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De Simone C, Dapavo P, Malagoli P, Martella A, Campanati A, Campione E, Errichetti E, Franchi C, Gambardella A, Megna M, Osti F, Ribero S, Zagni G, Calzavara‐Pinton P, Fabbrocini G, Amoruso GF, Baglieri F, Biamonte AS, Bianchelli T, Bigi L, Bortoli J, Brunetti B, Buligan C, Cagni E, Calderoni O, Calzavara‐Pinton P, Campanati A, Caputo A, Carrera CG, Carugno A, Chersi K, Cicchelli S, De Natale F, De Simone C, Dapavo P, Di Maria D, Errichetti E, Fabbrocini G, Ferrari AS, Fogli E, Forconi R, Franchi C, Galeazzi A, Gambardella A, Giovannini A, Giura MT, Iuculano M, Lazzaretti G, Leporati C, Magnanini M, Malagoli P, Marconi B, Martella A, Maruccia A, Megna M, Miglietta R, Minuti A, Mocci L, Modica S, Narcisi A, Odorici G, Osti F, Pazzaglia M, Peila R, Pertusi G, Pezza M, Pezzullo E, Puccia N, Raulo U, Ribero S, Rossi M, Rusignuolo S, Sapienza G, Savarese C, Scalisi M, Strippoli D, Stroppiana E, Tiberio R, Trischitta A, Tucci MG, Vaira F, Verrone A, Villa L, Zagni F, Zoccali A. Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach. Int J Dermatol 2022; 61:1543-1551. [PMID: 35609147 PMCID: PMC9790732 DOI: 10.1111/ijd.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. METHODS A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. RESULTS Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. CONCLUSIONS The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.
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Affiliation(s)
- Clara De Simone
- Department of DermatologyCatholic University of the Sacred Heart, Policlinico ‘A. Gemelli’, IRCCSRomeItaly
| | - Paolo Dapavo
- ASO City of Health and ScienceUniversity Dermatological ClinicTorinoItaly
| | | | | | - Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular SciencesPolytechnic Marche UniversityAnconaItaly
| | - Elena Campione
- Dermatologic Unit, Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Enzo Errichetti
- Institute of DermatologyS.Maria della Misericordia University HospitalUdineItaly
| | | | - Alessio Gambardella
- Department of Precision Medicine, Dermatology UnitUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | | | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | | | | | - Gabriella Fabbrocini
- Institute of DermatologyS.Maria della Misericordia University HospitalUdineItaly
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Rigopoulos D, Lazaridou E, Papadavid E, Georgiou S, Chasapi V, Sfaelos K, Cheliotis G, Ioannides D. Sub-population analysis of patients with plaque psoriasis treated with calcipotriol/betamethasone aerosol foam; effectiveness and patient satisfaction, according to baseline disease severity and prior psoriasis treatment experience, in a Greek population. Dermatol Ther 2022; 35:e15484. [PMID: 35373423 DOI: 10.1111/dth.15484] [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: 01/12/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
Fixed combination calcipotriol/betamethasone (Cal/BD) aerosol foam has been shown to be effective in psoriasis treatment in clinical trials, but real-world evidence is currently sparse. The real-world CELSUS study in Greece found that Cal/BD aerosol foam treatment was effective and associated with satisfaction in psoriasis patients. Patients from the CELSUS study (N = 400) were stratified by baseline disease severity according to physician's global assessment (PGA) score (mild vs. moderate vs. severe) and by previous psoriasis treatment (naïve vs. treatment-experienced). Proportions of patients achieving treatment success (clear/almost clear [PGA 0/1]) after 4 weeks' treatment with Cal/BD aerosol foam were reported for each subgroup. Psoriasis area and severity index (PASI) and patient-reported itch, itch-related sleep loss, scaling, dry skin, and erythema numerical rating scores were reported by subgroup. At baseline, 216 (54%) patients were systemic-or-topical psoriasis treatment-naïve and 184 (46%) were treatment experienced. By disease severity, there were 135 versus 89 patients with mild, 69 versus 83 with moderate and 12 versus 12 with severe disease in the treatment-naïve versus treatment-experienced groups, respectively. In the treatment-naïve group, treatment success was achieved by 72.6%, 56.5%, and 66.7% of patients with mild, moderate, and severe disease, respectively, while the proportions in the treatment-experienced group were 60.7%, 42.2%, and 25%, respectively. Reduction from baseline in psoriasis symptoms was observed in all patient groups. The greatest reductions were observed in treatment-naïve patients with severe disease. Clinically relevant benefits were observed with Cal/BD aerosol foam in psoriasis patients, regardless of prior treatment-experience and disease severity at baseline.
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Affiliation(s)
| | - Elisavet Lazaridou
- 2nd Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, ATTIKON University Hospital, Athens, Greece
| | - Sophia Georgiou
- Department of Dermatology, Medical School, General University Hospital, University of Patras, Rio, Greece
| | - Vasiliki Chasapi
- Department of Dermatology and Venereology NHS, Andreas Syggros Hospital, Athens, Greece
| | | | | | - Dimitrios Ioannides
- First Department of Dermatology-Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fabbrocini G, De Simone C, Dapavo P, Malagoli P, Martella A, Calzavara Pinton P. Long-term maintenance treatment of psoriasis: the role of calcipotriol/betamethasone dipropionate aerosol foam in clinical practice. J DERMATOL TREAT 2021; 33:2425-2432. [PMID: 34694953 DOI: 10.1080/09546634.2021.1998310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Most patients with psoriasis present with localized mild-to-moderate disease. In this case, the application of topical treatments in the first-line setting is recommended in most cases.Among different topical options, the fixed-dose combination of betamethasone dipropionate (BD) and vitamin D analogue (Cal) aerosol foam (Enstilar®, Leo Pharma) is approved as first-line topical therapy for the treatment of psoriasis in USA and the EU, due to its high efficacy and its favorable administration scheme.The PSO-LONG was the first trial to report on the long-term efficacy and safety of the Cal/DB foam treatment for the proactive management of psoriasis and now, the indications of Cal/BD foam included its use in the psoriasis maintenance treatment. However, the precise role of this treatment and the potential therapeutic schemes in the long-term management of psoriasis need further clarification.This Position Paper, authored by a group of Italian Expert Dermatologists, critically discusses the long-term management of psoriasis with Cal/BD foam in clinical practice. In particular, the biological rationale in the proactive treatment with Cal/BD foam and current evidence regarding this therapeutic approach are presented, along with its application also in patients with moderate-to-severe disease, difficult-to-treat lesions, or within combination regimens. In addition, strategies to improve adherence to long-term treatment of psoriasis are discussed.
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Affiliation(s)
- G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Policlinico "A. Gemelli", IRCCS, Rome, Italy
| | - P Dapavo
- ASO City of Health and Science, University Dermatological Clinic, Corso Vittorio Emanuele II, 62, Torino, Italy
| | - P Malagoli
- Head Psocare Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato, Milano, Italy
| | - A Martella
- Myskin Dermatology Practice, Tiggiano, Lecce, Italy
| | - P Calzavara Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili, P.le Spedali Civili, 1, Brescia, Italy
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Fabbrocini G, Dauden E, Jalili A, Bewley A. Calcipotriol/betamethasone dipropionate aerosol foam in the treatment of psoriasis: new perspectives for the use of an innovative topical treatment from real-life experience. GIORN ITAL DERMAT V 2020; 155:212-219. [PMID: 32394674 DOI: 10.23736/s0392-0488.20.06492-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The fixed-dose combination of calcipotriol/betamethasone dipropionate (Cal/BD foam) in aerosol foam formulation is approved for the treatment of plaque psoriasis, and showed prompt onset of action, persistent efficacy and safety both in clinical trials and in real-life studies. The use of Cal/BD foam and its future perspectives of use were discussed during the symposium "Go beyond with topical treatment in psoriasis", held at the 2019 World Congress of Dermatology. We herein present the key topics of the symposium, namely the importance of Cal/BD foam in overcoming poor adherence, the possibility of a proactive (long-term) management of psoriasis and its potential role beyond mild psoriasis. Furthermore, proper adherence to treatment is crucial to achieve optimal clinical outcomes. In clinical trials and real-life experiences, Cal/BD foam has proven to have a fast onset of action and a good benefit/risk ratio due to increased efficacy and similar safety profile compared with other Cal/BD formulations. Given its chronic nature, psoriasis requires a long-term management, also due to the presence of underlying 'silent' inflammation that persists beyond resolution of flares. Cal/BD foam appears a favorable treatment for long-term management, and a specific trial is ongoing to investigate this new proactive approach. Lastly, evidence both from clinical studies and real-life experiences supports the use of Cal/BD foam in patients with moderate-to-severe disease, and this approach also showed greater effectiveness over some non-biologic systemic treatments. Therefore, Cal/BD foam may be considered as the new gold standard in topical therapy for patients with plaque psoriasis.
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Affiliation(s)
- Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy -
| | - Esteban Dauden
- Department of Dermatology, de la Princesa University Hospital, Madrid, Spain
| | - Ahmad Jalili
- Dermatology and Skin Care, Bürgenstock Medical Center, Lucerne, Switzerland
| | - Anthony Bewley
- Barts Health NHS Trust, Department of Dermatology, Whipps Cross University Hospital, Leytonstone, UK
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