID: 37240864 DOI: 10.3390/life13051219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Psoriasis is an immune-mediated chronic skin disease that is associated with a significant psychological burden. A newer line of therapy is represented by biologic agents. Our study aimed to evaluate the effect of biologic therapies in the treatment of psoriasis concerning both disease severity and psychological comorbidity. MATERIAL AND METHODS We performed a prospective case-control comparison to evaluate the prevalence of depression and anxiety in psoriasis patients and unaffected individuals. All patients were recruited between October 2017 and February 2021. Baseline depression (PHQ-9), anxiety (GAD-7), PASI, and DLQI scores were noted. Then, we evaluated the efficacy of biologic treatment in reducing these scores at 6 months of therapy. Patients were treated with either ixekizumab, secukinumab, guselkumab, certolizumab, ustekinumab, risankizumab, or adalimumab. RESULTS 106 bio-naïve patients with psoriasis and 106 controls without the disease were included in this study. Depression and anxiety were significantly more common among psoriasis patients than in unaffected individuals (p < 0.0001). Female patients presented both depression and anxiety more frequently than men in both case and control groups. Disease severity was significantly associated with worsened depression and anxiety symptoms. Biologic therapy resulted in a significant decrease in all four scores at the 6-month mark for each patient (p < 0.0001). Only an improved PASI correlated significantly with lower depression and anxiety scores (p < 0.005), whereas a decreased DLQI did not (p > 0.955). None of the seven biologic agents used was discovered to be superior. CONCLUSION biologic therapies are effective in decreasing both disease severity and alleviating depression and anxiety symptoms in psoriasis.
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Affiliation(s)
- Teodora-Larisa Timis
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Lehel Beni
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Teodora Mocan
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioan-Alexandru Florian
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Remus-Ioan Orasan
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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27
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Lee LL, Huo AP, Chen SL. Experiences and coping behaviours of patients with psoriasis: a qualitative study. J DERMATOL TREAT 2023; 34:2193661. [PMID: 36942918 DOI: 10.1080/09546634.2023.2193661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Psoriasis is a complex, chronic, lifelong inflammatory skin disease characterized by the development of erythematous, indurated, scaly, pruritic and often painful skin plaques, and it is currently incurable. It profoundly affects psychological wellbeing and social functioning and has significant associated co-morbidities. To improve clinical approaches, understanding of the experiences of patients with psoriasis is needed. OBJECTIVE To explore the experiences and coping behaviours of patients with psoriasis. METHODS A qualitative study approach was conducted. Through semi-structured interviews, 20 patients with psoriasis were recruited from general practices and specialist dermatology practices in a regional teaching hospital in Taiwan. Recorded interviews were transcribed and analysed by content analysis. RESULTS Three themes and nine subthemes were identified: 1. Symptoms distress: (a) trouble with scaling, (b) bothersome itching, and (c) complex pain experiences; 2. Psychological distress: (a) encountering discrimination and (b) feeling stigmatised; 3. Managing psoriasis: (a) coping with symptoms, (b) seeking alternative methods, (c) using biologic agents, and (d) changing thinking and coexisting with the disease. CONCLUSION The experience of patients with psoriasis has significant negative impacts on their lives. The findings of this study can provide healthcare professionals with a reference for the care of patients with psoriasis.
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Affiliation(s)
- Lin-Lin Lee
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
| | - An-Ping Huo
- Department of Internal Medicine, Jen-Ai Hospital, Dali, Taichung 412224, Taiwan
| | - Shu-Ling Chen
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
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Comparison of Real-World Costs, Healthcare Resource Utilization, and Comorbidity-Related Costs Between Ixekizumab and Secukinumab Among Biologic-Experienced Patients with Psoriasis Over 18 Months in the USA. Clin Drug Investig 2023; 43:185-196. [PMID: 36840815 PMCID: PMC10011324 DOI: 10.1007/s40261-022-01240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Data on real-world healthcare costs for ixekizumab (IXE) and secukinumab (SEC) in biologic-experienced patients with psoriasis are limited. This study compared real-world costs and healthcare resource utilization between IXE and SEC in biologic-experienced patients with psoriasis over an 18-month follow-up period in the USA. METHODS Adult patients with a diagnosis of psoriasis between 1 March, 2015 and 31 October, 2019 were identified using health insurance claims data from IBM Watson Health MarketScan®. The index date was the date of the first IXE or SEC claim. Biologic-experienced patients with one or more pre-period claims for biologic drugs were identified. Inverse probability of treatment weighting was used to reduce cohort imbalances. All-cause and psoriasis-related direct healthcare costs along with index drug costs were estimated during the follow-up and reported as per patient per month. Discount factors published by the Institute for Clinical and Economic Review were applied to psoriasis-related biologics to adjust pharmacy costs. RESULTS A total of 411 IXE and 780 SEC users were included. After weighting, all-cause inpatient admissions were similar between IXE (9.5%) and SEC users (10.3%). Weighted, mean ± standard deviation per patient per month all-cause healthcare costs were higher in IXE users ($6670 ± $2910) than in SEC users ($6239 ± $3903; p = 0.049). Psoriasis-related and monthly index drug costs were higher in IXE users ($5609 ± $2009; p < 0.001 and $4688 ± $1994; p < 0.001, respectively) than in SEC users ($5095 ± $2291 and $3853 ± $1977, respectively). After Institute for Clinical and Economic Review adjustment, mean per patient per month all-cause ($4363 ± $2576 vs $4398 ± $3517) and psoriasis-related costs ($3302 ± $1264 vs $3253 ± $1504) were similar between the groups. Institute for Clinical and Economic Review- and adherence-adjusted mean per patient per month index drug costs were similar between IXE and SEC users (p = 0.339). CONCLUSIONS Institute for Clinical and Economic Review-adjusted all-cause and psoriasis-related costs were comparable between IXE and SEC users among biologic-experienced patients over an 18-month follow-up period.
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Fournier H, Calcagni N, Morice-Picard F, Quintard B. Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet J Rare Dis 2023; 18:39. [PMID: 36823650 PMCID: PMC9951542 DOI: 10.1186/s13023-023-02629-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Since the beginning of human genetic research, there are very few publications sharing insights of the negative impact of rare genetic skin diseases (RGSD) on patients' experiences. This systematic review assessed the psychosocial implications of these conditions in terms of daily life experiences, emotional state, self-perception, and Quality of Life (QoL). METHODOLOGY A systematic review was carried out on albinism, neurofibromatosis type 1 (NF1), birthmarks and inherited ichthyosis. The PubMed, Scopus, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection, and SOCindex databases were queried. Inclusion criteria were adult patients with one of these RGSDs. Simple descriptive statistics and qualitative content analysis were conducted to summarize the main results reported by the authors. RESULTS Of the 9987 articles retrieved, 48 articles were included: albinism (16), NF1 (16), inherited ichthyosis (10), birthmarks (6). The majority of the studies on albinism were conducted in Africa. Twenty-seven studies quantitatively assessed diverse psychological parameters: 13 showed a significant impact of the disease on QoL, five on emotional state, two on self-representation and two others on psychiatric comorbidities. Disease severity and visibility were good predictors of QoL (except for albinism). Body image and appearance concerns were also associated with QoL and emotional state. The 19 qualitative studies highlighted recurring themes across each of these diseases: discrimination and stigma during childhood and adolescence, discomfort in social interactions, guilt of transmission, the importance of social support from family and friends, altered daily life functioning, altered romantic and sex life, limited academic and professional aspirations, lack of interest and support from the medical field, and the unpredictability of the evolution of the disease. The only two mixed-method studies in this review were unable to contribute to any inferential analyses but could corroborate some of the qualitative findings. CONCLUSION These results showed that RGSDs have a significant impact on different aspects of patients' lives. This review has demonstrated that there is a real need for support systems for patients with these diseases. Such systems should be developed to provide them with necessary information and to guide them through an appropriate care pathway.
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Affiliation(s)
- Hugo Fournier
- Laboratoire de Psychologie (LabPsy) EA4139, Univ. Bordeaux, 3 ter Place de la Victoire, Bâtiment A - 1er étage, 33000 Bordeaux, France
| | | | | | - Bruno Quintard
- Laboratoire de Psychologie (LabPsy) EA4139, Univ. Bordeaux, 3 ter Place de la Victoire, Bâtiment A - 1er étage, 33000 Bordeaux, France
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Asahina A, Okubo Y, Morita A, Tada Y, Igarashi A, Langley RG, Deherder D, Matano M, Vanvoorden V, Wang M, Ohtsuki M, Nakagawa H. Bimekizumab Efficacy and Safety in Japanese Patients with Plaque Psoriasis in BE VIVID: A Phase 3, Ustekinumab and Placebo-Controlled Study. Dermatol Ther (Heidelb) 2023; 13:751-768. [PMID: 36648594 PMCID: PMC9984664 DOI: 10.1007/s13555-022-00883-y] [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: 09/29/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Bimekizumab treatment resulted in improved clinical outcomes in patients with moderate-to-severe plaque psoriasis in BE VIVID, a 52-week, phase 3, randomized, ustekinumab and placebo-controlled study. We present data from the BE VIVID Japan patient subpopulation. METHODS Globally, patients were randomized to receive bimekizumab 320 mg every 4 weeks (Q4W), ustekinumab (45/90 mg weight-based at baseline and week 4, then every 12 weeks), or placebo (Q4W through week 16, then bimekizumab 320 mg Q4W). Efficacy endpoints included week 16 Psoriasis Area and Severity Index (PASI) 90 and Investigator's Global Assessment (IGA) 0/1, and other outcomes [PASI 100, PASI 75, IGA 0, Dermatology Life Quality Index (DLQI) 0/1, absolute PASI, scalp IGA, Psoriasis Symptoms and Impacts Measure (P-SIM) responses]. Safety analyses were conducted. RESULTS There were 108 Japanese randomized patients (bimekizumab: 62; ustekinumab: 29; placebo: 17). At week 16, bimekizumab-treated patients had a higher clinical response versus ustekinumab and placebo (PASI 90: 85.5% versus 51.7% and 5.9%; IGA 0/1: 82.3% versus 48.3% and 0.0%). Over 52 weeks, improved clinical response was maintained with bimekizumab, including patients switching from placebo at week 16. Overall, the safety profile in Japanese patients was consistent with that observed in the global population. CONCLUSION Bimekizumab resulted in improved clinical response versus ustekinumab and placebo, and was well-tolerated in Japanese patients. TRIAL REGISTRATION NCT03370133.
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Affiliation(s)
- Akihiko Asahina
- grid.411898.d0000 0001 0661 2073Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukari Okubo
- grid.410793.80000 0001 0663 3325Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Akimichi Morita
- grid.260433.00000 0001 0728 1069Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yayoi Tada
- grid.264706.10000 0000 9239 9995Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Igarashi
- grid.414992.3Department of Dermatology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Richard G. Langley
- grid.55602.340000 0004 1936 8200Division of Clinical Dermatology and Cutaneous Science, Department of Medicine, Dalhousie University, Halifax, NS Canada
| | - Delphine Deherder
- grid.421932.f0000 0004 0605 7243UCB Pharma, Braine L’alleud, Belgium
| | - Mizuho Matano
- UCB Pharma, UCB Japan Co., Ltd, 8-17-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
| | - Veerle Vanvoorden
- grid.421932.f0000 0004 0605 7243UCB Pharma, Braine L’alleud, Belgium
| | | | - Mamitaro Ohtsuki
- grid.410804.90000000123090000Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - Hidemi Nakagawa
- grid.411898.d0000 0001 0661 2073Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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Loo WJ, Turchin I, Prajapati VH, Gooderham MJ, Grewal P, Hong CH, Sauder M, Vender RB, Maari C, Papp KA. Clinical Implications of Targeting the JAK-STAT Pathway in Psoriatic Disease: Emphasis on the TYK2 Pathway. J Cutan Med Surg 2023; 27:3S-24S. [PMID: 36519621 DOI: 10.1177/12034754221141680] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cytokines in the interleukin (IL)-23/IL-17 axis are central to psoriasis pathogenesis. Janus kinase (JAK) signal transducer and activator of transcription (STAT) regulates intracellular signalling of several cytokines (including IL-12, 23, 22, 6, 17, and interferon (IFN)-γ) in the IL-23/IL-17 axis, and, as a result, has become a therapeutic target for psoriasis treatment. Although several JAK1-3 inhibitors, with varying degrees of selectivity, have been developed for immune-mediated inflammatory diseases, use in psoriasis is limited by a low therapeutic index as anticipated by signals from other disease indications. More selective inhibition of the JAK family is an area of interest. Specifically, selective tyrosine kinase (TYK)2 inhibition suppresses IL-23/IL-17 axis signalling, and at therapeutic doses, has a favorable safety profile compared to therapeutic doses of JAK1-3 inhibitors. Phase III efficacy and safety data for the selective allosteric TYK2-inhibitor, deucravacitinib, in adult patients with moderate-to-severe plaque psoriasis is promising. Furthermore, phase II clinical trials for ropsacitinib (PF-06826647), a selective TYK2 inhibitor, and brepocitinib (PF-06700841), a JAK1/TYK2 inhibitor, have also demonstrated efficacy and an acceptable safety profile in adult patients with moderate-to-severe plaque psoriasis. Other novel TYK2 allosteric inhibitors, NDI-034858 and ESK-001, are currently being investigated in adult patients with plaque psoriasis. This article reviews the details of the JAK-STAT pathway in psoriasis pathophysiology, the rationale for selective targeting of JAKs in the treatment of psoriasis, and provides clinical perspective on clinical trial data for JAK and TYK2 inhibitors.
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Affiliation(s)
- Wei Jing Loo
- DermEffects, London, Ontario, Canada.,468790 Probity Medical Research Inc., Waterloo, ON, Canada
| | - Irina Turchin
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Brunswick Dermatology Center, Fredericton, NB, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Vimal H Prajapati
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section of Community Pediatrics, Department of Pediatrics, Calgary, AB, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,468790 Probity Medical Research, Calgary, AB, Canada
| | - Melinda J Gooderham
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Parbeer Grewal
- Rejuvenation Dermatology, Edmonton, AB, Canada.,Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Dr. Chih-Ho Hong Medical Inc., Surrey, BC, Canada
| | - Maxwell Sauder
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronald B Vender
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada.,Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Catherine Maari
- Innovaderm Research Inc, Montreal, QC, Canada.,10051 Department of Medicine, Division of Dermatology, Montreal University Hospital Center, Montreal, QC, Canada
| | - Kim A Papp
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,K Papp Clinical Research, Waterloo, ON, Canada
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Haberman RH, MacFarlane KA, Catron S, Samuels J, Blank RB, Toprover M, Uddin Z, Hu J, Castillo R, Gong C, Qian K, Piguet V, Tausk F, Yeung J, Neimann AL, Gulliver W, Thiele RG, Merola JF, Ogdie A, Rahman P, Chakravarty SD, Eder L, Ritchlin CT, Scher JU. Efficacy of guselkumab, a selective IL-23 inhibitor, in Preventing Arthritis in a Multicentre Psoriasis At-Risk cohort (PAMPA): protocol of a randomised, double-blind, placebo controlled multicentre trial. BMJ Open 2022; 12:e063650. [PMID: 36564123 PMCID: PMC9791418 DOI: 10.1136/bmjopen-2022-063650] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a complex, immune-mediated disease associated with skin psoriasis that, if left untreated, can lead to joint destruction. Up to 30% of patients with psoriasis progress to PsA. In most cases, psoriasis precedes synovio-entheseal inflammation by an average of 5-7 years, providing a unique opportunity for early and potentially preventive intervention in a susceptible and identifiable population. Guselkumab is an effective IL-23p19 inhibitor Food and Drug Administration (FDA-approved for treatment of moderate-to-severe psoriasis and PsA. The Preventing Arthritis in a Multicentre Psoriasis At-Risk cohort (PAMPA) study aims to evaluate the efficacy of guselkumab in preventing PsA and decreasing musculoskeletal power Doppler ultrasound (PDUS) abnormalities in a population of patients with psoriasis who are at-increased risk for PsA progression. METHODS AND ANALYSIS The PAMPA study is a multicentre, randomised, double-blind, placebo-controlled, interventional, preventive trial comparing PDUS involvement and conversion to PsA in patients with psoriasis at-increased risk for progression treated with guselkumab compared with non-biological standard of care. The study includes a screening period, a double-blind treatment period (24 weeks) and an open-label follow-up period (72 weeks). At baseline, 200 subjects will be randomised (1:1) to receive either guselkumab 100 mg (arm 1) or placebo switching to guselkumab 100 mg starting at week 24 (arm 2). Arm 3 will follow 150 at-risk psoriasis patients who decline biological therapy and randomisation. Changes from baseline in the PDUS score at week 24 and the difference in proportion of patients transitioning to PsA at 96 weeks will be examined as the coprimary endpoints. ETHICS AND DISSEMINATION Ethics approval for this study was granted by the coordinating centre's (NYU School of Medicine) Institutional Review Board (IRB). Each participating site received approval through their own IRBs. The findings will be shared in peer-reviewed articles and scientific conference presentations. TRIAL REGISTRATION NUMBER NCT05004727.
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Affiliation(s)
- Rebecca H Haberman
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Katrina A MacFarlane
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Sydney Catron
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Jonathan Samuels
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Rebecca B Blank
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Michael Toprover
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Zakwan Uddin
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Jiyuan Hu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rochelle Castillo
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Cinty Gong
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA
| | - Kun Qian
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Vincent Piguet
- University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Francisco Tausk
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea L Neimann
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Wayne Gulliver
- Department of Dermatology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Ralf G Thiele
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Joseph F Merola
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology/Department of Medicine/Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexis Ogdie
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Proton Rahman
- Department of Medicine, Division of Rheumatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Soumya D Chakravarty
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Lihi Eder
- Department of Medicine, Division of Rheumatology, University of Toronto and Women's College Hospital, Toronto, ON, Canada
| | - C T Ritchlin
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
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Lada G, Chinoy H, Talbot PS, Warren RB, Kleyn CE. Associations between psoriatic arthritis and mental health among patients with psoriasis: A replication and extension study using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). SKIN HEALTH AND DISEASE 2022; 2:e149. [PMID: 36479266 PMCID: PMC9720192 DOI: 10.1002/ski2.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 06/17/2023]
Abstract
Background Despite some evidence that psoriatic arthritis (PsA) may increase psychological burden in psoriasis, the mental health of this subpopulation is under-investigated. Objectives To investigate whether PsA is associated with higher depression and anxiety in moderate-to-severe psoriasis; explore whether pain mediates these associations; and estimate the prevalence of undiagnosed and untreated depression. Methods Baseline data from British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) participants completing the Hospital Anxiety and Depression Scale (HADS) were analysed. Results 707 patients (n = 540 with psoriasis only; n = 167 with PsA) were included. Depression prevalence was higher in patients with than without PsA, when a HADS-depression subscale cut-off ≥8 was used (33% vs. 23%, adjusted Odds Ratio [OR] (95% Confidence Intervals [CI]) = 1.64 (1.09-2.45)), but did not differ using the HADS cut-off ≥ 11. Anxiety prevalence was higher among PsA patients, regardless of HADS cut-off (cut-off ≥11: adjusted OR (95% CI) = 1.62 (1.07-2.45)). Pain fully mediated the effect of PsA on depression and anxiety in psoriasis. 53.6% of participants identified as depressed did not have a known psychiatric disorder; two thirds of depressed participants were not treated. Conclusions PsA comorbidity in psoriasis is associated with higher anxiety; its association with depression appears to be robust when milder depressive syndromes are included, but less consistent for higher-threshold depression definitions. Depression remains unrecognized and untreated in over half of moderately-to-severe psoriasis patients. Routine depression and anxiety screening is recommended in psoriasis and PsA. PsA comorbidity may increase depression and anxiety in psoriasis through pain experience.
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Affiliation(s)
- Georgia Lada
- Dermatology CentreSalford Royal NHS Foundation TrustNational Institute for Health Research Manchester Biomedical Research CentreThe University of ManchesterManchesterUK
- Division of Neuroscience and Experimental PsychologyFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research CentreManchester University NHS Foundation TrustThe University of ManchesterManchesterUK
| | - Peter S. Talbot
- Division of Neuroscience and Experimental PsychologyFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Richard B. Warren
- Dermatology CentreSalford Royal NHS Foundation TrustNational Institute for Health Research Manchester Biomedical Research CentreThe University of ManchesterManchesterUK
| | - C. Elise Kleyn
- Dermatology CentreSalford Royal NHS Foundation TrustNational Institute for Health Research Manchester Biomedical Research CentreThe University of ManchesterManchesterUK
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Bardazzi F, Bonci C, Sacchelli L, DI Altobrando A, Iommi M, Rucci P, Sacchelli P, Berardi D, Patrizi A, Tengattini V. Suicide risk and depression in patients with psoriasis. Ital J Dermatol Venerol 2022; 157:497-501. [PMID: 36651203 DOI: 10.23736/s2784-8671.22.07184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Psoriasis is associated with comorbid psychiatric conditions. However, its relationship with suicidality is not completely understood. The aim of this study was to analyze the prevalence and the correlates of depressive symptoms and suicide risk in patients with psoriasis. METHODS Adult psoriatic patients referring to the Outpatient Service of the Sant'Orsola-Malpighi Polyclinic were enrolled. Depressive symptoms and suicidality were assessed using the Patient Health Questionnaire (PHQ-9) and section C of Mini-International Neuropsychiatric Interview (M.I.N.I. 5.0.0). Psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). RESULTS The prevalence of depressive symptoms was 14.9% and that of suicidality 6.3%. PHQ-9 scores were higher in patients with moderate-to-severe psoriasis (PASI≥10, Mann-Whitney U Test=4014.5; P<0.001; BSA≥10, Mann-Whitney Test=3930.5; P<0.001) and poorer quality of life (Mann-Whitney Test=805.5; P=0.024). Moreover, PHQ-9 scores were higher in females (Mann-Whitney Test U=3612.5; P=0.008) and were unrelated to age (r<inf>s</inf>=-0.056, P=0.423). Conversely, suicide risk was significantly higher in younger patients (Mann-Whitney=744, P=0.013) and females (χ2=5.69, P=0.028), and was unrelated to psoriasis severity. CONCLUSIONS Patients with moderate-to-severe psoriasis, especially females, should be screened for depression and suicidal ideation to support them with effective strategies to treat depressive symptoms.
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Affiliation(s)
- Federico Bardazzi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Camilla Bonci
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Lidia Sacchelli
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy -
| | - Ambra DI Altobrando
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Sacchelli
- School of Specialization in Psychotherapy with "Relationship Psychoanalysis, " Area 25 Clinical Center, Società Italiana di Psicoanalisi della Relazione (SIPRe), Milan, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.,Departiment of Dermatology, IRCCS Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Vera Tengattini
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
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Trajectories of systemic agent use and associated depression- and anxiety-related health care costs among patients with psoriasis. JAAD Int 2022; 9:11-22. [PMID: 35996750 PMCID: PMC9391576 DOI: 10.1016/j.jdin.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Systemic treatment patterns and related mental health disorders and economic burden among patients with psoriasis are largely unknown. Objective To assess systemic treatment patterns and associated depression and anxiety-related health care costs among patients with psoriasis initiating a conventional systemic treatment (CST). Methods Using a retrospective cohort design with sequence and cluster analyses, we assessed systemic treatment trajectories (CST and tumor necrosis factor inhibitors or ustekinumab, [TNFi/UST]) over a 2-year period following CST initiation. We compared health care costs between trajectories using 2-part models. Results We included 781 patients and identified 8 trajectories: persistent methotrexate users, persistent acitretin users, early CST discontinuation, late methotrexate discontinuation, switch to TNFi/UST, adding TNFi/UST, discontinuation then restart on methotrexate, and discontinuation then restart on acitretin or multiple CST switches. Overall, 165 (21%) patients incurred depression- and anxiety-related health care costs (median annual cost, CAN$56; quartiles, $14-$127). Compared with persistent methotrexate users, adding a TNFi/UST (cost ratio, 3.63; 95% CI, 1.47-5.97) and discontinuation then restart on acitretin or multiple switches between systemic agents (cost ratio, 13.3; 95% CI 5.76-22.47) had higher costs. Limitations Trajectory misclassification may have occured. These date represent an association, and causality cannot be inferred, particularly given the risk of confounding. Conclusion Depression- and anxiety-related health care costs were high among patients adding TNFi/UST and those discontinuing then restarting on acitretin or experiencing multiple switches between systemic agents.
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Gisondi P, Geat D, Armeni P, Bellinato F, Maurelli M, Girolomoni G. Cost per responder of Adalimumab biosimilars MSB11022 and ABP 501 versus the originator and methotrexate in chronic plaque psoriasis. Expert Opin Biol Ther 2022; 22:1579-1584. [PMID: 35466843 DOI: 10.1080/14712598.2022.2070428] [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: 01/25/2023]
Abstract
BACKGROUND Pharmacoeconomic studies comparing the cost of adalimumab biosimilars versus the originator and conventional drugs in psoriasis are lacking. RESEARCH DESIGN AND METHODS To assess the cost per responder of adalimumab biosimilars versus the originator and methotrexate for psoriasis treatment. A cost per responder analysis comparing adalimumab biosimilars MSB11022 (Idacio®) and ABP 501 (Amgevita®), and methotrexate to the originator (Humira®) was performed. The incremental cost per responder was calculated by multiplying the cost of treatment based on the perspective of the National Healthcare System and number needed to treat for each therapy. RESULTS Considering the PASI75 response rate at 16 weeks, the cost per responder for MSB11022 and ABP 501 compared to the originator was € 500 versus 1,831 and € 968 versus 1,949, respectively. For the same endpoint, the cost per responder for subcutaneous or oral methotrexate was € 543 or 34 compared to 2,117 for adalimumab originator. At an indirect comparison among methotrexate, MSB11022 and ABP 501, the costs per PASI75 responder at week 16 were 2%, 26%, 27% and 50% of that of the originator, respectively. CONCLUSIONS The use of biosimilars was confirmed as a valuable pharmacoeconomic strategy to lower healthcare cost in patients with psoriasis.
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Affiliation(s)
- Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Davide Geat
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Martina Maurelli
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Gerdes S, Asadullah K, Hoffmann M, Korge B, Mortazawi D, Wegner S, Personke Y, Gomez M, Sticherling M. Real-world evidence from the non-interventional, prospective, German multicentre PERSIST study of patients with psoriasis after 1 year of treatment with guselkumab. J Eur Acad Dermatol Venereol 2022; 36:1568-1577. [PMID: 35569014 DOI: 10.1111/jdv.18218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND PERSIST was a prospective, non-interventional, long-term, German multicentre study of patients with moderate-to-severe psoriasis receiving guselkumab, an approved monoclonal antibody that binds to the p19 subunit of interleukin (IL)-23, in a real-world setting. OBJECTIVES Evaluation of the efficacy and safety of guselkumab, and its effect on health-related quality of life (HRQoL), in patients with moderate-to-severe psoriasis who have received 52 weeks of treatment. METHODS Patients (≥18 years old) were prescribed guselkumab as per routine clinical practice. End points assessed include Psoriasis Area and Severity Index (PASI), Physician's Global Assessment (PGA), target Nail Psoriasis Severity Index (NAPSI), and the Dermatology Life Quality Index (DLQI). RESULTS Overall, 303 patients were enrolled and treated with guselkumab. Mean disease duration was 21.0 years, and 77.2% and 51.2% of patients had received ≥1 prior conventional systemic or ≥1 prior biologic therapy, respectively. Mean PASI score decreased from 16.4 at baseline to 3.0 by Week (W) 28, and further decreased to 2.4 by W52, while the proportion of patients achieving an absolute PASI score of ≤1 increased from 1.3% at baseline, to 50.8% at W28 and to 58.4% by W52. PASI90 and PASI100 responses also showed marked improvements between W28 and W52, regardless of biologic treatment history. Clearance of psoriatic skin was observed in difficult-to-treat areas, with the percentage of patients achieving a PGA score ≤1 increasing between W28 and W52. Guselkumab improved HRQoL; mean DLQI score decreased from 13.7 at baseline to 2.8 by W28, and further decreased to 2.4 by W52. At W52, 64.6% of patients achieved a DLQI score ≤1. The cumulative probability of drug survival was 92.4% at W52. CONCLUSIONS Guselkumab is efficacious and well tolerated regardless of previous biologic therapies, comorbidities or psoriasis manifestation in difficult-to-treat areas. No new safety signals were observed.
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Affiliation(s)
- S Gerdes
- Psoriasis Center Kiel, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K Asadullah
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Prof. Dr. med. Asadullah, Hautarztpraxis, Potsdam, Germany
| | - M Hoffmann
- Dermatology Practice Dr. Matthias Hoffmann, Witten, Germany
| | - B Korge
- Dermatology Practice Dr. Bernhard Korge, Düren, Germany
| | - D Mortazawi
- Dermatology Practice Dr. Dariusch Mortazawi, Remscheid, Germany
| | - S Wegner
- Janssen-Cilag GmbH, MAF, Neuss, Germany
| | | | - M Gomez
- Janssen-Cilag GmbH, MAF, Neuss, Germany
| | - M Sticherling
- Department of Dermatology, University Hospital of Erlangen, Deutsches Zentrum für Immuntherapie, Erlangen, Germany
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Pellacani G, Bigi L, Parodi A, Burlando M, Lanna C, Campione E, Rongioletti F, Mugheddu C, Malara G, Moretti G, Stingeni L, Hansel K, Micali G, Naldi L, Pirro F, Peris K. Efficacy and Safety of Dimethyl Fumarate in Patients with Moderate-to-Severe Plaque Psoriasis: DIMESKIN-2, a Multicentre Single-Arm Phase IIIb Study. J Clin Med 2022; 11:jcm11164778. [PMID: 36013015 PMCID: PMC9410272 DOI: 10.3390/jcm11164778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
This open-label multicentre trial evaluated the efficacy and safety of oral dimethyl fumarate (DMF) in patients with moderate-to-severe plaque psoriasis in real-life clinical practice over 52 weeks. Disease severity and improvement were assessed using the psoriasis area severity index (PASI), body surface area (BSA) affected, and Physician Global Assessment (PGA). Quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. The visual analogue scale (VAS) was used to quantify pruritus and measure treatment satisfaction. A total of 141 patients were included, being 66.7% male, aged 49.1 ± 14.7 years and with disease duration of 16 ± 12.1 years. After 52 weeks, mean PASI decreased from 15.9 ± 6.8 to 1.5 ± 2 and 87.7%, 56.9% and 24.6% of patients achieved PASI 75/90/100 response, respectively. BSA decreased from 26.5 ± 14.8% to 2.7 ± 3.5% at 52 weeks, and 81.5% of patients had a PGA 0-1. DLQI scores decreased from 9.4 ± 6.4 to 2.1 ± 3.3, and VAS of pruritus decreased from 53 ± 28.4 to 19.1 ± 26.2 at Week 52. VAS for treatment satisfaction was 79.4 ± 29.4 at Week 52. A total of 34.2% of patients had an AE leading to permanent discontinuation. These findings show that DMF can significantly improve indices of disease severity, pruritus and QoL, with high levels of patient satisfaction and similar safety profile to other fumarates.
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Affiliation(s)
- Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Dermatology Clinic, Sapienza University of Rome, 00185 Rome, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-059-422-4264
| | - Aurora Parodi
- Section of Dermatology (DiSSal), University of Genoa, Ospedale-Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Martina Burlando
- Section of Dermatology (DiSSal), University of Genoa, Ospedale-Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Caterina Lanna
- Dermatology Unit, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Franco Rongioletti
- Vita Salute University IRCSS San Raffaele Hospital, 20132 Milan, Italy
- Dermatology Clinic, University of Cagliari, 09124 Cagliari, Italy
| | | | - Giovanna Malara
- Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, Italy
| | | | - Luca Stingeni
- Dermatology Section, Head of Resident School of Dermatology and Venereology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Head of Resident School of Dermatology and Venereology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Giuseppe Micali
- Azienda Ospedaliero—Universitaria “Policlinico—Vittorio Emanuele” P.O. Gaspare Rodolico U.O.C. di Dermatologia Catania, 95123 Catania, Italy
| | - Luigi Naldi
- Azienda ULSS 8 Berica-Ospedale San Bortolo U.O. di Dermatologia, 36100 Vicenza, Italy
| | - Federico Pirro
- Dermatology Unit, Catholic University of Rome, Fondazione Policlinico A. Gemelli, 00168 Rome, Italy
| | - Ketty Peris
- Dermatology Unit, Catholic University of Rome, Fondazione Policlinico A. Gemelli, 00168 Rome, Italy
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How important is subjective well-being for patients? A qualitative interview study of people with psoriasis. Qual Life Res 2022; 31:3355-3363. [PMID: 35948788 PMCID: PMC9587968 DOI: 10.1007/s11136-022-03189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE This qualitative study aimed to investigate the importance of subjective well-being (SWB) as an outcome of psoriasis treatment from patient's perspective. We focused on the affective component of SWB as assessed with the Daily Experience Sampling Questionnaire (DESQ), a validated daily diary. METHODS Semi-structured qualitative telephone interviews were conducted with in-patients of a dermatological rehabilitation clinic, after participants had completed the DESQ for up to seven days to get familiar with the concept of SWB. Patients were asked to reflect on the importance of SWB as treatment goal and on its relative importance as compared with other treatment outcomes. We also addressed whether SWB could be an indirect measure of benefit in that it reflects other important outcomes. Transcripts were analyzed using content analysis. RESULTS Eleven patients participated (24-63 years, mean 53 years, 8 male, 3 female). Participants uniformly confirmed that changes in SWB reflected treatment benefit. All but one considered SWB to be a central aspect of treatment benefit-either as the most important treatment goal or as an indirect benefit indicator. In particular, participants described positive associations of SWB with other outcomes, such as symptoms. They reported that both the disease and the medical treatment had an impact on their SWB, which was reflected in the DESQ. CONCLUSION Our findings suggest that SWB is a relevant indicator of treatment benefit for patients with psoriasis. Therefore, SWB measures, such as the DESQ, could be used to operationalize patient-relevant benefit of psoriasis treatment, complementing outcome measures currently used.
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Topical VX-509 attenuates psoriatic inflammation through the STAT3/FABP5 pathway in keratinocytes. Pharmacol Res 2022; 182:106318. [PMID: 35728766 DOI: 10.1016/j.phrs.2022.106318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease, with lesions mainly manifesting as scaly erythematous plaques. The mild or moderate of psoriasis is the main type of patients in hospital, and topical application remains the preferred treatment option for psoriasis therapy, therefore, the development of novel topical agents has an essential role in psoriasis therapy. OBJECTIVE To identify potential drugs for psoriasis topical treatment. METHODS We performed drug screening by Imiquimod (IMQ)-induced psoriatic like inflammation in mouse model, followed mouse epidermis by RNA-seq to find the key molecules affecting the drug. The qRT-PCR, WB were performed to test mRNA and protein expression, and Chip assay had been conducted to examine Stat3 bound to promoter of FABP5. RESULTS In this study, we identified VX-509, which topical application significantly attenuated IMQ-induced psoriatic like inflammation in mouse model. And then, we verified Epidermal Fatty acid binding protein (E-FABP/FABP5) was significantly decreased in VX-509 treated mouse epidermis by RNA-seq. FABP5 is a key molecule in lipid metabolism, administration of FABP5 inhibitor or knock down of FABP5 expression remarkably abrogated psoriatic inflammation as well as lipid metabolism. Mechanistically, our finding showed that VX-509 blocked IL-22 induced signaling pathway, particular in activation of Stat3. Furthermore, we identified Stat3 is a transcriptional factor associated with FABP5 promoters and VX-509 treatment remarkably attenuated IL-22-induced FABP5 expression through Stat3 in KCs. CONCLUSIONS This study demonstrated administration of VX-509 is a potential promising topical drug for treatment of psoriasis, FABP5 is a critical targeted molecule in psoriasis therapy.
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Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, Hughes C, Naldi L, Afach S, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2022; 5:CD011535. [PMID: 35603936 PMCID: PMC9125768 DOI: 10.1002/14651858.cd011535.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease with either skin or joints manifestations, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. The relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the efficacy and safety of non-biological systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis using a network meta-analysis, and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS For this update of the living systematic review, we updated our searches of the following databases monthly to October 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults over 18 years with moderate-to-severe plaque psoriasis, at any stage of treatment, compared to placebo or another active agent. The primary outcomes were: proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90; proportion of participants with serious adverse events (SAEs) at induction phase (8 to 24 weeks after randomisation). DATA COLLECTION AND ANALYSIS We conducted duplicate study selection, data extraction, risk of bias assessment and analyses. We synthesised data using pairwise and network meta-analysis (NMA) to compare treatments and rank them according to effectiveness (PASI 90 score) and acceptability (inverse of SAEs). We assessed the certainty of NMA evidence for the two primary outcomes and all comparisons using CINeMA, as very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer treatment hierarchy, from 0% (worst for effectiveness or safety) to 100% (best for effectiveness or safety). MAIN RESULTS This update includes an additional 19 studies, taking the total number of included studies to 167, and randomised participants to 58,912, 67.2% men, mainly recruited from hospitals. Average age was 44.5 years, mean PASI score at baseline was 20.4 (range: 9.5 to 39). Most studies were placebo-controlled (57%). We assessed a total of 20 treatments. Most (140) trials were multicentric (two to 231 centres). One-third of the studies (57/167) had high risk of bias; 23 unclear risk, and most (87) low risk. Most studies (127/167) declared funding by a pharmaceutical company, and 24 studies did not report a funding source. Network meta-analysis at class level showed that all interventions (non-biological systemic agents, small molecules, and biological treatments) showed a higher proportion of patients reaching PASI 90 than placebo. Anti-IL17 treatment showed a higher proportion of patients reaching PASI 90 compared to all the interventions, except anti-IL23. Biologic treatments anti-IL17, anti-IL12/23, anti-IL23 and anti-TNF alpha showed a higher proportion of patients reaching PASI 90 than the non-biological systemic agents. For reaching PASI 90, the most effective drugs when compared to placebo were (SUCRA rank order, all high-certainty evidence): infliximab (risk ratio (RR) 50.19, 95% CI 20.92 to 120.45), bimekizumab (RR 30.27, 95% CI 25.45 to 36.01), ixekizumab (RR 30.19, 95% CI 25.38 to 35.93), risankizumab (RR 28.75, 95% CI 24.03 to 34.39). Clinical effectiveness of these drugs was similar when compared against each other. Bimekizumab, ixekizumab and risankizumab showed a higher proportion of patients reaching PASI 90 than other anti-IL17 drugs (secukinumab and brodalumab) and guselkumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab and brodalumab) and anti-IL23 drugs (risankizumab and guselkumab) except tildrakizumab showed a higher proportion of patients reaching PASI 90 than ustekinumab and three anti-TNF alpha agents (adalimumab, certolizumab and etanercept). Ustekinumab was superior to certolizumab; adalimumab and ustekinumab were superior to etanercept. No significant difference was shown between apremilast and two non-biological drugs: ciclosporin and methotrexate. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. The risk of SAEs was significantly lower for participants on methotrexate compared with most of the interventions. Nevertheless, the SAE analyses were based on a very low number of events with low- to moderate-certainty for all the comparisons (except methotrexate versus placebo, which was high-certainty). The findings therefore have to be viewed with caution. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1), the results were similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that, compared to placebo, the biologics infliximab, bimekizumab, ixekizumab, and risankizumab were the most effective treatments for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of high-certainty evidence. This NMA evidence is limited to induction therapy (outcomes measured from 8 to 24 weeks after randomisation), and is not sufficient for evaluating longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean 44.5 years) and high level of disease severity (PASI 20.4 at baseline) may not be typical of patients seen in daily clinical practice. We found no significant difference in the assessed interventions and placebo in terms of SAEs, and the safety evidence for most interventions was low to moderate quality. More randomised trials directly comparing active agents are needed, and these should include systematic subgroup analyses (sex, age, ethnicity, comorbidities, psoriatic arthritis). To provide long-term information on the safety of treatments included in this review, an evaluation of non-randomised studies and postmarketing reports from regulatory agencies is needed. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Anna Chaimani
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Ignacio Garcia-Doval
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Corinna Dressler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Camille Hua
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Carolyn Hughes
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Luigi Naldi
- Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - Sivem Afach
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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Prignano F, Brunasso AMG, Fabbrocini G, Argenziano G, Bardazzi F, Borroni RG, Burlando M, Cagni AE, Campione E, Cinotti E, Cuccia A, Dastoli S, De Pasquale R, De Simone C, Di Lernia V, Dini V, Fargnoli MC, Faure E, Giacchetti A, Giofrè C, Girolomoni G, Lasagni C, Lembo S, Loconsole F, Montesu MA, Pella P, Pigatto P, Richetta AG, Stroppiana E, Venturini M, Zichichi L, Piaserico S. Sharing Patient and Clinician Experiences of Moderate-to-Severe Psoriasis: A Nationwide Italian Survey and Expert Opinion to Explore Barriers Impacting upon Patient Wellbeing. J Clin Med 2022; 11:jcm11102801. [PMID: 35628929 PMCID: PMC9146704 DOI: 10.3390/jcm11102801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
A nationwide survey was conducted in adult patients with psoriasis (PsO) across Italy to obtain their real-world perspective of the impact of PsO on their wellbeing. Patients completed a 26-question survey (based on the patient benefit index; PBI, The Dermatology Life Quality Index; DLQI and the World Health Organization-five; WHO-5 wellbeing index) and workshop discussion sessions were undertaken by dermatologists to interpret results from the survey. 392 patients with PsO completed the survey. Analysis of results was restricted to patients who had moderate-to-severe plaque psoriasis (assessed by patients; n = 252; 64.3%). Dermatologists (n = 32) completed one question from the survey related to wellbeing and rated social, physical and mental domains as contributing to a similar extent, with comparable scores also observed by patients. For treatment, biologics yielded higher scores on average, whereas little difference was observed between topical and conventional systemic treatments. Only 23.8% of patients felt that their dermatologist was taking into consideration their wellbeing and 32.6% of the patients considered their therapy as inadequate in improving signs and symptoms of the disease. This survey identified key factors contributing to barriers impacting on patient wellbeing. Simple, but comprehensive questionnaires can provide important insight to patients’ needs that may significantly increase clinician awareness during visits leading to tailored treatment.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
- Correspondence: ; Tel.: +39-055-6939624
| | | | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico Ii, 80138 Naples, Italy;
| | | | - Federico Bardazzi
- Dermatology Unit—IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy;
| | - Riccardo G. Borroni
- Dermatology Unit, Humanitas Clinical and Research Center—IRCCS, Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
| | - Martina Burlando
- Dermatologic Clinic, DISSAL, San Martino Policlinico San Martino Hospital, 16132 Genova, Italy;
| | - Anna Elisabetta Cagni
- Unità Operativa Dipartimentale di Dermatologia e Venereologia, Ospedale San Gerardo—Monza, 20900 Milan, Italy;
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, 52100 Arezzo, Italy;
| | - Stefano Dastoli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Clara De Simone
- Institute of Dermatology, Catholic University, 00185 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy;
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Elisa Faure
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | | | - Claudia Giofrè
- Dermatology Complex Operative Unit, Papardo Hospital, 98158 Messina, Italy;
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Claudia Lasagni
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy;
| | - Francesco Loconsole
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy;
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Maria Antonia Montesu
- Department of Surgical, Microsurgical and Medical Sciences, Dermatology, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Pella
- Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, Istituto Ortopedico Galezzi, University of Milan, 20122 Milan, Italy;
| | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Rome, Italy;
| | - Elena Stroppiana
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili, 25121 Brescia, Italy;
| | - Leonardo Zichichi
- Unit of Dermatology, San Antonio Abate Hospital, 80057 Trapani, Italy;
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, 35122 Padova, Italy;
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Psychopathology and Alexithymia in Patients with Moderate-to-Severe Psoriasis: Development of a Novel Index with Prognostic Value. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074029. [PMID: 35409713 PMCID: PMC8998217 DOI: 10.3390/ijerph19074029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psoriasis is a chronic, relapsing, inflammatory disease with a high risk of developing mental health difficulties. OBJECTIVE The purposes of the study were to evaluate in moderate-to-severe psoriasis (a) the prevalence of depression and psychopathology, (b) the relationship between depression, psychopathology symptoms, and alexithymia, including its three dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT), and (c) to establish a novel index for the development of depression according to patients' psychopathological profile. METHODS In 104 patients, alexithymia was evaluated with the Toronto Alexithymia Scale (TAS-20), depression with the Beck Depression Inventory (BDI), and psychopathology with the Brief Symptom Inventory SCL-90 (SCL90). A psychopathology index that combines information from the BDI and SCL90 scales was constructed and the performance of the index with alexithymia was examined. RESULTS Female patients and active smokers score higher on BDI and SCL90 scales. Overweight patients tend to score arithmetically higher. The psychopathology index developed correlates significantly with age, DIF, DDF, and TAS-20. DIF, DDF, and TAS-20 are significant predictors of the psychopathology index. Patients with alexithymia/possible alexithymia are six times as likely to score higher in one of the psychopathology scales. CONCLUSIONS Alexithymia is a significant factor in the development of psychopathology in psoriasis patients. The use of the proposed novel psychopathology index could be essential in order to identify patients with moderate-to-severe psoriasis who are more likely to experience depression and psychopathology. This could have an impact on the decision-making of psoriasis treatment and monitoring of the patient.
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Alamri A, Alqahtani R, Alshareef I, Alshehri A, Balkhy A. Psoriasis in Saudi Population: Gender Differences in Clinical Characteristics and Quality of Life. Cureus 2022; 14:e22892. [PMID: 35399485 PMCID: PMC8982498 DOI: 10.7759/cureus.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Patients with psoriasis suffer from an inflammatory immune-mediated skin condition that impacts their quality of life severely. In our study, we aimed to analyze the gender differences in clinical characteristics in patients with psoriasis and to assess the quality of life in these patients. Methods This is a retrospective observational study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Results A total of 139 patients with psoriasis met the inclusion criteria, with a mean ± SD age of 45.53 ± 15.3 years. No statistically significant gender differences were observed in terms of disease duration, BMI, clinical type and body surface area (BSA) (P=0.657, P=0.782, P=0.565, P=0.088, respectively). However, psoriasis caused a significant impairment in the quality of life in female patients compared to males (P=0.036). Conclusion This study reports the gender differences in clinical characteristics in patients with psoriasis and its impact on the quality of life. More researches with larger sample size and different populations are needed in order to identify more potential gender-specific variations.
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Teixeira A, Ribeiro C, Gaio R, Torres T, Magina S, Pereira T, Teixeira M, Rocha JC, Lobo JMS, Almeida IF, Vidal DG, Pedrosa E Sousa HF, Dinis MAP, Almeida V. Influence of psoriasis lesions' location and severity on psychosocial disability and psychopathology. Observational study and psychometric validation of the SAPASI Portuguese version. J Psychosom Res 2022; 154:110714. [PMID: 35007943 DOI: 10.1016/j.jpsychores.2021.110714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The psychosocial impact of psoriasis is well documented. However, the contributing role of clinical disease characteristics is not satisfactorily explored. This study aimed to validate the Self-administered Psoriasis Area and Severity Index (SAPASI) to a Portuguese population (SAPASI-PT) and to perform its cross-validation, assessing how the results will generalize to an independent data set, with the Psoriasis Area and Severity Index (PASI), in order to assess the influence of psoriasis' severity on psychosocial disability and psychopathology. METHODS A cross-sectional study with 228 patients with psoriasis was carried out. Data was collected through a sociodemographic and clinical questionnaire, SAPASI-PT, the Psoriasis Disability Index (PDI) and the Brief Symptoms Inventory (BSI). The cultural and linguistic adaptation of SAPASI to a Portuguese version and the cross validation with PASI was carried out. Multiple associations between psychosocial disability, psychopathology and severity, discomfort and location of lesions were investigated through logistic regression models. RESULTS A good adjustment model for SAPASI-PT is found. Also, associations between psychosocial disability, psychopathology and the psoriasis severity and discomfort are found. The existence of lesions is positively associated with the severity of the disease. Patients with lesions in hands or genitals are those reporting a greater discomfort. The presence of lesions in hands is positively associated with PDI, i.e., with leisure and with treatment, marginally. Additionally, patients scoring higher in the personal dimension are found to have a significantly greater percentage of lesions in the genitals. CONCLUSIONS The psoriasis severity and location of lesions are important determinants of patients´ quality of life. Lesions on face, hands and genitals are associated with a higher impact on psychosocial wellbeing of patients. Psychological counselling should be considered within psoriasis treatment context in patients with the described disease manifestations.
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Affiliation(s)
- Ana Teixeira
- TOXRUN - Unidade de Investigação em Toxicologia, Instituto Universitário de Ciências da Saúde, CESPU, CRL, 4585-116 Gandra, Portugal; UCIBIO, REQUIMTE, Laboratório de Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Cristiano Ribeiro
- Instituto Universitário de Ciências da Saúde, CESPU, CRL, 4585-116 Gandra, Portugal
| | - Rita Gaio
- Centro de Matemática da Universidade do Porto & Departamento de Matemática, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal
| | - Tiago Torres
- Serviço de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo António, Rua D. Manuel II, Ex. CICAP, 4099-001 Porto, Portugal
| | - Sofia Magina
- Serviço de Dermatologia, Centro Hospitalar de São João e Departamento de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Teresa Pereira
- Centro de Dermatologia Epidermis, Instituto CUF, R. Fonte das Sete Bicas, 170, 4460-188 Senhora da Hora, Portugal
| | - Maribel Teixeira
- TOXRUN - Unidade de Investigação em Toxicologia, Instituto Universitário de Ciências da Saúde, CESPU, CRL, 4585-116 Gandra, Portugal.
| | - José Carlos Rocha
- Instituto Universitário de Ciências da Saúde, CESPU, CRL, 4585-116 Gandra, Portugal
| | - José Manuel Sousa Lobo
- UCIBIO, REQUIMTE, Laboratório de Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Isabel Filipa Almeida
- UCIBIO, REQUIMTE, Laboratório de Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Diogo Guedes Vidal
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa (UFP), Praça 9 de Abril 349, 4249-004 Porto, Portugal
| | - Hélder Fernando Pedrosa E Sousa
- Department of Mathematics (DM.UTAD), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5001-801 Vila Real, Portugal
| | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa (UFP), Praça 9 de Abril 349, 4249-004 Porto, Portugal
| | - Vera Almeida
- UCIBIO, REQUIMTE, Laboratório de Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; UNIPRO - Unidade de Investigação em Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde (IUCS), CESPU, 4585-116 Gandra, Portugal
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Purzycka-Bohdan D, Kisielnicka A, Zabłotna M, Nedoszytko B, Nowicki RJ, Reich A, Samotij D, Szczęch J, Krasowska D, Bartosińska J, Narbutt J, Lesiak A, Barasińska P, Owczarczyk-Saczonek A, Czerwińska J, Szepietowski JC, Batycka-Baran A, Czajkowski R, Górecka-Sokołowska M, Rudnicka L, Czuwara J, Sobalska-Kwapis M, Strapagiel D, Szczerkowska-Dobosz A. Chronic Plaque Psoriasis in Poland: Disease Severity, Prevalence of Comorbidities, and Quality of Life. J Clin Med 2022; 11:jcm11051254. [PMID: 35268344 PMCID: PMC8911198 DOI: 10.3390/jcm11051254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
The epidemiology of psoriasis has not been widely assessed in Polish population so far. This study aimed to investigate psoriasis epidemiological situation by evaluating disease course and severity, management, comorbidities, environmental factors, and knowledge about this disorder among psoriatic patients in Poland. A cross-sectional cohort population-based study enrolled 1080 psoriatic patients and 1200 controls. The mean age of psoriasis onset was 27.6 years; 78.24% had type I psoriasis. Positive family history of psoriasis was reported in 44.81% of patients, whereas itch was reported in vast majority of patients (83.33%). Based on PASI score moderate psoriasis was the most common in studied group (mean 12.63 ± 9.33, range 0−67.2). The DLQI score (12.01 ± 7.41, range 0−30.0) indicated a very large effect of psoriasis on the quality of life. Hypertension was the most prevalent comorbidity (33.80%), followed by obesity (16.85%) and dyslipidemia (11.85%). Stress was the foremost cause of disease exacerbation (66.20%); however, infections (44.07%) and seasonal changes (45.09%) had also an impact on the course of psoriasis. Psoriatic patients were more often smokers (37.59%) vs. general population (27.50%; p < 0.0001). In conclusion, epidemiological studies help clinicians in better disease and patient understanding, which may translate into better management and patient compliance.
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Affiliation(s)
- Dorota Purzycka-Bohdan
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Correspondence:
| | - Anna Kisielnicka
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Monika Zabłotna
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Invicta Fertility and Reproductive Centre, Molecular Laboratory, 80-850 Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dominik Samotij
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Justyna Szczęch
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dorota Krasowska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Bartosińska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Paulina Barasińska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Joanna Czerwińska
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Aleksandra Batycka-Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Magdalena Górecka-Sokołowska
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Marta Sobalska-Kwapis
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Dominik Strapagiel
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
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Dykukha I, Schoenenberger A, Kasujee I, Mrowietz U, Vonthein R. Application of the Statistical Method to Convert Published PASI 50/75/90/100 into Absolute PASI Response Rate in Patients with Moderate-to-Severe Plaque Psoriasis Treated with Tildrakizumab Based on Data from the Two Pivotal Phase 3 Studies reSURFACE 1 and reSURFACE 2. Dermatology 2022; 238:910-918. [PMID: 35168231 DOI: 10.1159/000522009] [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: 06/22/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Absolute Psoriasis Area and Severity Index (PASI) is a key endpoint in psoriasis management. Petto et al. [Pharm Stat. 2019;18(1):4-21] developed a statistical method to estimate the proportion of patients reaching absolute PASI response given baseline PASI score and proportion of patients achieving relative improvements at predefined time points. OBJECTIVES To test this method on clinical data from two phase 3 tildrakizumab trials (reSURFACE 1/2) comparing estimated absolute PASI ≤1/≤2/≤3/≤5 responses with reference responses from clinical databases. METHODS Reference PASI responses of ≤1/≤2/≤3/≤5 were extracted from clinical databases. Estimation of absolute PASI ≤1/≤2/≤3/≤5 response rates at week (W) 12 and W28 by treatment and trial were performed. Differences between estimated and reference responses were analysed. Bland-Atman limits of agreement and Passing-Bablok regression to assess variations between estimated and reference responses were performed. RESULTS Differences between estimated and reference absolute PASI ≤1/≤2/≤3/≤5 responses at W12 and W28 by treatment and trial were of little clinical relevance with an overall mean difference in PASI response proportion of -2.2% (e.g., for the tildrakizumab 100-mg arm, original proportions of patients achieving PASI of ≤1/≤2/≤3/≤5 at W28 were 38.5%/52.2%/63.5%/73.9% and 39.8%/54.8%/63.6%/76.9% [reSURFACE 1 and 2, respectively] vs. estimated proportions of 33.2%/49.8%/62.5%/78.3% and 34.3%/51.6%/64.5%/79.9%). Limits of agreement were -7.1% to 1.4% at W12 and -6.8% to 4.3% at W28. Scatterplots revealed linearity that stood the cusum test in Passing-Bablok regression with slope 1.14 (95% confidence intervals: 1.06 to 1.20). CONCLUSION Good estimates of absolute PASI response rates were achieved with the application of the statistical method to tildrakizumab data reported in the phase 3 studies, in particular in the verum study arms. Our data support the method provided by Petto et al. [2019] to estimate proportions of psoriasis patients reaching absolute PASI value thresholds using relative PASI improvements.
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Affiliation(s)
| | | | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Reinhard Vonthein
- Universität zu Lübeck, Institut für Medizinische Biometrie und Statistik, Lübeck, Germany
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Lada G, Chinoy H, Heal C, Warren RB, Talbot PS, Kleyn CE. Depression and suicidality in patients with psoriasis and the role of psoriatic arthritis; a cross-sectional study in a tertiary setting. J Acad Consult Liaison Psychiatry 2022; 63:372-383. [PMID: 35017124 DOI: 10.1016/j.jaclp.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Depression is overrepresented in psoriasis. However, it is not clear whether the presence of psoriatic arthritis (PsA) independently increases patients' depressive burden. Furthermore, current evidence regarding suicidality risk of psoriasis populations is conflicting and the role of PsA on suicidality outcomes in psoriasis is unknown. OBJECTIVES (i) To test whether PsA is associated with depression and lifetime suicidal ideation among patients with psoriasis; (ii) to capture different suicidal phenomena in these patients; and (iii) to investigate whether suicidality and depressive symptom severity are associated with clinical markers of psoriasis severity and chronicity. METHODS A cross-sectional survey of tertiary patients (n=219, aged 18-65 years) with dermatologist-confirmed chronic plaque psoriasis, of whom 84 had rheumatologist-confirmed PsA, was undertaken. The Hospital Anxiety and Depression Scale and Sheehan-Suicidality Tracking Scale were used to assess depression and lifetime suicidality respectively. RESULTS PsA presence was associated with depression in patients with psoriasis, independently of other physical comorbidities (adjusted Odds Ratio 2.92, 95% Confidence Interval 1.53-5.68). Furthermore, patients with PsA experienced significantly higher levels of anhedonia and anxiety, after controlling for psychiatric history. 48.8% of all participants reported lifetime suicidal ideation with or without intent; 21.3% reported suicidal planning and 9.4% suicide attempts. Lifetime suicidality prevalence did not differ between patients with and without PsA. Depressive symptom severity and lifetime suicidality scores were not associated with objective measures of psoriasis severity or treatment group. CONCLUSION These data suggest that joint involvement in psoriasis is associated with higher depressive burden. There is a need for routine depression screening among patients with psoriasis, in particular when PsA is present. Anhedonia appears to be a particularly relevant symptom in the depression phenotype of this population. We did not find a statistically significant association between PsA and suicidality. Nevertheless, suicidality rates in tertiary patients with psoriasis appear to be higher than in the general population. Suicidality monitoring is recommended to help in reducing future psychiatric morbidity and mortality in patients with psoriasis.
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Affiliation(s)
- Georgia Lada
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, M6 8HD, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL, UK.
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, M6 8HD, UK
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester UK
| | - C Elise Kleyn
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, M6 8HD, UK
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Armstrong A, Edson-Heredia E, Zhu B, Burge R, Bell S, Crowley JJ, Smith S. Treatment Goals for Psoriasis as Measured by Patient Benefit Index: Results of a National Psoriasis Foundation Survey. Adv Ther 2022; 39:2657-2667. [PMID: 35399114 PMCID: PMC9122869 DOI: 10.1007/s12325-022-02124-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION This cross-sectional survey was conducted with National Psoriasis Foundation (NPF) to capture treatment perspectives and expectations in patients with psoriasis (PsO) using Patient Needs Questionnaire (PNQ) of Patient Benefit Index (PBI). METHODS Adult participants with self-reported diagnosis of PsO responded to the PNQ portion of PBI by indicating how much they valued different treatment attributes. All the treatment goals were captured on a five-point Likert scale (0 = "Not important", 4 = "Very important"). Treatment goals were obtained for overall population and subgroups based on severity of disease Patient Global Assessment (PGA), age, gender, and Dermatology Life Quality Index (DLQI) total score. All data were expressed as mean and standard deviation [SD]. RESULTS A total of 1200 participants completed the survey (mean age 51.5 years). Top treatment goal in the overall population was "to have confidence in the therapy" (3.46 [1.01]). Unique to the higher severity subgroup (PGA ≥ 3), "to find a clear diagnosis and therapy" was a top five goal and "to get better skin quickly" was for those with lesser severity (PGA < 3). "To be free of itching" (3.36 [0.99]) was the unique goal in the < 40 age group whereas it was "to get better skin quickly" (3.27 [1.12]) in the ≥ 40 group. In women and men, "to be free of itching" (3.38 [1.13]) and "to get better skin quickly" (3.20 [1.09]) were top five goals, respectively. Patients with ≥ 10 DLQI scores expressed higher treatment goal "to regain control of the disease" (3.66 [0.67]) compared to those with ≤ 10 DLQI scores who expressed "to have confidence in the therapy" (3.40 [1.11]) as the topmost treatment goal. CONCLUSION Our results suggest that in patients with PsO, treatment preferences can vary with different characteristics such as age, severity, and gender as measured by using PNQ. Further exploration of this data will help inform treatment decisions and optimize patient outcomes.
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Affiliation(s)
- April Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | | | - Baojin Zhu
- Value Evidence Outcomes, Eli Lilly and Company, Indianapolis, USA
| | - Russel Burge
- Value Evidence Outcomes, Eli Lilly and Company, Indianapolis, USA
- University of Cincinnati, Cincinnati, USA
| | - Stacie Bell
- National Psoriasis Foundation, Portland, USA
| | | | - Stacy Smith
- California Dermatology and Clinical Research Institute, Encinitas, USA
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Son SW, Yu DY, Kim Y, Ahn HH, Jang YH, Roh JY, Lee YB, Lee JY, Kim MH, Lee Y, Park GH, Yoon HS, Youn SW. Differences in Clinical Responses to Ustekinumab Treatment among Body Regions: Results from a Real-World Prospective, Observational, and Multi-Center Study in Korea. Ann Dermatol 2022; 34:14-21. [PMID: 35221590 PMCID: PMC8831313 DOI: 10.5021/ad.2022.34.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 11/08/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Sang Wook Son
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Dae Young Yu
- Department of Public Health, Korea University College of Medicine, Seoul, Korea
- Medical Affairs, Janssen Korea, Seoul, Korea
| | | | - Hyo Hyun Ahn
- Department of Dermatology, Korea University Anam Hospital, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ji Yeoun Lee
- Department of Dermatology, Chungbuk National University Hospital, Cheongju, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - YoungJa Lee
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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