Effectiveness of risk minimization measures for the use of cilostazol in United Kingdom, Spain, Sweden, and Germany

Purpose

The purpose of the study is to evaluate the effectiveness of risk minimization measures—labeling changes and communication to health care professionals—recommended by the European Medicines Agency for use of cilostazol for the treatment of intermittent claudication in Europe.

Methods

Observational study of cilostazol in The Health Improvement Network (United Kingdom), EpiChron Cohort (Spain), SIDIAP (Spain), Swedish National Databases, and GePaRD (Germany).

Among new users of cilostazol, we compared the prevalence of conditions targeted by the risk minimization measures in the periods before (2002‐2012) and after (2014) implementation. Conditions evaluated were prevalence of smoking, cardiovascular conditions, concurrent use of ≥2 antiplatelet agents, concurrent use of potent CYP3A4/CYP2C19 inhibitors and high‐dose cilostazol, early monitoring of all users, and continuous monitoring of users at high cardiovascular risk.

Results

We included 22 593 and 1821 new users of cilostazol before and after implementation of risk minimization measures, respectively. After implementation, the frequency of several conditions related to the labeling changes improved in all the study populations: prevalence of use decreased between 13% (EpiChron) and 57% (SIDIAP), frequency of cardiovascular contraindications decreased between 8% (GePaRD) and 84% (EpiChron), and concurrent use of high‐dose cilostazol and potent CYP3A4/CYP2C19 inhibitors decreased between 6% (Sweden) and 100% (EpiChron). The frequency of other conditions improved in most study populations, except smoking, which decreased only in EpiChron (48% reduction).

Conclusions

This study indicates that the risk minimization measures implemented by the EMA for the use of cilostazol have been effective in all European countries studied, except for smoking cessation before initiating cilostazol, which remains an area of improvement.

[Allergic contact dermatitis to cosmetics]

INTRODUCTION

Contact dermatitis to cosmetics is a common problem in the general population, although its prevalence appears to be underestimated. We reviewed cases of allergic contact dermatitis to cosmetics diagnosed in our dermatology department over a 7-year period with a view to identifying the allergens responsible, the frequency of occurrence of these allergens, and the cosmetic products implicated.

METHODS

Using the database of the skin allergy department, we undertook a search of all cases of allergic contact dermatitis to cosmetics diagnosed in our department from January 2000 through October 2007.

RESULTS

In this period, patch tests were carried out on 2,485 patients, of whom 740 were diagnosed with allergic contact dermatitis and the cause was cosmetics in 202 of these patients (170 women and 32 men), who accounted for 27.3 % of all cases. A total of 315 positive results were found for 46 different allergens. Allergens most often responsible for contact dermatitis in a cosmetics user were methylisothiazolinone (19 %), paraphenylenediamine (15.2 %), and fragrance mixtures (7.8 %). Acrylates were the most common allergens in cases of occupational disease. Half of the positive results were obtained with the standard battery of the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC). The cosmetic products most often implicated among cosmetics users were hair dyes (18.5 %), gels/soaps (15.7 %), and moisturizers (12.7 %).

CONCLUSION

Most patients affected were women. Preservatives, paraphenylenediamine, and fragrances were the most frequently detected cosmetic allergens, in line with previous reports in the literature. Finally, in order to detect new cosmetic allergens, cooperation between physicians and cosmetics producers is needed.

[Clinical experience with etanercept in the treatment of psoriasis]

BACKGROUND

Etanercept is one of the new biologic agents available for treating psoriasis. It has proved an effective option in a high percentage of patients, leading to sustained improvements in the psoriasis area severity index (PASI). Likewise, it is effective at controlling psoriatic arthritis, and its safety profile is excellent, with a much lower specific organ toxicity than traditional drugs and few side effects. Many of the data published to date are derived from clinical trials with this medication, but further studies are needed on the use of this therapy to manage patients in daily clinical practice.

METHODS

This was a retrospective observational study of 36 patients with psoriasis who received etanercept between March 2004 and March 2006. We describe the experience of using this agent at our hospital, with the clinical outcomes and the problems we have faced.

RESULTS

The PASI score was assessed before treatment and at 3 and 6 months of patient follow-up. After 3 months of treatment, 13 patients (36.11 %) had achieved a 50 % improvement in PASI score (PASI(50)), and 16 patients (44 %) had achieved a 75 % improvement (PASI(75)). Two of the patients (5.56 %) experienced an improvement in their disease without reaching PASI(50) and only 4 patients (11.11 %) did not show clinical improvement or deteriorated. After 6 months, efficacy improved, with 27 patients (75 %) achieving PASI(75), 6 patients (16.67 %) achieving PASI(50), and 2 patients (5.56 %) showing no benefit from treatment. After 6 months, 13 of the patients (36.1 %) had achieved a 90 % improvement in PASI score. No adverse events of sufficient significance to warrant discontinuation of treatment were reported. At present, 11 of the patients remain on etanercept treatment as efficacy has been sustained and they have not experienced any adverse events of note.

CONCLUSIONS

Our clinical experience with the use of etanercept for treating plaque psoriasis shows a favorable efficacy and safety profile. We propose a standardized procedure for consultations with psoriasis patients involving extensive data collection on each visit and the creation of a national surveillance system for patients under treatment with biologic agents.

[Superficial migratory thrombophlebitis: a clinical and histologic review of 8 cases]

INTRODUCTION

Superficial migratory thrombophlebitis (SMT) or thrombophlebitis migrans is characterized by recurrent episodes of localized thrombosis of the superficial veins in the limbs and trunk. It has been associated with various systemic diseases that should be taken into consideration when assessing the patient.

MATERIAL AND METHODS

Between 1997 and 2007, 8 patients with SMT were seen at Hospital General Universitario de Valencia in Valencia, Spain. We review the clinical features and histopathology, along with the associated diseases.

RESULTS

The most common clinical presentation was with painful nodules mimicking erythema nodosum on the lower extremities. Other sites were on the abdomen and trunk. Only in 1 case was SMT diagnosed clinically. In other cases, the clinical diagnoses were cellulitis, lymphangitis, nodular vasculitis, and panarteritis nodosa. The histologic characteristics were compatible with superficial thrombophlebitis, and orcein staining revealed the internal elastic lamina to be absent in all cases. No evidence of an occult tumor was found in any of the cases. Two cases had a history of Buerger disease and in another the condition presented in association with a fever of unknown origin.

CONCLUSION

The possible association of SMT with systemic diseases, including cancer, makes its diagnosis important. In our case series we did not find evidence of associated disease in the majority of cases. However, since cancer can manifest months and even years after the appearance of SMT, follow-up is necessary in these patients.

[Sensitization to gallates: review of 46 cases]

BACKGROUND

Since 1947, the cosmetics, pharmaceutical, and food industries have used gallates as antioxidants to prevent the oxidation of unsaturated fats in their products. The aim of this study was to review the cases of sensitization to gallates diagnosed in our department between 1985 and 2006.

METHODS

All suspected cases of allergic contact dermatitis with patch tests positive for propyl gallate, octyl gallate, and/or dodecyl gallate were retrieved from the database of the allergy section of our dermatology department.

RESULTS

Forty-six patients had positive patch tests for 1 or more gallates (36 women and 10 men, with a mean age of 42.8 years). The most common presenting complaint was cheilitis (63% of the cases) followed by dermatitis of the hands (28.26%). The most common sensitizing agent was lipstick (54.3%) followed by bakery products (15.2%). The test result was considered clinically relevant in 73.9% of the cases whereas the relevance was unknown in 23.9 %.

CONCLUSIONS

In our case series, most patients sensitized to gallates attended the clinic due to cheilitis. The main allergen was propyl gallate and the most common mechanism of sensitization was use of lipstick. The most common gallate among bakers was octyl gallate. This agent was considered to be clinically relevant in all cases studied.

[Neutrophilic dermatosis of the dorsal hands]

Neutrophilic dermatosis of the dorsal hands is a recently described disorder. It is still debatable if it constitutes a separate entity, a variant of Sweet syndrome or pyoderma gangrenosum or an overlap disorder of both. We report the clinical features, histopathological findings, and evolution of a 35-year-old patient with the diagnosis of neutrophilic dermatosis of the dorsal hands and distant lesions on the forehead.

[Atypical pigmented penile macules]

Two patients with pigmented lesions of the penis are described. The lesions consisted of asymptomatic, multifocal, irregular macules, with variegated pigmentation. The main differential diagnostic problem was with mucocutaneous melanoma. Histologic examination of the lesions showed basal layer hyperpigmentation. No cytologic atypia of melanocytes was detectable. The diagnosis in both cases was melanotic macules. Because of their atypical clinical appearance, genital melanotic macules are often misinterpreted as mucocutaneous melanoma. However histopathologic study solves the problem because genital melanotic macules show no melanocytic proliferation nor melanocytic atypia.

Modulation by chronic nifedipine of plasma atrial natriuretic peptide, cell Na+ transport and plasma volume in rats with renal hypertension

The influence of a 6-week treatment of female Wistar rats with one-kidney, one clip (1-K, 1 C) renal hypertension, with the calcium antagonist nifedipine on plasma volume, red cell Na+ handling and plasma atrial natriuretic peptide immunoreactivity (ANP-IR) was studied. Measurements were performed at 2 and 6 weeks after surgery. In 1-K, 1 C rats plasma volume was increased and red cell Na+ pump activity was reduced only after 2 weeks. Blood pressure, heart weights and plasma ANP were massively increased after both 2 and 6 weeks. 1-K, 1 C-rats treated with nifedipine had normal plasma volume, plasma ANP, and red cell Na+ pump activity in comparison with sham-operated rats. Increases in blood pressure and heart weights were attenuated. It is concluded that 1-K, 1 C hypertension in the rat is associated with cardiomegaly, rise in plasma ANP, initial hypervolemia and depression of the membrane Na+ pump. Nifedipine prevents the occurrence of hypervolemia and secondary phenomena such as rises in plasma ANP and cardiomegaly. This may play an important contributory role in the prevention of pathological sequelae.