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Vincken NLA, Balak DMW, Knulst AC, Welsing PMJ, van Laar JM. Systemic glucocorticoid use and the occurrence of flares in psoriatic arthritis and psoriasis: a systematic review. Rheumatology (Oxford) 2022; 61:4232-4244. [PMID: 35285486 PMCID: PMC9629346 DOI: 10.1093/rheumatology/keac129] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives The use of systemic glucocorticoids (SGCs) is traditionally discouraged in the treatment of PsA and psoriasis due to the risk of psoriatic flares. However, despite this recommendation, SGCs are frequently prescribed for these patients. In this study we reappraise the old paradigm that SGCs are contra-indicated in the treatment of PsA and psoriasis. Methods A systematic search of MEDLINE, EMBASE and the Cochrane Library databases was performed in November 2019 to identify articles on any SGC use compared with no use in the PsA and psoriasis population. Topical glucocorticoid treatment was excluded. Our two primary outcomes focused on the prescribing characteristics and the occurrence of any type of flare. Results Our search yielded 4922 articles, and of these 21 full-text articles were eligible for inclusion. There were 11 retro- and prospective cohorts involving a total of 4,171,307 patients. Of these, 6727 (37.82%) of the patients with PsA and 1 460 793 (35.17%) of the patients with psoriasis were treated with any type of SGC. Ten observational/interventional studies did not report an increased risk or occurrence of psoriatic flares related to SGC use. Conclusion Our results indicate that SGCs are frequently prescribed for PsA and psoriasis patients. The occurrence of psoriatic flares appears to be low upon SGC exposure. In patients with a clear indication for SGCs, e.g. in need of rapid anti-inflammatory therapy or bridging of therapies, the use of SGCs should be considered in view of the low risk of skin flaring. It remains of importance to weigh risks for short- and long-term SGC-related side effects in clinical decision making.
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Affiliation(s)
- Nanette L A Vincken
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepak M W Balak
- Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - André C Knulst
- Department of Dermatology & Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Kharkar V, Rane M. Gratifying results of apremilast in unstable erythrodermic psoriasis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Megna M, Ocampo-Garza SS, Fabbrocini G, Cinelli E, Ruggiero A, Camela E. A case of erythrodermic psoriasis successfully treated with apremilast. Dermatol Ther 2021; 35:e15204. [PMID: 34783133 PMCID: PMC9286543 DOI: 10.1111/dth.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/17/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Sonia Sofìa Ocampo-Garza
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Dermatology Department, Universidad Autónoma de Nuevo León, University Hospital Dr. José Eleuterio González, Monterrey, Mexico
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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4
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Lo Y, Tsai TF. Updates on the Treatment of Erythrodermic Psoriasis. PSORIASIS (AUCKLAND, N.Z.) 2021; 11:59-73. [PMID: 34136373 PMCID: PMC8200157 DOI: 10.2147/ptt.s288345] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022]
Abstract
Erythrodermic psoriasis (EP) is a rare variant of psoriasis, which is potentially life threatening and often resistant to conventional therapy. Biologics have revolutionized the treatment of plaque-type psoriasis, and shown promise in EP. However, due to the lack of head-to-head studies and the rarity of EP, no high level evidence-based treatment guidelines for EP have been established, and the evidence of treatment of EP is limited to case reports or small case series. Here, we present a narrative review focusing on the up-to-date information for the treatment of EP.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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5
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Gioe OA, Savoie C, Grieshaber EB, Hilton DC. Treatment of erythrodermic psoriasis with apremilast. JAAD Case Rep 2021; 11:36-37. [PMID: 33898682 PMCID: PMC8054184 DOI: 10.1016/j.jdcr.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Olivia A Gioe
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana
| | | | - Elizabeth B Grieshaber
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana
| | - Deborah C Hilton
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana
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6
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Shao S, Wang G, Maverakis E, Gudjonsson JE. Targeted Treatment for Erythrodermic Psoriasis: Rationale and Recent Advances. Drugs 2020; 80:525-534. [PMID: 32180204 DOI: 10.1007/s40265-020-01283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Erythrodermic psoriasis (EP) is an extreme and often refractory variant of psoriasis with high morbidity and increased mortality, and is frequently classified as a dermatological emergency. The pathophysiology of EP is largely unknown but is thought to differ from that of plaque psoriasis. Treatment of EP is challenging, and usually based on clinical experience and patient co-morbidities, due to its low incidence and limited clinical evidence. Conventional treatments, such as topical glucocorticoid therapy, cyclosporin, acitretin, and methotrexate have some but limited efficacy in EP, and treatment discontinuation may result in flares. Newer biological drugs, including anti-TNF, anti-IL-17, and anti-IL-12/23 agents, have shown promise in therapeutic management of EP, but most of the available evidence is currently based on small case series and reports. Few studies have compared available treatment options for EP, and further clinical studies are necessary to provide clinical data and optimal treatment guidelines for EP patients. Here, we provide a comprehensive review of the background of EP, assess the available clinical data on the efficacy of targeted therapies, and aim to provide a foundation for clinical decision making for this rare form of psoriasis.
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Affiliation(s)
- Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, 710032, China
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, 710032, China
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, 95616, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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7
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Maloney NJ, Zhao J, Tegtmeyer K, Lee EY, Cheng K. Off-label studies on apremilast in dermatology: a review. J DERMATOL TREAT 2019; 31:131-140. [PMID: 30935262 DOI: 10.1080/09546634.2019.1589641] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: Apremilast is a phosphodiesterase-4 inhibitor FDA approved for psoriatic arthritis and moderate to severe plaque psoriasis. In recent years, multiple studies have suggested other potential uses for apremilast in dermatology. A summary of these various studies will be a valuable aid to dermatologists considering apremilast for an alternative indication.Materials and methods: The PubMed/MEDLINE and ClinicalTrials.gov databases were queried with the term 'apremilast,' with results manually screened to identify published data on off-label uses of apremilast. The article was structured by the quality of evidence available.Results: Apremilast use in dermatology beyond plaque psoriasis and psoriatic arthritis is frequently described in the literature, with a mixture of positive and negative results. Randomized controlled data is available for Behçet's disease, hidradenitis suppurativa, nail/scalp/palmoplantar psoriasis, alopecia areata, and atopic dermatitis.Conclusion: The relatively safe adverse effect profile of apremilast and its broad immunomodulatory characteristics may make it a promising option in the future for patients with difficult to treat diseases in dermatology, refractory to first line therapies, but further studies will be necessary to clarify its role.
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Affiliation(s)
- Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kyle Tegtmeyer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ernest Y Lee
- David Geffen School of Medicine at UCLA, UCLA-Caltech Medical Scientist Training Program, Los Angeles, CA, USA.,Department of Bioengineering, UCLA, Los Angeles, CA, USA
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Krishnamoorthy G, Kotecha A, Pimentel J. Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy. BMJ Case Rep 2019; 12:12/1/e226959. [PMID: 30709830 DOI: 10.1136/bcr-2018-226959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Erythrodermic psoriasis (EP) is the most serious type of psoriasis with high morbidity and mortality. First-line recommended therapies for EP, cyclosporine and infliximab have significant adverse effects. Cyclosporine increases the risk of hypertension, leucopenia, infections and renal failure. Infliximab increases the risk of reactivation of tuberculosis, hepatitis B and histoplasmosis, and increases risk for hepatitis, autoantibody formation, congestive heart failure, demyelinating disorders, pancytopenia, lymphoma and skin cancer. An effective drug with a much safer side effect profile will be of significant benefit in EP. The phosphodiesterase 4 inhibitor apremilast is U.S Food and Drug Administration (FDA) approved for plaque psoriasis and psoriatic arthritis. Adverse effects of apremilast reported are headache, nausea, diarrhoea, upper respiratory tract infection, potential for depression and weight loss. We report complete and long-standing resolution of EP with first-line apremilast monotherapy. Apremilast may be an effective option with comparatively minor side effects for EP.
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Affiliation(s)
| | - Aditya Kotecha
- Pulmonary/Critical Care, Henry Ford Hospital, Detroit, Michigan, USA
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Papadavid E, Kokkalis G, Polyderas G, Theodoropoulos K, Rigopoulos D. Rapid clearance of erythrodermic psoriasis with apremilast. J Dermatol Case Rep 2017; 11:29-31. [PMID: 29367871 DOI: 10.3315/jdcr.2017.1246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/11/2017] [Indexed: 12/20/2022]
Abstract
Background Apremilast is a new immunomodulatory drug, a small molecule inhibitor of PDE4, which down-regulates the expression of multiple pro-inflammatory cytokines, such as tumor necrosis factor alpha, interleukin 17, interleukin 23. Main observations We describe a case of a 54-year-old man with erythroderma in the course of psoriasis (PASI=49), with contraindications to other psoriasis therapies, in whom total clearance of skin lesions was achieved by day 20 after therapy with apremilast at a dose of 30 mg bid (ΔPASI = 100). The patient had a history of prior use of cyclosporine, methotrexate and adalimumab. His comorbidities included obesity, fatty liver and hypercholesterolemia. Conclusion In this case of erythroderma in the course of psoriasis apremilast led to total clearance of all cutaneous lesions.
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Affiliation(s)
- Evangelia Papadavid
- 2nd Deaprtment of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON Hospital, Greece
| | - Georgios Kokkalis
- 2nd Deaprtment of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON Hospital, Greece
| | - Georgios Polyderas
- 2nd Deaprtment of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON Hospital, Greece
| | - Konstantinos Theodoropoulos
- 2nd Deaprtment of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON Hospital, Greece
| | - Dimitrios Rigopoulos
- 2nd Deaprtment of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON Hospital, Greece
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