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Spuls PI. Sex stratification of adverse events should be included in studies about skin disease. J Eur Acad Dermatol Venereol 2024; 38:635-636. [PMID: 38523506 DOI: 10.1111/jdv.19879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Affiliation(s)
- P I Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam, The Netherlands
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2
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Musters AH, van Lookeren FL, van der Gang LF, Middelkamp-Hup MA, Bosma AL, Jessurun NT, Lapeere H, Nguyen AL, Ouwerkerk W, de Schepper S, Gerbens LAA, Spuls PI. Real-world reported adverse events related to systemic immunomodulating therapy in patients with atopic dermatitis: Results from the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry. J Eur Acad Dermatol Venereol 2024; 38:530-542. [PMID: 38031478 DOI: 10.1111/jdv.19643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Evidence on the (long-term) safety of systemic immunomodulating therapies in atopic dermatitis (AD) generated by real-world data is sparse. OBJECTIVES To describe real-world reported adverse drug reactions (AEs) related to systemic immunomodulating therapy in patients with AD and to compare the incidence rates of AEs with the Summaries of Product Characteristics (SmPCs). METHODS We conducted an observational prospective multi-centre cohort study, using the TREAT NL registry. All severe AEs, AEs of special interest and serious AEs in adult and paediatric patients on systemic immunomodulating treatment (ciclosporin, methotrexate, azathioprine, mycophenolic acid, dupilumab, tralokinumab, baricitinib and upadacitinib) were assessed. Incidences rates of all (potentially) drug-related AEs were standardized in patient years and compared to the cumulative incidences in the associated SmPCs. RESULTS We collected 422 patient years of safety data from 266 patients, of whom 129 (48.5%) reported a total of 224 (potentially) drug-related AEs. Compared to dupilumab's SmPC, higher incidence rates were found for four AEs (reported ≥5 times): eosinophilia, blepharitis, dry eyes and head and neck erythema (i.e. dupilumab facial redness). A higher incidence rate of fatigue was found in patients on oral methotrexate in our cohort compared to the SmPC. Two new drug-related AEs (reported ≥5 times) were found in patients on dupilumab, including non-infectious conjunctivitis and meibomian gland dysfunction. CONCLUSIONS Real-world reported AEs captured in AD patient registries can add information on the estimated incidence of AEs and benefit clinical decision aids. Future studies using data derived from the TREAT NL registry combined with data from other registries within the TREAT Registry Taskforce will provide more information on (rare) AEs associated with immunomodulating therapy in AD patients.
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Affiliation(s)
- A H Musters
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - F L van Lookeren
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - L F van der Gang
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - A L Bosma
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - N T Jessurun
- Netherlands' Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - A L Nguyen
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - W Ouwerkerk
- Department of Dermatology, Amsterdam Infection & Immunity Institute, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- National Heart Centre Singapore, Singapore, Singapore
| | - S de Schepper
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - L A A Gerbens
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- Huid Medisch Centrum, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
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3
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Steyn M, Gerbens LAA, Spuls PI, Mashayekhi S, Deleuran M, Barbarot S, Wollenberg A, Ferguson J, Ibbotson S, Flohr C. Phototherapy for atopic dermatitis: A survey of European practice. J Eur Acad Dermatol Venereol 2024; 38:521-529. [PMID: 38011002 DOI: 10.1111/jdv.19638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Phototherapy is used to treat atopic dermatitis (AD). Evidence for its efficacy, impact on quality of life, cost-effectiveness and short- and long-term safety with real-life usage is weak. OBJECTIVES We established a taskforce to examine how phototherapy is currently being used as a treatment for AD across the United Kingdom and Europe to inform our understanding and guide future research into management of patients with AD using UV-based phototherapies. METHODS An anonymous electronic multiple-response survey exploring phototherapy prescribing practices and experience of phototherapy modalities was developed by the study authors and sent to members of phototherapy networks from the United Kingdom and Europe. Responses were received between February and July 2021. RESULTS About 144 respondents from 27 European countries completed the survey. NBUVB was the most widely used [n = 138 (96%)]. Home-based NBUVB was available in 8/27 countries (25/144 respondents, 17%). Oral psoralen-UVA (PUVA) was more widely available than bath PUVA (n = 106, 74% vs. n = 60, 42%) and used mainly in adult patients. 49/144 (34%) of respondents had access to UVA1. Phototherapy would be considered instead of systemic treatment in 96% of adults and 82% of children for NBUVB, versus 40% of adults and 3% of children for PUVA. Starting doses, standard dosing increments, length of treatment courses, lifetime limits for treatments and thresholds for performing annual skin assessments varied between responders. CONCLUSIONS NBUVB was the most widely used phototherapy for AD in adult and paediatric patients, while PUVA and UVA1 were less used. Prescribing practices varied considerably, highlighting the lack of consensus practice in many different aspects of phototherapy for the treatment of AD in children and adults. This indicates that further studies are required to determine optimal phototherapeutic regimens for AD and informs our understanding of parameters that should be included in future high-quality randomized controlled trials (RCT) of phototherapy.
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Affiliation(s)
- M Steyn
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - S Mashayekhi
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - S Barbarot
- Department of Dermatology, CHU Nantes, Nantes Université, UMR 1280 PhAN, INRA, Nantes, France
| | - A Wollenberg
- Department of Dermatology and Allergy, Augsburg University Hospital, Augsburg, Germany
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - J Ferguson
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Ibbotson
- Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland
| | - C 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
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4
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Rossel SVJ, Clabbers JMK, Steijlen PM, van den Akker PC, Spuls PI, Middelkamp Hup MA, van Maarle MC, Vreeburg M, Bolling MC, van Geel M, Gostyński A. Expanding the molecular and clinical spectrum of autosomal recessive congenital ichthyosis caused by pathogenic variants in NIPAL4 and PNPLA1 and evaluation of novel therapeutic interventions. J Eur Acad Dermatol Venereol 2023; 37:e1405-e1409. [PMID: 37458571 DOI: 10.1111/jdv.19340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Affiliation(s)
- S V J Rossel
- Department of Dermatology, Expertise Centre for Genodermatoses, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - J M K Clabbers
- Department of Dermatology, Expertise Centre for Genodermatoses, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Dermatology, Haga Hospital, The Hague, The Netherlands
| | - P M Steijlen
- Department of Dermatology, Expertise Centre for Genodermatoses, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - P C van den Akker
- Department of Genetics, Expertise Centre for Genodermatoses, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, University of Amsterdam, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - M A Middelkamp Hup
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, University of Amsterdam, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - M C van Maarle
- Department of Human Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Vreeburg
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M C Bolling
- Department of Dermatology, Expertise Centre for Genodermatoses, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M van Geel
- Department of Dermatology, Expertise Centre for Genodermatoses, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A Gostyński
- Department of Dermatology, Expertise Centre for Genodermatoses, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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5
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van Huizen AM, Rietbergen NJ, van der Kraaij GE, Ubbink DT, Spuls PI. Effectiveness and patient satisfaction of a Dutch patient decision aid for psoriasis - a pilot study. J DERMATOL TREAT 2023; 34:2186157. [PMID: 36861943 DOI: 10.1080/09546634.2023.2186157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- A M van Huizen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - N J Rietbergen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - G E van der Kraaij
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ph I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
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6
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Jacobson ME, Thomas KS, Apfelbacher CJ, Leshem YA, Williams HC, Gerbens LAA, Spuls PI, Schmitt J, Howells L, Katoh N, Simpson EL. Implementation of the HOME core outcome set for clinical trials of atopic eczema-barriers and opportunities: the HOME IX meeting report. Arch Dermatol Res 2023; 315:2617-2622. [PMID: 37432466 DOI: 10.1007/s00403-023-02647-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023]
Abstract
The Harmonising Outcome Measures for Eczema (HOME) initiative established a core outcome set (COS) for atopic eczema (AE) clinical trials in 2019. This set encompasses four core outcome domains and corresponding measurement instruments: clinical signs (EASI), patient-reported symptoms (POEM and NRS 11 point for worst itch over the last 24 h), quality of life (DLQI/CDLQI/IDQoLI), and long-term control (Recap or ADCT). Following its roadmap, the HOME initiative is now focused on supporting implementation of the COS. To identify barriers and facilitators to implementation of the COS, and to guide the effort to promote COS uptake, a virtual consensus meeting was held over 2 days (September 25-26, 2021) attended by 55 participants (26 healthcare professionals, 16 methodologists, 5 patients, 4 industry representatives, and 4 students). Implementation themes were identified by a pre-meeting survey distributed to HOME members, presentations, and whole-group discussion. Participants were divided into five multi-professional small groups which ranked their top 3 most important themes, followed by whole-group discussion and anonymous consensus voting (consensus criteria: < 30% disagreement). Three most important implementation themes were identified and agreed upon: (1) awareness and stakeholder engagement, (2) universal applicability of the COS, and (3) ensuring minimum administrative burden. Working groups to address these issues are now a priority for the HOME initiative. The results from this meeting will inform the development of a HOME Implementation Roadmap in an effort to support other COS groups planning for effective implementation of their core sets.
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Affiliation(s)
- M E Jacobson
- Department of Dermatology, Oregon Health and Science University, 3303 S. Bond Avenue, Portland, Oregon, 97239, USA
| | - K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - C J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Ottovon Guericke University Magdeburg, Magdeburg, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Y A Leshem
- Division of Dermatology, Rabin Medical Center, Petach-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - L A A Gerbens
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - J Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - L Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - N Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - E L Simpson
- Department of Dermatology, Oregon Health and Science University, 3303 S. Bond Avenue, Portland, Oregon, 97239, USA.
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7
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Bosma AL, Ascott A, Iskandar R, Farquhar K, Matthewman J, Langendam MW, Mulick A, Abuabara K, Williams HC, Spuls PI, Langan SM, Middelkamp-Hup MA. Classifying atopic dermatitis: a systematic review of phenotypes and associated characteristics. J Eur Acad Dermatol Venereol 2022; 36:807-819. [PMID: 35170821 PMCID: PMC9307020 DOI: 10.1111/jdv.18008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported phenotypes of atopic dermatitis and any characteristics associated with them. Ovid EMBASE, Ovid MEDLINE and Web of Science were searched from inception till the 12th of February 2021 for studies attempting to classify atopic dermatitis. Primary outcomes are atopic dermatitis phenotypes and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. In total, 8,511 records were found. By focusing only on certain clinical phenotypes, 186 studies were eligible for inclusion. The majority of studies were hospital-based (59%, 109/186) and cross-sectional (76%, 141/186). The number of included patients ranged from seven to 526,808. Data-driven approaches to identify phenotypes were only used in a minority of studies (7%, 13/186). Ninety-one studies (49%) investigated a phenotype based on disease severity. A phenotype based on disease trajectory, morphology and eczema herpeticum was investigated in 56 (30%), 22 (12%) and 11 (6%) studies, respectively. Thirty-six studies (19%) investigated morphological characteristics in other phenotypes. Investigated associated characteristics differed between studies. In conclusion, we present an overview of phenotype definitions used in literature for severity, trajectory, morphology and eczema herpeticum, including associated characteristics. There is a lack of uniform and consistent use of atopic dermatitis phenotypes across studies.
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Affiliation(s)
- A L Bosma
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - A Ascott
- Department of Dermatology, University Hospitals Sussex NHS Foundation Trust, Worthing, United Kingdom
| | - R Iskandar
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - J Matthewman
- Department of Non-communicable disease epidemiology, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M W Langendam
- Department of Epidemiology and Data Science, UMC, location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A Mulick
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, United States
| | - H C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, United Kingdom
| | - P I Spuls
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - S M Langan
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands.,Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M A Middelkamp-Hup
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
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8
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Broderick C, Christian N, Apfelbacher C, Bosma AL, Dand N, Ghosh S, Hangel N, Hübenthal M, Middelkamp-Hup MA, Min JL, Musters AH, Paternoster L, Rodríguez E, Satagopam V, Scordis P, Spuls PI, Szymczak S, Weidinger S, Smith CH, Flohr C. The BIOMarkers in Atopic Dermatitis and Psoriasis (BIOMAP) glossary: developing a lingua franca to facilitate data harmonization and cross-cohort analyses. Br J Dermatol 2021; 185:1066-1069. [PMID: 34137018 DOI: 10.1111/bjd.20587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Broderick
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - N Christian
- ITTM S.A., Information Technology for Translational Medicine, Esch-sur-Alzette, Luxembourg
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - A L Bosma
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Ghosh
- Bioinformatics Core, Luxembourg Centre For Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg
| | - N Hangel
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
| | - M Hübenthal
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J L Min
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A H Musters
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L Paternoster
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Rodríguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - V Satagopam
- Bioinformatics Core, Luxembourg Centre For Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg
| | - P Scordis
- UCB Pharma (UCB Celltech Ltd), Slough, SL1 3WE, UK
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S Szymczak
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - C Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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9
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Langbroek GB, Wolkerstorfer A, Horbach SER, Spuls PI, Kelly KM, Robertson SJ, van Raath MI, Al-Niaimi F, Kono T, Boixeda P, Laubach HJ, Badawi AM, Troilius Rubin A, Haedersdal M, Manuskiatti W, van der Horst CMAM, Ubbink DT. Development of a core outcome domain set for clinical research on capillary malformations (the COSCAM project). J Eur Acad Dermatol Venereol 2021; 35:1888-1895. [PMID: 34014582 PMCID: PMC8453952 DOI: 10.1111/jdv.17376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023]
Abstract
Background Due to a large variety in treatment outcomes reported in therapeutic trials and lacking patient‐relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage. Methods The COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS‐COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM‐founding group. In stage two, we will present the subdomains in a three‐round e‐Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS. Results A total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM‐founding group. Seven were excluded because of overlap. Conclusion The final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.
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Affiliation(s)
- G B Langbroek
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - S J Robertson
- Department of Dermatology and Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - M I van Raath
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - F Al-Niaimi
- Private Dermatological Practice, London, UK.,Department of Dermatology, University of Aalborg, Aalborg, Denmark
| | - T Kono
- Department of Plastic Surgery, Tokai University School of Medicine, Shimokasuya Isehara Kanagawa, Kanagawa, Japan
| | - P Boixeda
- Department of Dermatology, Hospital Ramon y Cajal, Madrid, Spain
| | - H J Laubach
- Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - A M Badawi
- Department of Dermatology, Szeged University, Szeged, Hungary.,Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - A Troilius Rubin
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - W Manuskiatti
- Department of Dermatology, Siriraj Skin Laser Center Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - C M A M van der Horst
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Bosma AL, Gerbens LAA, Middelkamp-Hup MA, Spuls PI. Paternal and maternal use of dupilumab in patients with atopic dermatitis: a case series. Clin Exp Dermatol 2021; 46:1089-1092. [PMID: 33969522 PMCID: PMC8362034 DOI: 10.1111/ced.14725] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
Dupilumab is a relatively new treatment option for patients with moderate to severe atopic dermatitis. There is a lack of knowledge about the effects of treatment with dupilumab during conception for both men and women, as well as during pregnancy and lactation in women. We report four patients (two men, two women) who expressed a wish to conceive during treatment with dupilumab in daily practice. Both men conceived during dupilumab treatment, while the two women discontinued dupilumab because of anticipated pregnancy. Apart from disease flares in both of the patients who discontinued treatment, no complications were reported concerning the ability to conceive, the course of the pregnancy or the fetal outcome. We present an overview of the current available literature on dupilumab during conception, pregnancy and lactation, which can guide considerations for patients on dupilumab wishing to conceive a child. Until more data are available, preference should be given to treatment with topical corticosteroids, phototherapy, systemic corticosteroids and ciclosporin.
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Affiliation(s)
- A L Bosma
- Department of Dermatology, Amsterdam University Medical Centers (Amsterdam UMC), location Academic Medical Center, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam University Medical Centers (Amsterdam UMC), location Academic Medical Center, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam University Medical Centers (Amsterdam UMC), location Academic Medical Center, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers (Amsterdam UMC), location Academic Medical Center, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
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11
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Fledderus AC, Pasmans SGMA, Wolkerstorfer A, Oei W, Etchevers HC, van Kessel MS, van der Horst CMAM, Spuls PI. Domains and outcomes of the core outcome set of congenital melanocytic naevi for clinical practice and research (the OCOMEN project): part 2. Br J Dermatol 2021; 185:970-977. [PMID: 33959942 PMCID: PMC9290785 DOI: 10.1111/bjd.20437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Congenital melanocytic naevi (CMN) can have a great impact on patients’ lives owing to perceived stigmatization, and the risk of melanoma development and neurological complications. Development of a core outcome set (COS) for care and research in CMN will allow standard reporting of outcomes. This will enable comparison of outcomes, allowing professionals to offer advice about the best management options. In previous research, stakeholders (patients, parents and professionals) reached consensus on the core domains of the COS. To select the appropriate measurement instruments, the domains should be specified by outcomes. Objectives To reach consensus on the specific core outcomes describing the core domains pertaining to clinical care and research in CMN. Methods A list of provisional outcomes (obtained earlier) was critically reviewed by the Outcomes for COngenital MElanocytic Naevi (OCOMEN) research team and by relevant stakeholders through an online questionnaire, to refine this list and provide clear definitions for every outcome. When needed, discussion with individual participants was undertaken over the telephone or by email. During an online consensus meeting, stakeholders discussed the inclusion of potential outcomes. After the meeting, participants voted in two rounds for the inclusion of outcomes. Results Forty‐four stakeholders from 19 countries participated. Nine core outcomes were included in the COS relative to clinical care and 10 core outcomes for research. Conclusions These core outcomes will enable standard reporting in future care and research of CMN. This study facilitates the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is already known about this topic?Congenital melanocytic naevi (CMN) can be associated with psychosocial burden and increased risk of melanoma and/or neurological complications. Outcomes measured for research and care in CMN are heterogeneous, impeding comparison. A core outcome set (COS) may enhance standardized use and reporting, and reduce selective reporting bias. In previous research, relevant stakeholders reached consensus on what domains should be included in the core domain set (CDS).
What does this study add?To select the appropriate measurement instruments for the domains included in the CDS, the domains should be further specified by outcomes. We reached consensus on what outcomes should describe the domains of the CDS of CMN care and research. Through a consensus procedure, including online discussions, online consensus meeting and voting, relevant stakeholders reached consensus on a limited number of core outcomes describing the core domains.
What are the clinical implications of this work?Development of a COS will allow standard reporting of outcomes in future care and research of CMN. This will enable pooling and comparison of outcomes, allowing guideline development of optimal management policy.
Linked Comment: M.V. Heppt et al. Br J Dermatol 2021; 185:881–882. Plain language summary available online
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Affiliation(s)
- A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - H C Etchevers
- Aix Marseille Univ, INSERM, MMG, Faculté de Médecine AMU, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - M S van Kessel
- Patient representative, Naevus International, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
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12
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Lokhorst MM, Horbach SER, Young-Afat DA, Stor MLE, Haverman L, Spuls PI, van der Horst CMAM. Development of a condition-specific patient-reported outcome measure for measuring symptoms and appearance in vascular malformations: the OVAMA questionnaire. Br J Dermatol 2021; 185:797-803. [PMID: 33937977 PMCID: PMC8518089 DOI: 10.1111/bjd.20429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/16/2022]
Abstract
Background The symptoms and appearance of vascular malformations can severely harm a patient’s quality of life. The aim of treatment of vascular malformations generally is to improve condition‐specific symptoms and/or appearance. Therefore, it is highly important to start testing treatment effects in clinical studies from the patient’s perspective. Objectives To develop a patient‐reported outcome measure for measuring symptoms and appearance in patients with vascular malformations. Methods A first draft of the patient‐reported outcome measure was based on the previously internationally developed core outcome set. The qualitative part of this study involved interviews with 14 patients, which led to a second draft. The second draft was field tested cross‐sectionally, after which groups of items were evaluated for adequate internal consistency (Cronbach’s alpha > 0·7) to form composite scores. Construct validity was evaluated by testing 13 predefined hypotheses on known‐group differences. Results The patient interviews ensured adequate content validity and resulted in a general symptom scale with six items, a head and neck symptom scale with eight items, and an appearance scale with nine items. Cronbach’s alpha was adequate for two composite scores: a general symptom score (0·88) and an appearance score (0·85). Ten out of 13 hypotheses on known‐group differences were confirmed, confirming adequate construct validity. Conclusions With the development of the OVAMA questionnaire, outcomes of patients with vascular malformations can now be evaluated from the patient’s perspective. This may help improve the development of evidence‐based treatments and the overall care for patients with vascular malformations. What is already known about this topic?The symptoms and appearance of vascular malformations may severely impact the patient’s physical, mental and social functioning. Condition‐specific symptoms and appearance are the main drivers for treatment of vascular malformations. Symptoms and appearance were determined to be core outcome domains and should be measured in all clinical research on vascular malformations. No instrument exists for measuring patient‐reported symptoms and appearance problems in vascular malformations. Vascular malformation research is hampered by heterogeneity in outcome measures.
What does this study add?With this study, a condition‐specific patient‐reported outcome measure was developed for measuring symptoms and appearance in patients with vascular malformations: the OVAMA questionnaire. This study confirms adequate content and construct validity.
What are the clinical implications of this work?The problems that matter most to patients with vascular malformations can now be evaluated from the patient’s perspective. Treatments can be evaluated and compared for effects on these core outcome domains. This study is a big step in tackling current heterogeneity in outcome measures. Clinically distinct groups can be determined based on disease severity. The many applications of the OVAMA questionnaire may significantly improve research and, ultimately, the care for patients with vascular malformations.
Linked Comment: J. Tan. Br J Dermatol 2021; 185:695–696.
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Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - D A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - M L E Stor
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - L Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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13
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Ring J, Worm M, Wollenberg A, Thyssen JP, Jakob T, Klimek L, Bangert C, Barbarot S, Bieber T, de Bruin-Weller MS, Chernyshov PV, Christen-Zaech S, Cork M, Darsow U, Flohr C, Fölster-Holst R, Gelmetti C, Gieler U, Gutermuth J, Heratizadeh A, Hijnen DJ, von Kobyletzki LB, Kunz B, Paul C, De Raeve L, Seneschal J, Simon D, Spuls PI, Stalder JF, Svensson A, Szalai Z, Taieb A, Torrelo A, Trzeciak M, Vestergaard C, Werfel T, Weidinger S, Deleuran M. Risk of severe allergic reactions to COVID-19 vaccines among patients with allergic skin diseases - practical recommendations. A position statement of ETFAD with external experts. J Eur Acad Dermatol Venereol 2021; 35:e362-e365. [PMID: 33752263 PMCID: PMC8250791 DOI: 10.1111/jdv.17237] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Affiliation(s)
- J Ring
- Department Dermatology Allergy Biederstein, Technical University Munich, Munich, Germany
| | - M Worm
- Divison Allergy and Immunology, Department of Dermatology and Allergology, Charité University Hospital, Berlin, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - T Jakob
- Department of Dermatology, University Hospital Giessen-Marburg, Marburg, Germany
| | - L Klimek
- Allergy Center Wiesbaden, Wiesbaden, Germany
| | - C Bangert
- Department of Dermatology University, Vienna, Austria
| | - S Barbarot
- Department of Dermatology, Nantes Université, CHU Nantes UMR 1280 PhAN, INRAE, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - M S de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Cork
- Sheffield Dermatology Research. Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - U Darsow
- Department Dermatology Allergy Biederstein, Technical University Munich, Munich, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - R Fölster-Holst
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Venereology and Allergology, Kiel, Germany
| | - C Gelmetti
- Unit of Pediatric Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - U Gieler
- Department of Dermatology, University Hospital Giessen-Marburg, Marburg, Germany
| | - J Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - A Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - D J Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - L B von Kobyletzki
- Faculty of Medicine, University Healthcare Research Center, Lund University, Lund, Sweden.,Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - B Kunz
- Dermatologikum Hamburg, Hamburg, Germany
| | - C Paul
- Department of Dermatology, Toulouse University, Toulouse, France
| | - L De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - J Seneschal
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - P I Spuls
- Department of Dermatology. Amsterdam Public Health/Infection and Immunology, Location AMC, Amsterdam, The Netherlands
| | - J F Stalder
- Department of Dermatology, Nantes Université, CHU Nantes UMR 1280 PhAN, INRAE, Nantes, France
| | - A Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Z Szalai
- Department of Dermatology of Heim, Pál National Children's Institute Budapest, Budapest, Hungary
| | - A Taieb
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology Medical, University of Gdansk, Gdansk, Poland
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Venereology and Allergology, Kiel, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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14
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Thyssen JP, Vestergaard C, Barbarot S, de Bruin-Weller MS, Bieber T, Taieb A, Seneschal J, Cork MJ, Paul C, Flohr C, Weidinger S, Trzeciak M, Werfel T, Heratizadeh A, Darsow U, Simon D, Torrelo A, Chernyshov PV, Stalder JF, Gelmetti C, Szalai Z, Svensson Å, von Kobyletzki LB, De Raeve L, Fölster-Holst R, Christen-Zaech S, Hijnen DJ, Gieler U, Gutermuth J, Bangert C, Spuls PI, Kunz B, Ring J, Wollenberg A, Deleuran M. European Task Force on Atopic Dermatitis: position on vaccination of adult patients with atopic dermatitis against COVID-19 (SARS-CoV-2) being treated with systemic medication and biologics. J Eur Acad Dermatol Venereol 2021; 35:e308-e311. [PMID: 33587756 PMCID: PMC8014632 DOI: 10.1111/jdv.17167] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - S Barbarot
- Department of Dermatology, Nantes Université, CHU Nantes, UMR 1280 PhAN, INRAE, Nantes, France
| | - M S de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - A Taieb
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - J Seneschal
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - M J Cork
- Sheffield Dermatology Research. Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - C Paul
- Department of Dermatology, Toulouse University, Toulouse, France
| | - C Flohr
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - U Darsow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain
| | - P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - J-F Stalder
- Department of Dermatology, CHU, Nantes, France
| | - C Gelmetti
- Department of Pathophysiology and Transplantation, University of Milan, Head, Unit of Pediatric Dermatology, Milan, Italy
| | - Z Szalai
- Department of Dermatology of Heim, Pál National Children's Institute Budapest, Budapest, Hungary
| | - Å Svensson
- Department of Dermatology, Skane University hospital, Malmö, Sweden
| | - L B von Kobyletzki
- University Healthcare Research Center, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - L De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - R Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University clinics of Schleswig-Holstein, Kiel, Germany
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - D J Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - U Gieler
- Department of Dermatology and Allergology, University of Giessen, Giessen, Germany
| | - J Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - C Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P I Spuls
- Department of Dermatology. Amsterdam Public Health/Infection and Immunology, Location AMC, Amsterdam, The Netherlands
| | - B Kunz
- Dermatologikum Hamburg, Hamburg, Germany
| | - J Ring
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Department of Dermatology I, München Klinik Thalkirchner Strasse, Munich, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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15
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Oei W, Fledderus AC, Spuls PI, Eggen CAM, Kottner J, van der Horst CMAM, Wolkerstorfer A, van Kessel MS, Krengel S, Etchevers HC, Korfage IJ, Pasmans SGM. Development of an international core domain set for medium, large and giant congenital melanocytic naevi as a first step towards a core outcome set for clinical practice and research. Br J Dermatol 2021; 185:371-379. [PMID: 33237568 DOI: 10.1111/bjd.19694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medium, large and giant congenital melanocytic naevi (CMN) can impose a psychosocial burden on patients and families, and are associated with increased risk of developing melanoma or neurological symptoms. Lack of consensus on what outcomes to measure makes it difficult to advise patients and families about treatment and to set up best practice for CMN. OBJECTIVES Fostering consensus among patient representatives and professionals, we aim to develop a core outcome set, defined as the minimum set of outcomes to measure and report in care and all clinical trials of a specific health condition. We focused on the 'what to measure' aspect, the so-called core domain set (CDS), following the COMET and CS-COUSIN guidelines. METHODS We conducted a systematic review to identify outcomes reported in the literature. Focus groups with patient representatives identified patient-reported outcomes. All these outcomes were classified into domains. Through e-Delphi surveys, 144 stakeholders from 27 countries iteratively rated the importance of domains and outcomes. An online consensus meeting attended by seven patient representatives and seven professionals finalized the CDS. RESULTS We reached consensus on six domains, four of which were applied to both care and research: 'quality of life', 'neoplasms', 'nervous system' and 'anatomy of skin'. 'Adverse events' was specific to care and 'pathology' to research. CONCLUSIONS We have developed a CDS for medium-to-giant CMN. Its application in reporting care and research of CMN will facilitate treatment comparisons. The next step will be to reach consensus on the specific outcomes for each of the domains and what instruments should be used to measure these domains and outcomes.
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Affiliation(s)
- W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - C A M Eggen
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J Kottner
- Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - M S van Kessel
- President Naevus Global, Naevus International Patient Representative Working Group Leader, Utrecht, the Netherlands
| | - S Krengel
- Dermatological Group Practice, Lindenplatz 6, Lübeck, 23554, Germany
| | - H C Etchevers
- Aix Marseille University, INSERM, MMG, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13005, France
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - S G M Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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16
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Thomas KS, Apfelbacher CA, Chalmers JR, Simpson E, Spuls PI, Gerbens LAA, Williams HC, Schmitt J, Gabes M, Howells L, Stuart BL, Grinich E, Pawlitschek T, Burton T, Howie L, Gadkari A, Eckert L, Ebata T, Boers M, Saeki H, Nakahara T, Katoh N. Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol 2021; 185:139-146. [PMID: 33393074 PMCID: PMC8359383 DOI: 10.1111/bjd.19751] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 12/18/2022]
Abstract
Background The Harmonising Outcome Measures for Eczema (HOME) initiative has established a core outcome set of domains for atopic eczema (AE) clinical trials. Previous consensus meetings have agreed on preferred instruments for clinician‐reported signs (Eczema Area and Severity Index, EASI) and patient‐reported symptoms (Patient‐Oriented Eczema Measure, POEM). This paper reports consensus decisions from the HOME VII meeting. Objectives To complete the core outcome set for AE by agreeing on core outcome instruments for the domains of quality of life (QoL), long‐term control and itch intensity. Methods A face‐to‐face consensus meeting was held in Tokyo, Japan (8–10 April 2019) including 75 participants (49 healthcare professionals/methodologists, 14 patients, 12 industry representatives) from 16 countries. Consensus decisions were made by presentations of evidence, followed by whole and small group discussions and anonymous voting using predefined consensus rules. Results It was agreed by consensus that QoL should be measured using the Dermatology Life Quality Index (DLQI) for adults, the Children’s Dermatology Life Quality Index (CDLQI) for children and the Infant’s Dermatology Quality of Life Index (IDQoL) for infants. For long‐term control, the Recap of Atopic Eczema (RECAP) instrument or the Atopic Dermatitis Control Test (ADCT) should be used. Consensus was not reached over the frequency of data collection for long‐term control. The peak itch numerical rating scale (NRS)‐11 past 24 h was recommended as an additional instrument for the symptom domain in trials of older children and adults. Agreement was reached that all core outcome instruments should be captured at baseline and at the time of primary outcome assessment as a minimum. Conclusions For now, the core outcome set for clinical trials in AE is complete. The specified domains and instruments should be used in all new clinical trials and systematic reviews of eczema treatments.
What is already known about this topic?
Core outcomes sets improve the design and reporting of clinical trials, reduce selective outcome reporting bias and facilitate meta‐analysis of results in systematic reviews. The HOME core outcome set for eczema recommends the inclusion of four core domains in all atopic eczema trials: clinician‐reported signs, patient‐reported symptoms, health‐related quality of life (HrQoL) and long‐term control. Clinician‐reported signs should be captured using the Eczema Area and Severity Index (EASI) and patient‐reported symptoms using the Patient‐Oriented Eczema Measure (POEM).
What does this study add?
The HOME core outcome set is now complete and recommended core outcome instruments have been agreed on for all four domains. Core outcome instruments for HrQoL: Dermatology Life Quality Index (DLQI) for adults, Children’s Dermatology Life Quality Index (CDLQI) for children and Infant’s Dermatology Quality of Life Index (IDQoL) for infants. Core outcome instruments for long‐term control: either the Recap of Atopic Eczema (RECAP) or the Atopic Dermatitis Control Test (ADCT). In addition, itch intensity should be measured using the peak NRS‐11 past 24 h for trials including older children and adults.
What are the clinical implications of this work?
If all future trials of eczema treatments include the HOME core outcome instruments, then trial results will be more readily incorporated into meta‐analyses in systematic reviews and clinical care will be informed by the best available evidence.
Linked Comment: D.F. Murrell and C.F. Paul. Br J Dermatol 2021; 185:13–14.
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Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, Nottingham, UK
| | - C A Apfelbacher
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - J R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, Nottingham, UK
| | - E Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C Williams
- Centre of Evidence Based Dermatology, School of Medicine, Nottingham, UK
| | - J Schmitt
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - M Gabes
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - L Howells
- Centre of Evidence Based Dermatology, School of Medicine, Nottingham, UK
| | - B L Stuart
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - E Grinich
- School of Medicine (Department of Dermatology), Oregon Health & Science University, Portland, OR, USA
| | - T Pawlitschek
- School of Medicine (Department of Dermatology), Oregon Health & Science University, Portland, OR, USA
| | - T Burton
- Patient representative (independent), Nottingham, UK
| | - L Howie
- Global Parents for Eczema Research, Brisbane, Australia
| | - A Gadkari
- Health Economics and Outcomes Research, Boehringer Ingelheim Inc., Ingelheim, Rheinland-Pfalz, Germany
| | - L Eckert
- Global Dupixent Business Partner, sanofi GHEVA, 1 av. Pierre Brossolette, Chilly-Mazarin, 91380, France
| | - T Ebata
- Chitofuna Dermatology Clinic, Tokyo, Japan
| | - M Boers
- Department of Epidemiology and Data Science, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - H Saeki
- Department of Dermatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - T Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - N Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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van der Kraaij GE, van Huizen AM, Baerveldt EM, Boshuizen M, Determann D, van Ee I, Hageman M, de Kort W, Tafuni G, Smeets PMG, Spuls PI. Online decision aid for patients with psoriasis. Br J Dermatol 2020; 184:981-983. [PMID: 33369728 PMCID: PMC8248141 DOI: 10.1111/bjd.19761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- G E van der Kraaij
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - A M van Huizen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - E M Baerveldt
- Bravis hospital, Department of Dermatology, Bergen op Zoom, the Netherlands
| | - M Boshuizen
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - D Determann
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - M Hageman
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - W de Kort
- Amphia hospital, Department of Dermatology, Breda, the Netherlands
| | - G Tafuni
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - P M G Smeets
- University Medical Center Utrecht, Department of Dermatology, Utrecht, the Netherlands
| | - Ph I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
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18
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Lokhorst MM, Horbach SER, Waner M, O TM, van der Vleuten CJM, Spuls PI, van der Horst CMAM. Responsiveness of quality of life measures in children with peripheral vascular malformations: The OVAMA project. JPRAS Open 2020; 27:70-79. [PMID: 33364290 PMCID: PMC7753079 DOI: 10.1016/j.jpra.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
Background The OVAMA (Outcome Measures for VAscular MAlformations) project determined quality of life (QoL) as a core outcome domain for evaluating treatment effect in vascular malformations. To correctly evaluate treatment effect on QoL, patient-reported outcome measures (PROMs) are needed that are responsive to changes. In children with vascular malformations, we explored if two widely used PROMs were responsive to changes: the Pediatric Quality of Life Inventory (PedsQL) and the Children's Dermatology Life Quality Index (CDLQI). Methods In an international multicenter prospective study, conservatively and invasively treated children completed the PedsQL and CDLQI at baseline and after follow-up of 6-8 weeks. At follow-up, change in health was assessed by a global rating of change (GRC) scale. Responsiveness was assessed by testing hypotheses on expected correlation strength between change scores of the PROMs and the GRC scale, and by calculating the area under the receiver operating characteristics curve (AUC). The PROMs were considered responsive if ≥75% of the hypotheses were confirmed or if the AUC was ≥0.7. Results Twenty-nine children were recruited in three centers in the Netherlands and United States, of which 25 completed all baseline and follow-up measurements. For both the PedsQL and CDLQI, less than 75% of the hypotheses were confirmed and the AUC was <0.7. Discussion The results suggest that these PROMs are not sufficiently responsive for evaluating treatment effect in peripheral vascular malformations. Our study emphasizes the need for assessing responsiveness before using a PROM in evaluating treatment effect.
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Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - M Waner
- Vascular Birthmark Institute of New York, Department of Otolaryngology, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York, U.S.A
| | - T M O
- Vascular Birthmark Institute of New York, Department of Otolaryngology, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York, U.S.A
| | - C J M van der Vleuten
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
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19
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Thomas KS, Apfelbacher CA, Chalmers JR, Simpson E, Spuls PI, Gerbens LAA, Williams HC, Schmitt J, Gabes M, Howells L, Stuart BL, Grinich E, Pawlitschek T, Burton T, Howie L, Gadkari A, Eckert L, Ebata T, Boers M, Saeki H, Nakahara T, Katoh N. Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol 2020:bjd.19673. [PMID: 33179283 DOI: 10.1111/bjd.19673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Harmonising Outcome Measures for Eczema (HOME) initiative has established a core outcome set of domains for atopic eczema clinical trials. Previous consensus meetings have agreed upon preferred instruments for clinician-reported signs (Eczema Area and Severity Index - EASI) and patient-reported symptoms (Patient-Oriented Eczema Measure - POEM). This paper reports consensus decisions from the HOME VII meeting. OBJECTIVE To complete the core outcome set for atopic eczema by agreeing upon core outcome instruments for the domains of quality of life, long-term control and itch intensity. METHODS Face-to-face consensus meeting held in Tokyo, Japan (8th to 10th April, 2019) including 74 participants (47 healthcare professionals/methodologists, 14 patients, 13 industry representatives), from 16 countries. Consensus decisions were made by presentations of evidence, followed by whole and small group discussions and anonymous voting using pre-defined consensus rules. RESULTS It was agreed by consensus that quality of life should be measured using the Dermatology Life Quality Index (DLQI) for adults, the Children's Dermatology Life Quality Index (CDLQI) for children, and the Infant's Dermatology Quality of Life Index (IDQoL) for infants. For long-term control, the Recap of Atopic Eczema (RECAP) instrument or the Atopic Dermatitis Control Test (ADCT) should be used. Consensus was not reached over the frequency of data collection for long-term control. The peak itch numerical rating scale(NRS)-11 past 24 hours was recommended as an additional instrument for the symptom domain in trials of older children and adults. Agreement was reached that all core outcome instruments should be captured at baseline and at the time of primary outcome assessment as a minimum. CONCLUSIONS For now, the core outcome set for clinical trials in atopic eczema is complete. The specified domains and instruments should be used in all new clinical trials and systematic reviews of eczema treatments.
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Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - C A Apfelbacher
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - E Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J Schmitt
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - M Gabes
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - L Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - B L Stuart
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - E Grinich
- School of Medicine, Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - T Pawlitschek
- School of Medicine, Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - T Burton
- Patient Representative (independent), Nottingham, United Kingdom
| | - L Howie
- Global Parents for Eczema Research, Brisbane, Australia
| | - A Gadkari
- Health Economics and Outcomes Research, Boehringer Ingelheim Inc, Germany
| | - L Eckert
- Global Dupixent Business Partner, sanofi GHEVA, 1 av. Pierre Brossolette, 91 380, Chilly Mazatin, France
| | - T Ebata
- Chitofuna Dermatology Clinic, Tokyo, Japan
| | - M Boers
- Department of Epidemiology and data Science; Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - H Saeki
- Department of Dermatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - T Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - N Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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20
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van der Kraaij GE, Vermeulen FM, Smeets PMG, Smets EMA, Spuls PI. The current extent of and need for shared decision making in atopic dermatitis and psoriasis in the Netherlands: an online survey study amongst patients and physicians. J Eur Acad Dermatol Venereol 2020; 34:2574-2583. [PMID: 32163645 PMCID: PMC7818257 DOI: 10.1111/jdv.16340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/14/2020] [Indexed: 12/02/2022]
Abstract
Background In shared decision making (SDM), patients and physicians work together to choose the best treatment option for an individual patient. Atopic dermatitis (AD) and psoriasis are particularly suitable for SDM, considering that the best treatment option depends on a patient’s preferences and values (preference‐sensitive decisions). Currently, it is unknown to what extent SDM is applied in treatment decisions for these diseases in the Netherlands. Objectives Primary, to assess the current extent of SDM in AD and psoriasis in the Netherlands amongst patients and dermatologists. Secondary, to assess the degree to which patients and physicians endorse SDM, to explore which characteristics are related to their preference to be involved in SDM and to identify which barriers and facilitators for SDM they perceive. Methods Two similar online surveys, one for patients with AD or psoriasis and one for (resident) dermatologists, were carried out. The surveys comprised validated questionnaires (shared decision making questionnaire (SDM‐Q; range 0–100), Control Preference Scale) and study‐specific statements mainly regarding barriers and facilitators for SDM. Results The responses of 219 patients and 147 physicians were analysed. Dermatologists experienced significantly more SDM than patients (SDM‐Q 82 vs 55; P < 0.01). Most patients and dermatologists prefer to share treatment decisions. Mainly facilitators for SDM were perceived, including the positive perception of patients and dermatologists regarding SDM. The perceived barriers included lack of continuity of care by the same physician and lack of time. Conclusion Despite the dermatologists’ optimistic perspective, patients experience a limited extent of SDM and physicians should be aware of this gap. Improvement of SDM in AD and psoriasis is needed. The positive attitude of patients and dermatologists towards the process and outcome of SDM is important facilitators, while barriers were mainly perceived on an organizational level.
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Affiliation(s)
- G E van der Kraaij
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F M Vermeulen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P M G Smeets
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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21
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Mahil SK, Yiu ZZN, Mason KJ, Dand N, Coker B, Wall D, Fletcher G, Bosma A, Capon F, Iversen L, Langan SM, Di Meglio P, Musters AH, Prieto-Merino D, Tsakok T, Warren RB, Flohr C, Spuls PI, Griffiths CEM, Barker J, Irvine AD, Smith CH. Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic. Br J Dermatol 2020; 183:404-406. [PMID: 32348554 PMCID: PMC7267275 DOI: 10.1111/bjd.19161] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - K J Mason
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - N Dand
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - B Coker
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Wall
- Hair Restoration Blackrock, Dublin, Ireland.,National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - G Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - A Bosma
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F Capon
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark
| | - S M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P Di Meglio
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - A H Musters
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D Prieto-Merino
- Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - C Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - A D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Vermeulen FM, Gerbens LAA, Schmitt J, Deleuran M, Irvine AD, Logan K, Ouwerkerk W, Vestergaard C, Flohr C, Spuls PI. The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema. Br J Dermatol 2020; 183:1073-1082. [PMID: 32068893 PMCID: PMC7754420 DOI: 10.1111/bjd.18959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 01/01/2023]
Abstract
Background For many years dermatologists have had access to few therapies for patients with moderate‐to‐severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well‐known safety profiles, lower costs and wider availability. Objectives To provide insight into current prescribing practices of conventional phototherapy and systemic immunomodulatory therapies for adults with chronic AE, and the factors influencing these prescribing practices, before biologics and other novel therapeutics become routine clinical practice. Methods In this exploratory study dermatologists were invited to participate in an online survey via a mailing list of the European Academy of Dermatology and Venereology and national societies. Data were collected on participant characteristics (including clinical practice data), the use of phototherapies and systemic therapies, and factors influencing their use. Results From 30 European countries, 238 out of 361 dermatologists willing to participate (65·9%) completed the survey, with 229 meeting the inclusion criteria. For phototherapy (prescribed by 84·7%), most preferred narrowband ultraviolet B as first line (80·9%) and psoralen plus ultraviolet A as second (21·6%). For systemic therapy (prescribed by 95·2%) ciclosporin (54·1%), oral corticosteroids (32·6%) and methotrexate (30·7%) were used first line. Dermatologists relied mostly on personal experience for prescribing phototherapy and systemic therapy. Azathioprine and mycophenolic acid were prescribed by only 135 (59·0%) and 85 (37·1%) participants in total, mostly due to a lack of personal experience. Conclusions This study provides insight into prescribing practices for conventional phototherapy and systemic therapy in Europe and shows that off‐label therapies are also preferred as first‐line choice of systemic therapy. What is already known about this topic? Varying prescribing practices were found for adult (in the UK) and paediatric (in Northern America and Europe) patients with moderate‐to-severe atopic eczema (AE). Not much is known about the prescription of phototherapy and (off‐label) systemic therapy for adult patients in Europe. Although therapies like dupilumab are promising new treatment modalities, better‐known safety profiles, lower costs and better availability are reasons to improve the evidence profile of conventional systemic therapies like ciclosporin.
What does this study add? Prescribing practices of European dermatologists treating adult patients with moderate‐to-severe AE show diversity. Most dermatologists prefer narrowband ultraviolet B as first‐line phototherapy, followed by psoralen plus ultraviolet A as second line. Next to ciclosporin, which is most commonly prescribed, (off‐label) methotrexate and oral corticosteroids are also frequently used as first‐line systemic agents in chronic AE. Lack of personal experience with azathioprine and mycophenolic acid was the most important reason against their prescription.
What are the clinical implications of the work? The results from this study might help to improve the experience with, and prescribing of, all available conventional phototherapies and (off‐label) systemic therapies. Guidelines developers might use these results to develop and implement treatment algorithms.
Linked Comment:Bruin‐Weller. Br J Dermatol 2020; 183:987–988. Plain language summary available online
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Affiliation(s)
- F M Vermeulen
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - J Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,University Allergy Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - K Logan
- The Paediatric Allergy Research Group, the Department of Women and Children's Health, King's College London, London, UK
| | - W Ouwerkerk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.,National Heart Centre Singapore, Singapore
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - C Flohr
- National Heart Centre Singapore, Singapore
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
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Roekevisch E, Szegedi K, Hack DP, Schram ME, Res PCJM, Bos JD, Leeflang MMG, Luiten RM, Kezic S, Spuls PI, Middelkamp-Hup MA. Effect of immunosuppressive treatment on biomarkers in adult atopic dermatitis patients. J Eur Acad Dermatol Venereol 2020; 34:1545-1554. [PMID: 31855303 PMCID: PMC7496710 DOI: 10.1111/jdv.16164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Biomarkers to objectively measure disease severity and predict therapeutic responses are needed in atopic dermatitis (AD). OBJECTIVE Primary aim: To identify biomarkers reflecting therapeutic response in patients with AD treated systemically. Secondary aims: (i) To identify a biomarker pattern predicting responsiveness to systemic treatment. (ii) To identify differences in expression of biomarker in filaggrin gene (FLG) mutation carriers vs. non-FLG mutations carriers. METHODS Thirty-eight severe AD patients treated with methotrexate or azathioprine participated. Serum levels of a proliferation-inducing ligand, B-cell activating factor of the TNF family, thymus and activation-regulated chemokine (chemokine (C-C motif) ligand 17) (TARC (CCl-17)), interleukin-1 receptor antagonist (IL-1RA), interleukin-1 bèta, IL-4, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-18, IL-31, interferon gamma, tumour necrosis factor alpha, vascular endothelial growth factor (VEGF), monokine induced by interferon gamma (chemokine (C-X-C motif) ligand 9), interferon gamma-induced protein 10 (C-X-C motif chemokine Ligand 10), monocyte chemoattractant protein-1 (chemokine (C-C Motif) ligand 2), macrophage inflammatory protein-1 beta (chemokine (C-C motif) ligand 4), regulated on activation, normal T cell expressed and secreted (chemokine (C-C motif) ligand 5), Cutaneous T-cell-attracting chemokine (chemokine (C-C motif) ligand 27) (CTACK (CCL-27)), thymic stromal lymphopoietin, IL-5, interleukin-1 alpha and granulocyte-colony stimulating factor were analysed by ELISA and Luminex. The primary outcomes were differences in mean absolute change of SCORing Atopic Dermatitis (SCORAD) between groups after 12 weeks compared with baseline. Responders to treatment were defined by a SCORAD reduction in ≥50%. Buccal mucosa swabs were collected to determine FLG genotype status. RESULTS Thymus and activation-regulated chemokine, CTACK, IL-13 and VEGF showed a significant decrease after treatment with methotrexate or azathioprine. However, no decrease in individual cytokine levels was significantly correlated with a change in any of the outcome parameters. In addition, baseline biomarker levels were not significantly different between responders and non-responders, and FLG and non-FLG mutants showed similar biomarker profiles. CONCLUSION Thymus and activation-regulated chemokine and CTACK were confirmed as potential biomarkers. VEGF and IL-13 have a potential value as well. Biomarkers could not be used to discriminate at baseline between responders and non-responders, or FLG genotype status.
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Affiliation(s)
- E Roekevisch
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K Szegedi
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D P Hack
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M E Schram
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P C J M Res
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J D Bos
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R M Luiten
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Lokhorst MM, Horbach SER, Waner M, O TM, van der Vleuten CJM, Mokkink LB, van der Horst CMAM, Spuls PI. Responsiveness of quality-of-life measures in patients with peripheral vascular malformations: the OVAMA project. Br J Dermatol 2019; 182:1395-1403. [PMID: 31628861 PMCID: PMC7318211 DOI: 10.1111/bjd.18619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
Background The OVAMA (Outcome Measures for Vascular Malformations) project determined quality of life (QoL) as a core outcome domain for patients with vascular malformations. In order to measure how current therapeutic strategies alter QoL in these patients, a patient‐reported outcome measurement (PROM) responsive to changes in QoL is required. Objectives To assess the responsiveness of two widely used generic QoL PROMs, the Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29, in adult patients with vascular malformations. Methods In an international multicentre prospective study, treated and untreated patients completed the SF‐36 and Skindex‐29 at baseline and after a follow‐up period of 6–8 weeks. Global rating of change (GRC) scales assessing various QoL‐related outcome domains were additionally completed. Per subscale, responsiveness was assessed using two methods: by testing hypotheses on expected correlation strength between change scores of the questionnaires and the GRC scales, and by calculating the area under the receiver operating characteristics curve (AUC). The questionnaires were considered responsive if ≥ 75% of the hypotheses were confirmed or if the AUC was ≥ 0·7. Results Eighty‐nine participants were recruited in three centres in the Netherlands and the U.S.A., of whom 67 completed all baseline and follow‐up questionnaires. For all subscales of the SF‐36 and Skindex‐29, < 75% of the hypotheses were confirmed and the AUC was < 0·7. Conclusions Our findings suggest that the SF‐36 and Skindex‐29 seemed unresponsive to change in QoL. This suggests that alternative PROMs are needed to measure – and ultimately improve – QoL in patients with vascular malformations. What's already known about this topic? Quality of life is often impaired in patients with vascular malformations. Quality of life is considered a core outcome domain for evaluating treatment of vascular malformations. To measure the effect of treatment on quality of life, a patient‐reported outcome measure is required that is responsive to changes in quality of life.
What does this study add? This is the first study assessing the responsiveness of quality‐of‐life measures in patients with vascular malformations. The results seem to indicate that the Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29 are not responsive to changes in quality of life in patients with vascular malformations.
What are the clinical implications of this work? Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29 are not ideal to assess the effect on quality of life over time, of treatment strategies for peripheral vascular malformations.
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Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - M Waner
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, NY, U.S.A
| | - T M O
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, NY, U.S.A
| | - C J M van der Vleuten
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
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de Wijs LEM, Bosma AL, Erler NS, Hollestein LM, Gerbens LAA, Middelkamp-Hup MA, Kunkeler ACM, Nijsten TEC, Spuls PI, Hijnen DJ. Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data. Br J Dermatol 2019; 182:418-426. [PMID: 31145810 DOI: 10.1111/bjd.18179] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dupilumab is the first biologic registered for the treatment of moderate-to-severe atopic dermatitis (AD), and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there are limited daily practice data available for dupilumab, especially when it is combined with systemic immunosuppressants. OBJECTIVES To evaluate dupilumab treatment in daily practice in patients with AD. METHODS In this observational cohort study, we prospectively included all adult patients with AD who had been treated with dupilumab in two university hospitals in the Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician-reported outcome measures and patient-reported outcome measures (PROMs) after ≥ 12 weeks of follow-up were analysed. We used a linear mixed-effects model to determine changes in scores during follow-up. RESULTS Ninety-five patients were included. Of these, 62 patients were using systemic immunosuppressants at baseline; the use of systemic immunosuppressants was continued during dupilumab treatment in 43 patients. From baseline to 16 weeks of treatment, the estimated mean Eczema Area and Severity Index score (0-72) decreased from 18·6 [95% confidence interval (CI) 16·0-21·4)] to 7·3 (95% CI 5·4-10·0), and the estimated mean PROMs showed a decrease of 41-66%. Investigator's Global Assessment 0 or 1 (clear/almost clear) was reached in 38% of the patients. Five patients discontinued dupilumab treatment due to side-effects or ineffectiveness. Eye symptoms and orofacial (nonocular) herpes simplex virus (HSV) reactivation were reported in 62% and 8% of the patients, respectively. CONCLUSIONS Dupilumab treatment in daily practice shows a clinically relevant improvement of physician-reported outcome measures and PROMs, which is in line with efficacy data from clinical trials. Besides frequently reported eye symptoms and orofacial (nonocular) HSV reactivation, there were no apparent safety concerns. What's already known about this topic? Dupilumab has been shown to be an efficacious treatment for atopic dermatitis in several clinical trials. However, it is known that there may be considerable differences in patient characteristics and treatment responses between clinical trials and daily practice. What does this study add? This study presents the first experience with dupilumab treatment in 95 patients with atopic dermatitis in daily practice in two Dutch university hospitals. Less stringent inclusion and exclusion criteria and follow-up schedules, in contrast to those used in clinical trials, might better represent daily practice. Dupilumab treatment shows a clinically relevant improvement of physician- and patient-reported outcome measures; besides patient-reported eye symptoms (in 59 of 95 patients; 62%) and an apparent increase in orofacial (nonocular) herpes simplex virus reactivation (eight of 95 patients; 8%), there were no other safety concerns during follow-up up to 16 weeks of dupilumab treatment.
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Affiliation(s)
- L E M de Wijs
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A L Bosma
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - N S Erler
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A C M Kunkeler
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D J Hijnen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Oei W, Fledderus AC, Korfage I, Eggen CAM, van der Horst CMAM, Spuls PI, Brinkmann SJH, Wolkerstorfer A, van Kessel M, Pasmans S. Protocol for the development of core set of domains of the core outcome set for patients with congenital melanocytic naevi (OCOMEN project). J Eur Acad Dermatol Venereol 2019; 34:267-273. [PMID: 31419337 DOI: 10.1111/jdv.15874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Having large congenital melanocytic naevi (CMN) is associated with a psychosocial burden on patients and their parents because of its remarkable appearance and the extra care it may require. Large CMN also pose an increased risk of malignant melanoma or neurocutaneous melanosis. There is a lack of international consensus on what important outcome domains to measure in relation to treatment. This makes it difficult to compare options, to properly inform patients and their parents, and to set up treatment policy for CMN. Therefore, we aim to develop a core outcome set (COS), i.e. the minimum set of outcomes that are recommended to be measured and reported in all clinical trials of a specific health condition. This COS can be used in the follow-up of CMN patients with or without treatment, in clinical research and practice. METHODS In the Outcomes for Congenital Melanocytic Nevi (OCOMEN) projects, we follow the recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the Cochrane Skin Core Outcomes Set Initiative (CS-COUSIN). This project entails the following: (i) a systematic review to identify the previous reported outcomes in literature; (ii) focus groups with national and international patients and parents to identify patient-important outcomes; (iii) classification of outcomes into outcome domains; (iv) e-Delphi surveys in which stakeholders (patients/parents and professionals) can rate the importance of domains and outcomes; and (v) an online consensus meeting to finalize the core outcome domains of the COS. RESULTS The results will be disseminated by means of publication in a leading journal and presentations in international meetings or conferences. We engage international experts in CMN, both patients and professionals, to ensure the international utility and applicability of the COS.
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Affiliation(s)
- W Oei
- Department of Dermatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - I Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C A M Eggen
- Department of Dermatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - S J H Brinkmann
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M van Kessel
- Leader of Patient Representatives of Naevus International, Utrecht, The Netherlands
| | - S Pasmans
- Department of Dermatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lokhorst MM, Horbach SER, van der Horst CMAM, Spuls PI. Finalizing the international core domain set for peripheral vascular malformations: the OVAMA project. Br J Dermatol 2019; 181:1076-1078. [PMID: 31021456 PMCID: PMC6900166 DOI: 10.1111/bjd.18043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
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Vermeulen FM, Gerbens LAA, Bosma AL, Apfelbacher CJ, Irvine AD, Arents BWM, Barbarot S, Deleuran M, Eichenfield LF, Manca A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Middelkamp-Hup MA, Spuls PI, Flohr C. TREatment of ATopic eczema (TREAT) Registry Taskforce: consensus on how and when to measure the core dataset for atopic eczema treatment research registries. Br J Dermatol 2019; 181:492-504. [PMID: 30719709 PMCID: PMC6771812 DOI: 10.1111/bjd.17715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Background Comparative, real‐life and long‐term evidence on the effectiveness and safety of phototherapy and systemic therapy in moderate‐to‐severe atopic eczema (AE) is limited. Such data must come from well‐designed prospective patient registries. Standardization of data collection is needed for direct comparisons and data pooling. Objectives To reach a consensus on how and when to measure the previously defined domain items of the TREatment of ATopic eczema (TREAT) Registry Taskforce core dataset for research registries for paediatric and adult patients with AE. Methods Proposals for the measurement instruments were based on recommendations of the Harmonising Outcome Measures for Eczema (HOME) initiative, the existing AE database of TREATgermany, systematic reviews of the literature and expert opinions. The proposals were discussed at three face‐to‐face consensus meetings, one teleconference and via e‐mail. The frequency of follow‐up visits was determined by an expert survey. Results A total of 16 experts from seven countries participated in the ‘how to measure’ consensus process and 12 external experts were consulted. A consensus was reached for all domain items on how they should be measured by assigning measurement instruments. A minimum follow‐up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment was defined. Conclusions This core dataset for national AE research registries will aid in the comparability and pooling of data across centres and country borders, and enables international collaboration to assess the long‐term effectiveness and safety of phototherapy and systemic therapy used in patients with AE. What's already known about this topic? Comparable, real‐life and long‐term data on the effectiveness and safety of phototherapy and systemic therapy in patients with atopic eczema (AE) are needed. There is a high diversity of outcomes and instruments used in AE research, which require harmonization to enhance comparability and allow data pooling.
What does this study add? Our taskforce has reached international consensus on how and when to measure core domain items for national AE research registries. This core dataset is now available for use by researchers worldwide and will aid in the collection of unified data.
What are the clinical implications of this work? The data collected through this core dataset will help to gain better insights into the long‐term effectiveness and safety of phototherapy and systemic therapy in AE and will provide important information for clinical practice. Standardization of such data collection at the national level will also allow direct data comparisons and pooling across country borders (e.g. in the analysis of treatment‐related adverse events that require large patient numbers).
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Affiliation(s)
- F M Vermeulen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - L A A Gerbens
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - A L Bosma
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - B W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - A Manca
- Centre for Health Economics, University of York, York, U.K
| | - J Schmitt
- Centre for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.,University Allergy Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M A Middelkamp-Hup
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - P I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
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Gerbens LAA, Apfelbacher CJ, Irvine AD, Barbarot S, de Booij RJ, Boyce AE, Deleuran M, Eichenfield LF, Hof MH, Middelkamp-Hup MA, Roberts A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Williamson PR, Flohr C, Spuls PI. TREatment of ATopic eczema (TREAT) Registry Taskforce: an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema photo- and systemic therapy registries. Br J Dermatol 2018; 180:790-801. [PMID: 29761486 PMCID: PMC7379963 DOI: 10.1111/bjd.16714] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence of immunomodulatory therapies to guide clinical management of atopic eczema (AE) is scarce, despite frequent and often off-label use. Patient registries provide valuable evidence for the effects of treatments under real-world conditions that can inform treatment guidelines, give the opportunity for health economic evaluation and the evaluation of quality of care, as well as pharmacogenetic and dynamic research, which cannot be adequately addressed in clinical trials. OBJECTIVES The TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek international consensus on a core set of domains and items ('what to measure') for AE research registries, using a Delphi approach. METHODS Participants from six stakeholder groups were included: doctors, nurses, nonclinical researchers, patients, industry and regulatory body representatives. The eDelphi comprised three sequential online rounds, requesting participants to rate the importance of each proposed domain item. Participants could add domain items to the proposed list in round 1. A final consensus meeting was held to ratify the core set. RESULTS Participants (n = 479) from 36 countries accessed the eDelphi platform, of whom 86%, 79% and 74% completed rounds 1, 2 and 3, respectively. At the face-to-face consensus meeting attended by 42 participants the final core set was established containing 19 domains with 69 domain items (49 baseline and 20 follow-up items). CONCLUSIONS This core set of domains and items to be captured by national AE systemic therapy registries will standardize data collection and thereby allow direct comparability across registries and facilitate data pooling between countries. Ultimately, it will provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | | | - A E Boyce
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - M H Hof
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - A Roberts
- Contributing patient.,Nottingham Support Group for Carers of Children with Eczema, Nottingham, U.K
| | - J Schmitt
- Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,University Allergy Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - P R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Horbach SER, van de Ven JS, Nieuwkerk PT, Spuls PI, van der Horst CMAM, Reekers JA. Patient-Reported Outcomes of Bleomycin Sclerotherapy for Low-Flow Vascular Malformations and Predictors of Improvement. Cardiovasc Intervent Radiol 2018; 41:1494-1504. [PMID: 29948003 PMCID: PMC6132854 DOI: 10.1007/s00270-018-1999-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/21/2018] [Indexed: 01/28/2023]
Abstract
Purpose There is paucity of data on patient-perceived outcomes of bleomycin sclerotherapy for low-flow vascular malformations. In this study, the long-term outcomes of bleomycin sclerotherapy were investigated in terms of quality of life (QoL) and patient-perceived changes in health. Materials and Methods A cohort of Dutch patients with vascular malformations treated with bleomycin sclerotherapy (June 2010-November 2015) completed a questionnaire evaluating disease symptoms, QoL (Short Form 36), patient-perceived change in health status (Global Rating of Change scales) and treatment satisfaction. QoL was assessed for the patient’s status before and after treatment and was analyzed relative to an age and sex-matched Dutch reference population. Predictive factors associated with QoL and patient-perceived improvement in overall health status were assessed using multivariable linear and logistic regression analyses, respectively. Results Seventy-seven patients, with a median follow-up of 22 months, were enrolled. About half of the respondents (49.3%) indicated that they perceived (any form of) improvement in their overall health status. Most often improved were the specific health aspects ‘pain’ (54.5%) and ‘overall severity of symptoms’ (57.1%). No factors were significantly predictive for patient-perceived improvement in health with respect to the vascular malformation. Impairment in work- or study-related activities prior to sclerotherapy was found to negatively impact physical QoL at follow-up (p = 0.03). Conclusion Approximately half of patients with low-flow vascular malformations indicate an improvement in overall health status following bleomycin sclerotherapy, particularly concerning pain and severity of symptoms. However, most patients only perceived little to moderate improvement to their health and desire further treatment.
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Affiliation(s)
- S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J S van de Ven
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Ph I Spuls
- Department of Dermatology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J A Reekers
- Department of Radiology, Division of Interventional Radiology, Academic Medical Center (AMC), Amsterdam, The Netherlands
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31
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Chalmers JR, Thomas KS, Apfelbacher C, Williams HC, Prinsen CA, Spuls PI, Simpson E, Gerbens LAA, Boers M, Barbarot S, Stalder JF, Abuabara K, Aoki V, Ardeleanu M, Armstrong J, Bang B, Berents TL, Burton T, Butler L, Chubachi T, Cresswell-Melville A, DeLozier A, Eckert L, Eichenfield L, Flohr C, Futamura M, Gadkari A, Gjerde ES, van Halewijn KF, Hawkes C, Howells L, Howie L, Humphreys R, Ishii HA, Kataoka Y, Katayama I, Kouwenhoven W, Langan SM, Leshem YA, Merhand S, Mina-Osorio P, Murota H, Nakahara T, Nunes FP, Nygaard U, Nygårdas M, Ohya Y, Ono E, Rehbinder E, Rogers NK, Romeijn GLE, Schuttelaar MLA, Sears AV, Simpson MA, Singh JA, Srour J, Stuart B, Svensson Å, Talmo G, Talmo H, Teixeira HD, Thyssen JP, Todd G, Torchet F, Volke A, von Kobyletzki L, Weisshaar E, Wollenberg A, Zaniboni M. Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol 2018; 178:e332-e341. [PMID: 29672835 DOI: 10.1111/bjd.16543] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/11/2022]
Abstract
This is the report from the fifth meeting of the Harmonising Outcome Measures for Eczema initiative (HOME V). The meeting was held on 12-14 June 2017 in Nantes, France, with 81 participants. The main aims of the meeting were (i) to achieve consensus over the definition of the core domain of long-term control and how to measure it and (ii) to prioritize future areas of research for the measurement of the core domain of quality of life (QoL) in children. Moderated whole-group and small-group consensus discussions were informed by presentations of qualitative studies, systematic reviews and validation studies. Small-group allocations were performed a priori to ensure that each group included different stakeholders from a variety of geographical regions. Anonymous whole-group voting was carried out using handheld electronic voting pads according to predefined consensus rules. It was agreed by consensus that the long-term control domain should include signs, symptoms, quality of life and a patient global instrument. The group agreed that itch intensity should be measured when assessing long-term control of eczema in addition to the frequency of itch captured by the symptoms domain. There was no recommendation of an instrument for the core outcome domain of quality of life in children, but existing instruments were assessed for face validity and feasibility, and future work that will facilitate the recommendation of an instrument was agreed upon.
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Affiliation(s)
- J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C A Prinsen
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - E Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, U.S.A
| | - L A A Gerbens
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - M Boers
- VU University Medical Center, Amsterdam, the Netherlands
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital (CHU de Nantes), France
| | - J F Stalder
- Department of Dermatology, Nantes University Hospital (CHU de Nantes), France
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Aoki
- University of São Paulo Medical School, São Paulo, Brazil
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | | | - B Bang
- LEO Pharma, Ballerup, Denmark
| | | | | | - L Butler
- National Eczema Association, San Rafael, CA, U.S.A
| | - T Chubachi
- GlaxoSmithKline, Research Triangle Park, NC, U.S.A
| | | | - A DeLozier
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | | | - L Eichenfield
- Rady Children's Hospital, University of California San Francisco, San Diego, CA, U.S.A
| | - C Flohr
- St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | | | - A Gadkari
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | - E S Gjerde
- The Psoriasis and Eczema Association of Norway, Oslo, Norway
| | - K F van Halewijn
- Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - L Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - L Howie
- Global Parents for Eczema Research, Brisbane, Australia
| | | | - H A Ishii
- Brazilian Atopic Dermatitis Association (AADA), São Paulo, Brazil
| | - Y Kataoka
- Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | | | - W Kouwenhoven
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, U.K
| | - Y A Leshem
- Beilinson Hospital and Tel Aviv University, Petah Tikva and Tel Aviv, Israel
| | - S Merhand
- Association Française de l'Eczéma, Redon, France
| | | | - H Murota
- Department of Dermatology, Osaka University, Suita, Japan
| | - T Nakahara
- Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - F P Nunes
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - U Nygaard
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | | | - Y Ohya
- National Centre for Child Health and Development, Tokyo, Japan
| | - E Ono
- Osaka University, Osaka, Japan
| | - E Rehbinder
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - N K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - G L E Romeijn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A V Sears
- St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | | | - J A Singh
- Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, U.S.A
| | - J Srour
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU - München, Munich, Germany
| | - B Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, U.K
| | - Å Svensson
- Department of Dermatology and Venereology, Lund University, Malmö, Sweden
| | - G Talmo
- The Psoriasis and Eczema Association of Norway, Haugesund, Norway
| | - H Talmo
- The Psoriasis and Eczema Association of Norway, Haugesund, Norway
| | | | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - G Todd
- University of Cape Town, Cape Town, South Africa
| | - F Torchet
- Association Française de l'Eczéma, Redon, France
| | - A Volke
- Department of Dermatology, University of Tartu, Tartu, Estonia
| | - L von Kobyletzki
- Department of Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.,CF Wahlgren, Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Department of Dermatology, Venereology and Allergy University Hospital Schleswig-Holstein, Kiel, Germany
| | - E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, Heidelberg, Germany
| | | | - M Zaniboni
- University of São Paulo, Campinas, Brazil
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32
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Gerbens LAA, Hamann SAS, Brouwer MWD, Roekevisch E, Leeflang MMG, Spuls PI. Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial. Br J Dermatol 2018; 178:1288-1296. [PMID: 29237228 DOI: 10.1111/bjd.16240] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Systemic treatment is indicated for moderate-to-severe atopic dermatitis (AD) refractory to topical treatment. Long-term evidence, up to 5 years, of off-label prescribed methotrexate (MTX) and azathioprine (AZA) is lacking. OBJECTIVES To investigate long-term effectiveness, safety and drug survival of MTX and AZA. METHODS In an open-label follow-up phase of a clinical trial, patients were seen every 3 months for 5 years. MTX and AZA doses could be increased or decreased concurrent with daily clinical practice. Primary effectiveness outcomes were mean absolute and relative reduction in SCORing Atopic Dermatitis (SCORAD) index and Investigator's Global Assessment (IGA) after 5 years compared with baseline. To assess safety, the type, frequency, severity and relatedness to treatment of adverse events were investigated. Drug survival was analysed by Kaplan-Meier curves. RESULTS Thirty-five of 43 originally included patients participated, of whom 27 completed the follow-up. At year 5, the mean relative reduction in SCORAD index was similar in the MTX and AZA groups: 53% and 54% using descriptive analysis. Twelve serious adverse events occurred in 5 years; for three there was a possible causal relationship. Drug survival demonstrated a longer survival for MTX, but survival in both groups was low after 5 years (MTXn = 5, AZAn = 1). CONCLUSIONS Based on this relatively small pragmatic study, MTX and AZA seem to be effective and safe as maintenance treatments in moderate-to-severe AD up to 5 years. Few patients in both groups survive on their originally allocated drug although some discontinued because of controlled AD.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - S A S Hamann
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - M W D Brouwer
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - E Roekevisch
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - M M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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33
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Affiliation(s)
- C A C Prinsen
- VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands
| | - P I Spuls
- Academic Medical Center, Department of Dermatology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - C B Terwee
- VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands
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34
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Busard CI, Nolte JYC, Pasch MC, Spuls PI. Reporting of outcomes in randomized controlled trials on nail psoriasis: a systematic review. Br J Dermatol 2018; 178:640-649. [PMID: 28722209 DOI: 10.1111/bjd.15831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Harmonization of outcome measures is needed to increase the value of clinical trials on nail psoriasis. OBJECTIVES To provide the first step in core outcome set (COS) development for nail psoriasis. METHODS A systematic review was performed to identify outcome instruments and corresponding outcome domains used in (ongoing) randomized controlled trials. RESULTS Identified outcome domains included clinical signs, quality of life, symptoms and delivery of care. The Nail Psoriasis Severity Index (NAPSI) was the most commonly used measure to assess clinical signs (74% of studies). Other outcome instruments used included the Nail Area Severity score, composite fingernail score, a Physician's Global Assessment, individual nail features or a combination of these. Heterogeneity in type and reporting (e.g. NAPSI 50, NAPSI 75) of outcome instruments was high and characteristics were often insufficiently reported. In total 43% of studies assessed quality of life, with 3% of studies using a nail psoriasis-specific tool. Assessment of symptoms and delivery of care was limited. CONCLUSIONS Heterogeneity in the type and reporting of nail psoriasis outcome instruments needs to be addressed in the process towards COS development. Sufficient reporting of instrument characteristics should be encouraged. As nail psoriasis is generally assessed secondarily to psoriasis of the skin or joints, collaboration between different research groups in COS development is needed.
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Affiliation(s)
- C I Busard
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - J Y C Nolte
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - M C Pasch
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
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35
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Drucker AM, Eyerich K, de Bruin-Weller MS, Thyssen JP, Spuls PI, Irvine AD, Girolomoni G, Dhar S, Flohr C, Murrell DF, Paller AS, Guttman-Yassky E. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol 2018; 178:768-775. [PMID: 28865094 PMCID: PMC5901393 DOI: 10.1111/bjd.15928] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread. OBJECTIVES To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD. METHODS A survey consisting of statements accompanied by visual analogue scales ranging from 'strongly disagree' to 'neutral' to 'strongly agree' was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of 'neutral' towards 'strongly disagree'. RESULTS Sixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high-quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards 'strongly disagree'), consensus would have been reached on fewer statements. CONCLUSIONS Based on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.
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Affiliation(s)
- A M Drucker
- Department of Dermatology, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, U.S.A.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - A D Irvine
- Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland
| | - G Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - S Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, U.K
| | - D F Murrell
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - E Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, U.S.A
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Roekevisch E, Leeflang MMG, Schram ME, Campbell LE, Irwin McLean WH, Kezic S, Bos JD, Spuls PI, Middelkamp-Hup MA. Patients with atopic dermatitis with filaggrin loss-of-function mutations show good but lower responses to immunosuppressive treatment. Br J Dermatol 2017; 177:1745-1746. [PMID: 27864930 DOI: 10.1111/bjd.15191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Roekevisch
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M E Schram
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - L E Campbell
- Centre for Dermatology and Genetic Medicine, University of Dundee, Dundee, U.K
| | - W H Irwin McLean
- Centre for Dermatology and Genetic Medicine, University of Dundee, Dundee, U.K
| | - S Kezic
- Academic Medical Center, Coronel Institute of Occupational Health, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - J D Bos
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Callander J, Anstey AV, Ingram JR, Limpens J, Flohr C, Spuls PI. How to write a Critically Appraised Topic: evidence to underpin routine clinical practice. Br J Dermatol 2017; 177:1007-1013. [PMID: 28967117 DOI: 10.1111/bjd.15873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 12/26/2022]
Abstract
Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatology.
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Affiliation(s)
- J Callander
- Department of Dermatology, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, U.K
| | - A V Anstey
- Department of Dermatology, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, U.K
| | - J R Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, U.K
| | - J Limpens
- The Medical Library, Research Support, University of Amsterdam, Amsterdam, the Netherlands
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's& St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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38
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van den Reek JMPA, Menting SP, Janssen WWL, Dhaliwal R, Heijboer AC, van Herwaarden AE, Sweep FCGJ, de Jong LM, Tjwa ET, Otero ME, Spuls PI, de Jong EMGJ. Procollagen-3 N-terminal peptide measurements for the detection of liver fibrosis in methotrexate-treated patients with psoriasis: daily practice use and clinical implications. Br J Dermatol 2017; 177:1454-1457. [PMID: 28112796 DOI: 10.1111/bjd.15313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- J M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S P Menting
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - W W L Janssen
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R Dhaliwal
- Department of Allergology, University Medical Center, Groningen, the Netherlands
| | - A C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, the Netherlands
| | - A E van Herwaarden
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - L M de Jong
- Department of Dermatology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | - E T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M E Otero
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
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39
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Kadouch DJ, Elshot YS, Zupan-Kajcovski B, van Haersma de With ASE, van der Wal AC, Leeflang M, Jóźwiak K, Wolkerstorfer A, Bekkenk MW, Spuls PI, de Rie MA. One-stop-shop with confocal microscopy imaging vs. standard care for surgical treatment of basal cell carcinoma: an open-label, noninferiority, randomized controlled multicentre trial. Br J Dermatol 2017; 177:735-741. [PMID: 28391599 DOI: 10.1111/bjd.15559] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine punch biopsies are considered to be standard care for diagnosing and subtyping basal cell carcinoma (BCC) when clinically suspected. OBJECTIVES We assessed the efficacy of a one-stop-shop concept using in vivo reflectance confocal microscopy (RCM) imaging as a diagnostic tool vs. standard care for surgical treatment in patients with clinically suspected BCC. METHODS In this open-label, parallel-group, noninferiority, randomized controlled multicentre trial we enrolled patients with clinically suspected BCC at two tertiary referral centres in Amsterdam, the Netherlands. Patients were randomly assigned to the RCM one-stop-shop (diagnosing and subtyping using RCM followed by direct surgical excision) or standard care (planned excision based on the histological diagnosis and subtype of a punch biopsy). The primary outcome was the proportion of patients with tumour-free margins after surgical excision of BCC. RESULTS Of the 95 patients included, 73 (77%) had a BCC histologically confirmed using a surgical excision specimen. All patients (40 of 40, 100%) in the one-stop-shop group had tumour-free margins. In the standard-care group tumour-free margins were found in all but two patients (31 of 33, 94%). The difference in the proportion of patients with tumour-free margins after BCC excision between the one-stop-shop group and the standard-care group was -0·06 (90% confidence interval -0·17-0·01), establishing noninferiority. CONCLUSIONS The proposed new treatment strategy seems suitable in facilitating early diagnosis and direct treatment for patients with BCC, depending on factors such as availability of RCM, size and site of the lesion, patient preference and whether direct surgical excision is feasible.
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Affiliation(s)
- D J Kadouch
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - Y S Elshot
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.,Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Zupan-Kajcovski
- Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A S E van Haersma de With
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - A C van der Wal
- Department of Pathology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - M Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - K Jóźwiak
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - M W Bekkenk
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.,Department of Dermatology, VU Medical Center, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - M A de Rie
- Department of Dermatology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.,Department of Dermatology, VU Medical Center, Amsterdam, the Netherlands
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de Vries ACQ, Thio HB, de Kort WJA, Opmeer BC, van der Stok HM, de Jong EMGJ, Horvath B, Busschbach JJV, Nijsten TEC, Spuls PI. A prospective randomized controlled trial comparing infliximab and etanercept in patients with moderate-to-severe chronic plaque-type psoriasis: the Psoriasis Infliximab vs. Etanercept Comparison Evaluation (PIECE) study. Br J Dermatol 2017; 176:624-633. [PMID: 27416891 DOI: 10.1111/bjd.14867] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are currently no independent data available comparing infliximab and etanercept for the treatment of psoriasis. OBJECTIVES To compare these biologics without funding from pharmaceutical companies. METHODS Overall, 50 patients were randomized to etanercept (n = 23) 50 mg subcutaneously twice weekly or infliximab (n = 25) 5 mg kg-1 intravenously at week 0, 2, 6, 14 and 22. After 24 weeks, 19 patients stopped and 22 continued treatment and were followed up to week 48. The primary outcome was ≥ 75% improvement of Psoriasis Area and Severity Index (PASI 75) at week 24. The secondary outcomes included PASI 75 at week 6 (onset of action) and week 12, Investigator's Global Assessment (IGA), Patient Global Assessment, impact on quality of life (Skindex-17 and SF-36), Treatment Satisfaction Questionnaire of Medication, duration of remission, maintenance treatment and safety. RESULTS At week 24, PASI 75 was achieved in 72% (infliximab) vs. 35% (etanercept) (P = 0·01). The onset of action was achieved in 52% (infliximab) and 4% (etanercept). At week 12, 76% (infliximab) and 22% (etanercept) achieved PASI 75 (P < 0·001). At week 24, IGA 'clear or almost clear' was observed in 76% (infliximab) and 30% (etanercept) (P = 0·01). Skindex-17 symptom score was significantly better for infliximab. Maintenance treatment achieved PASI 75 for 67% (n = 6) infliximab vs. 50% (n = 5) etanercept, at week 48 (P = 0·65). Mild adverse events were reported in 76% (infliximab) vs. 66% (etanercept). CONCLUSIONS Infliximab showed a rapid and significant higher level of efficacy until week 24 compared with etanercept. Long-term data showed no significant differences between both groups at week 48. Safety parameters were comparable.
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Affiliation(s)
- A C Q de Vries
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - H B Thio
- Department of Dermatology, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands
| | - W J A de Kort
- Department of Dermatology, Amphia Hospital, Molengracht 21, 4818 CK, Breda, the Netherlands
| | - B C Opmeer
- Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - H M van der Stok
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, UMC St Radboud, René Descartesdreef 1, 6525 GL, Nijmegen, the Netherlands
| | - B Horvath
- Department of Dermatology, UMC Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - J J V Busschbach
- Medical Psychology and Psychotherapy Section, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands
| | - Ph I Spuls
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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41
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Gerbens LAA, Chalmers JR, Rogers NK, Nankervis H, Spuls PI. Reporting of symptoms in randomized controlled trials of atopic eczema treatments: a systematic review. Br J Dermatol 2016; 175:678-86. [PMID: 27012805 DOI: 10.1111/bjd.14588] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 02/04/2023]
Abstract
'Symptoms' is a core outcome domain for atopic eczema (AE) trials, agreed by consensus as part of the Harmonising Outcome Measures for Eczema (HOME) initiative. To standardize and validate the core domain symptoms and symptom instruments for AE trials the HOME roadmap is followed. Its first step is to establish if and how symptoms have been measured in published AE treatment trials. Therefore the Global Resource for Eczema Trials database was used to collect all randomized controlled trials (RCTs) of treatments for AE between January 2000 and April 2014. Study selection and data extraction were performed by three reviewers independently. We identified the use of symptoms in 295 of 378 trials (78%). Symptoms as a primary end point were applied by 147 RCTs (50%). Seventeen different symptoms were measured, but mostly itch and sleep loss. Symptoms were assessed by only 37% of trials by a stand-alone symptom measurement. Overall 63% of RCTs used a composite instrument, and 30 different instruments were identified. The Scoring Atopic Dermatitis (SCORAD) index was the most commonly applied, but only 23% of RCTs reported the SCORAD symptom score separately. This systematic review demonstrates that symptoms, most frequently itch and sleep loss, are commonly reported in AE treatment trials, but are measured using many different instruments. Often symptoms are evaluated as part of a composite instrument, and currently it is not possible to extract symptoms-only data from most published studies. Future trials should report symptom scores to permit meta-analysis of the core outcomes.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - N K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - H Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Nast A, Gisondi P, Ormerod AD, Saiag P, Smith C, Spuls PI, Arenberger P, Bachelez H, Barker J, Dauden E, de Jong EM, Feist E, Jacobs A, Jobling R, Kemény L, Maccarone M, Mrowietz U, Papp KA, Paul C, Reich K, Rosumeck S, Talme T, Thio HB, van de Kerkhof P, Werner RN, Yawalkar N. European S3-Guidelines on the systemic treatment of psoriasis vulgaris--Update 2015--Short version--EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2015; 29:2277-94. [PMID: 26481193 DOI: 10.1111/jdv.13354] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022]
Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A D Ormerod
- Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - P Saiag
- Service de Dermatologie, Hôpital Ambroise Paré Université Paris V, Boulogne, France
| | - C Smith
- Clinical Lead for Dermatology, St Johns Institute of Dermatology, St Thomas' Hospital, London, UK
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - P Arenberger
- Third Faculty of Medicine, Department of Dermatology, Charles University, Prague, Czech Republic
| | - H Bachelez
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - J Barker
- St. Johns Institute of Dermatology, St. Thomas' Hospital, London, UK
| | - E Dauden
- Hospital Universitario de la Princesa, Madrid, Spain
| | - E M de Jong
- University Medical Center Nijmegen St Radboud, Nijmegen, The Netherlands
| | - E Feist
- Medizinische Klinik mit Schwerpunkt Rheumatologie u. klinische Immonologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Jacobs
- Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - L Kemény
- SZTE Borgyogyaszati Klinika, Szeged, Hungary
| | | | - U Mrowietz
- Department of Dermatology, Psoriasis-Center University Medical Center Schleswig Holstein, Kiel, Germany
| | | | - C Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - K Reich
- Dermatologikum Hamburg, Hamburg, Germany
| | - S Rosumeck
- Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Talme
- Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - H B Thio
- Department of Dermatology, Erasmus University, Rotterdam, The Netherlands
| | - P van de Kerkhof
- Department of Dermatology, University Hospital Nijmegen, Nijmegen, The Netherlands
| | - R N Werner
- Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - N Yawalkar
- Department of Dermatology, Inselspital, Universitätsklinik für Dermatologie, Bern, Switzerland
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Kadouch DJ, Schram ME, Leeflang MM, Limpens J, Spuls PI, de Rie MA. In vivo confocal microscopy of basal cell carcinoma: a systematic review of diagnostic accuracy. J Eur Acad Dermatol Venereol 2015; 29:1890-7. [PMID: 26290493 DOI: 10.1111/jdv.13224] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/22/2015] [Indexed: 12/22/2022]
Abstract
Basal cell carcinoma (BCC) is the most prevalent type of skin cancer. Histologic analysis of punch biopsy or direct excision specimen is used to confirm clinical diagnosis. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging modality that could facilitate early diagnosis and minimize unnecessary invasive procedures. We systematically reviewed diagnostic accuracy (sensitivity and specificity) of RCM in diagnosing primary BCCs to judge its usefulness. Eligible studies were reviewed for methodological quality using the QUADAS-2 tool. We used the bivariate random-effects model to calculate summary estimates of sensitivity and specificity. Six studies met the selection criteria and were included for analysis. The meta-analysis showed a summary estimate of sensitivity 0.97 (95% CI, 0.90-0.99) and specificity 0.93 (95% CI, 0.88-0.96). All but one of the QUADAS-2 items showed a high or unclear risk of bias with regards to patient selection. RCM may be a promising diagnostic tool, but the limited number of available studies and potential risk of bias of included studies do not allow us to draw firm conclusions. Future accuracy studies should take these limitations into account.
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Affiliation(s)
- D J Kadouch
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - M E Schram
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - M M Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Limpens
- Medical Library, Academic Medical Center, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
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44
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Menting SP, van den Reek JMPA, Baerveldt EM, de Jong EMGJ, Prens EP, Lecluse LLA, Wolbink GJ, Van der Kleij D, Spuls PI, Rispens T. The correlation of clinical efficacy, serum trough levels and antidrug antibodies in ustekinumab-treated patients with psoriasis in a clinical-practice setting. Br J Dermatol 2015; 173:855-7. [PMID: 25865153 DOI: 10.1111/bjd.13834] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S P Menting
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - E M Baerveldt
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L L A Lecluse
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - G J Wolbink
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - D Van der Kleij
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands.,Biologicals Laboratory, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Ph I Spuls
- Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - T Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
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Williams HC, Apfelbacher C, Chalmers JR, Schmitt J, Simpson EL, Spuls PI, Thomas KS. Clearing up misunderstandings around core outcomes for atopic dermatitis. Br J Dermatol 2015; 173:623-4; discussion 624-5. [PMID: 25819300 DOI: 10.1111/bjd.13787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C Apfelbacher
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - J Schmitt
- Centre for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - E L Simpson
- Oregon Health & Science University, Department of Dermatology, Portland, OR, U.S.A
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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Affiliation(s)
- J Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, University of Nottingham, Lenton Lane, Nottingham, NG7 2NR, U.K.
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47
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van Lümig PPM, Menting SP, van den Reek JMPA, Spuls PI, van Riel PLCM, van de Kerkhof PCM, Fransen J, Kievit W, de Jong EMGJ. An increased risk of non-melanoma skin cancer during TNF-inhibitor treatment in psoriasis patients compared to rheumatoid arthritis patients probably relates to disease-related factors. J Eur Acad Dermatol Venereol 2014; 29:752-60. [PMID: 25229823 DOI: 10.1111/jdv.12675] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Concerns exist about a risk of non-melanoma skin cancer (NMSC) in psoriasis patients and rheumatoid arthritis (RA) patients treated with TNF-inhibitors. However, current data also show that in some psoriasis patients, NMSC is diagnosed relatively short after the start of TNF-inhibitors, which suggests that these NMSC can be explained by previous therapies instead of by TNF-inhibitor therapy. OBJECTIVE To investigate whether there was a difference in time until first NMSC and the rate of NMSC between psoriasis and RA patients on TNF-inhibitors. METHODS Time until first NMSC and the rate of NMSC were compared between psoriasis and RA patients from the same region treated with TNF-inhibitors and followed up for at least one year in prospective cohort studies, by using Cox regression and Poisson regression. Both analyses were corrected for confounders (age, gender, disease duration, prior NMSC, duration of anti-TNF and other systemic therapies). RESULTS The NMSC risk was significantly higher in the psoriasis group [fully adjusted HR 6.0 (1.6-22.4 95%CI)] with a shorter time until first NMSC in psoriasis compared to RA. By Poisson regression, psoriasis patients had a 5.5 (2.2-13.4 95%CI) higher rate of NMSC. CONCLUSION The time until first NMSC was significantly shorter and the rate of NMSC was significantly higher in psoriasis compared with RA. This indicates that disease-related factors like phototherapy may be important contributing factors to NMSC diagnosed in psoriasis patients treated with TNF-inhibitors.
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Affiliation(s)
- P P M van Lümig
- Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands
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Zweegers J, de Jong EMGJ, Nijsten TEC, de Bes J, te Booij M, Borgonjen RJ, van Cranenburgh OD, van Deutekom H, van Everdingen JJE, de Groot M, Van Hees CLM, Hulshuizen H, Koek MBG, de Korte WJA, de Korte J, Lecluse LLA, Pasch MC, Poblete-Gutiérrez PA, Prens EP, Seyger MMB, Thio HB, Torcque LA, de Vries ACQ, van de Kerkhof PCM, Spuls PI. Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology. Dermatol Online J 2014; 20:doj_21769. [PMID: 24656281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 06/03/2023] Open
Abstract
This document provides a summary of the Dutch S3-guidelines on the treatment of psoriasis. These guidelines were finalized in December 2011 and contain unique chapters on the treatment of psoriasis of the face and flexures, childhood psoriasis as well as the patient's perspective on treatment. They also cover the topical treatment of psoriasis, photo(chemo)therapy, conventional systemic therapy and biological therapy.
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Affiliation(s)
- J Zweegers
- Dutch Society of Dermatology and Venereology.
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Garritsen FM, ter Haar NM, Spuls PI. House dust mite reduction in the management of atopic dermatitis. A critically appraised topic. Br J Dermatol 2013; 168:688-91. [PMID: 23528056 DOI: 10.1111/bjd.12283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F M Garritsen
- Academic Medical Center, University of Amsterdam, Department of Dermatology, A0-229, PO Box 22700, 1100 DD Amsterdam, The Netherlands.
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Vrijman C, Kroon MW, Limpens J, Leeflang MMG, Luiten RM, van der Veen JPW, Wolkerstorfer A, Spuls PI. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol 2012; 167:1224-35. [PMID: 22860695 DOI: 10.1111/j.1365-2133.2012.11198.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thyroid disease has been suggested to be associated with vitiligo. However, the outcomes of prevalence studies on thyroid disease in vitiligo vary widely. OBJECTIVES To summarize and critically appraise current evidence of the prevalence of thyroid diseases in vitiligo. METHODS A systematic review was performed searching the electronic databases OVID MEDLINE, OVID EMBASE and PubMed. Guidelines for the critical appraisal of studies on prevalence of a health problem were adapted to evaluate the methodological quality of the included studies. Results were analysed in a meta-analysis with a risk ratio (RR). RESULTS Forty-eight studies published between 1968 and 2012 met the inclusion criteria. Most of the studies (50%) were of fair methodological quality, whereas 18 studies (38%) were of poor quality and six studies (12%) were of good quality. Thyroid disease, autoimmune thyroid disease and presence of thyroid-specific autoantibodies showed a mean prevalence of, respectively, 15·1%, 14·3% and 20·8% in patients with vitiligo and an RR of, respectively, 1·9, 2·5 and 5·2 (all statistically significant). This review shows an increased prevalence and an increased risk of (autoimmune) thyroid disease in patients with vitiligo compared with nonvitiligo. This risk seems to increase with age. CONCLUSIONS Clinicians should be aware of this increased risk in patients with vitiligo and should be attentive for symptoms of thyroid disease. To make recommendations on screening for thyroid disease in patients with vitiligo future research of good methodological quality, including differentiation of vitiligo types and the use of standardized outcome measures, is needed.
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Affiliation(s)
- C Vrijman
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
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