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Saraswat A, Dogra S, Shenoy M, Verma S, K S, Ghate S, Ganjoo A, Aurangabadkar S, Tiwari A, Poojary S, Inamdar A, Majid I, Girdhar M, Shah B, Varma S, Ramamoorthy R, Dhoot D, Barkate H. Clinical Use of Super Bioavailable Itraconazole for the Management of Dermatophytosis: Consensus Statement by Dermatologists from India via the Modified Delphi Technique. Dermatology 2024:000538080. [PMID: 38697027 DOI: 10.1159/000538080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/26/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Super bioavailable itraconazole (SB ITZ) overcomes the limitations of conventional itraconazole (CITZ) such as inter-individual variability and reduced bioavailability. It has been approved for systemic mycoses in Australia and Europe as 50mg and the United States as 65mg and in India as 50mg, 65mg, 100mg, and 130mg. However, data on the ideal dose and duration of SB ITZ treatment in managing dermatophytosis is insufficient. This consensus discusses the suitability, dosage, duration of treatment, and relevance of using SB ITZ in managing dermatophytosis in different clinical scenarios. METHODS Sixteen dermatologists, (>15 years of experience in the field and ≥2 years clinical experience with SB ITZ) formed the expert panel. A modified Delphi technique was employed, and a consensus was reached if the concordance in response was >75%. RESULTS A total of 26 consensus statements were developed. The preferred dose of SB ITZ is 130mg once daily and if not tolerated, 65mg twice daily. The preferred duration for treating naïve dermatophytosis is 4-6 weeks and that for recalcitrant dermatophytosis is 6-8 weeks. Moreover, cure rates for dermatophytosis are a little better with SB ITZ than with CITZ with a similar safety profile as of CITZ. Better patient compliance and efficacy are associated with SB ITZ than with CITZ, even in patients with comorbidities and special needs such as patients with diabetes, extensive lesions, corticosteroid abuse, adolescents, and those on multiple drugs. CONCLUSION Expert opinions indicate that overall clinical experience with SB ITZ is better than that with CITZ.
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Dhar S, De A, Saha A, Chitnis KR, Mane A, Dhoot D, Barkate H. Intermittent or Sequential Topical Tacrolimus in Atopic Dermatitis: Systematic Review and Meta-Analysis. Cureus 2023; 15:e50640. [PMID: 38229798 PMCID: PMC10789587 DOI: 10.7759/cureus.50640] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Topical calcineurin inhibitors (TCIs) and topical corticosteroids (TCS) are the mainstays of flare management for atopic eczema or atopic dermatitis (AD). Tacrolimus (an immunomodulator), belongs to the class of calcineurin inhibitors, with promising efficacy in AD. We performed this systematic review to obtain an up-to-date coverage map of controlled clinical trials of sequential or intermittent treatments with TCI as a therapeutic intervention for AD. Articles of interest were retrieved from PubMed, Google Scholar, and EMBASE published between between January 2000 and March 2023. Key words were "calcineurin inhibitors," "corticosteroids," "atopic dermatitis," "pruritus," "sequential," "intermittent" and "consecutive" while fixed language search consisted of "Intermittent topical calcineurin inhibitors AND topical corticosteroids AND atopic dermatitis OR eczema" AD patients who were administered sequential and/or intermittent applications of TCI for management of atopic eczema were included. Outcome measures included but were not limited to Scoring of Atopic Dermatitis (SCORAD) and the Eczema Area Severity Score (EASI). Four clinical trials were considered for the purpose of review. A total of 101 patients with AD were analysed. The risk of bias was low in two studies, while the other two had an unclear risk of bias. Overall, pooled data from two trials revealed that sequential therapy with TCS/TCI was comparable to monotherapy or emollients, as the test for overall effect determined was non-significant with a p-value of 0.33. The two studies were highly heterogeneous, as indicated by a very high I2 of 92% and an extremely significant p-value (p=0.0005). Sequential therapy with TCS and TCIs was effective and well tolerated in the management of AD and it may be considered an important treatment approach during the initial period.
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Affiliation(s)
- Sandipan Dhar
- Dermatology, Institute of Child Health, Kolkata, IND
| | - Abhishek De
- Dermatology, Calcutta National Medical College and Hospital, Kolkata, IND
| | - Abhijit Saha
- Dermatology, Institute of Child Health, Kolkata, IND
| | - Kruttika R Chitnis
- Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Abhishek Mane
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Shenoy M, De A, Shah B, Das A, Saraswat A, Lahiri K, Dhoot D. Comparative Efficacy and Safety of Super-Bioavailable Itraconazole-130 mg Once Daily in Obese and Non-Obese Patients of Glabrous Tinea. Indian Dermatol Online J 2023; 14:839-843. [PMID: 38099030 PMCID: PMC10718122 DOI: 10.4103/idoj.idoj_120_23] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 12/17/2023] Open
Abstract
Background Obesity is considered one of the risk factors for dermatophytosis and warrants systemic therapy. Itraconazole is the most commonly used antifungal, but owing to pharmacokinetic challenges, super-bioavailable itraconazole (SITZ) was approved globally, recently. For the management of dermatophytosis in obese patients, there are mixed opinions regarding the dosing of systemic antifungals. Materials and Methods This study was conducted to compare the efficacy and safety of SITZ-130 mg once daily in glabrous tinea or dermatophytosis in obese and non-obese patients for a total duration of 10 weeks on 87 eligible patients. Efficacy and safety assessments were done at weeks 3 and 6 with follow-up at week 10 for relapse. The primary objective was to assess the proportion of patients achieving complete cure at week 6 with the assessment of safety, clinical, and mycological cure rates as secondary objectives. Results Out of 87 patients, 80 were considered for analysis. At week 6, 22/35 (63%) and 33/45 (73%) patients in obese and non-obese groups were completely cured (P = 0.47). Similarly, there was no statistically significant difference for mycological and clinical cure in both the groups (P = 0.17 and P = 0.61, respectively). Four patients in the obese group (18% of completely cured), while one patient in the non-obese group (3% of completely cured), relapsed within 4 weeks of completion of treatment (P = 0.14). The therapy was well tolerated by both groups, with only one patient in the non-obese group experiencing pruritus. Conclusion SITZ-130 mg once daily achieved desired and similar clinical response in obese patients as of non-obese patients suffering from dermatophytosis, and hence, a higher dose may not require in obesity.
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Affiliation(s)
- Manjunath Shenoy
- Department of Dermatology, Omega Hospital, Mangalore, Karnataka, India
| | - Abhishek De
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Bela Shah
- Department of Dermatology, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Anupam Das
- Department of Dermatology, Iris Multispecialty Hospital, Kolkata, West Bengal, India
| | - Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, Uttar Pradesh, India
| | - Koushik Lahiri
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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De A, Shah B, Banodkar PD, Dhoot D, Chitnis K, Barkate H. Real-World Indian Experience of Switchover to Bilastine 40 mg/day in CSU Patient Refractory to Other Antihistamines at Double Dose. Indian J Dermatol 2023; 68:674-677. [PMID: 38371575 PMCID: PMC10869010 DOI: 10.4103/ijd.ijd_89_23] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Although second-generation antihistamines (SGAHs) are recommended as first-line drugs in chronic spontaneous urticaria (CSU), symptom relief has been reported in <50% of patients at licensed doses and up to fourfold dosing is recommended for these patients. Bilastine (SGAH), at licensed doses and higher doses, is efficacious in CSU. However, large-scale real-world data is scarce. Objectives To report the real-world evidence of the safety and effectiveness of bilastine at a double dose (40-mg per day) in CSU management. Materials and Methods In this retrospective questionnaire-based study carried out from February 2022 to July 2022, a pre-validated questionnaire was used to gather data on patients with CSU in dermatology practice from 62 centres across India. Adult patients of either gender diagnosed with CSU and switched over to bilastine 40 mg/day due to a non-satisfactory response (UCT score <12) to other antihistamines at double dose were considered for analysis. Based on UCT scores, patients were classified as responders (UCT ≥12) and non-responders at follow-up assessment at 2 weeks as compared to baseline. Results 177 patients with a mean disease duration of 2.11 ± 1.48 years were included in the final analysis, with 53% females and 47% males. At the end of two weeks, 74/177 (42%) patients were classified as responders, and 103/177 (58%) were non-responders to Bilastine 40 mg/day. The mean change of UCT score from 5.0 ± 2.2 at baseline to 8.08 ± 5.41 (62% improvement) was significant (P < 0.001). Sedation was reported by ten patients without any discontinuation of treatment. Conclusion Bilastine 40 mg/day was effective and well-tolerated in controlling CSU symptoms refractory to antihistamines at double doses.
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Affiliation(s)
- Abhishek De
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Bela Shah
- Department of Dermatology, Venereology and Leprology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | | | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Kruttika Chitnis
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
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Sattur S, Talathi A, Shetty G, Arsiwala S, Pereira R, Dhoot D. Comparative Clinical Study Evaluating the Efficacy and Safety of Topical 5% Cetosomal Minoxidil and Topical 5% Alcohol-Based Minoxidil Solutions for the Treatment of Androgenetic Alopecia in Indian Men. Cureus 2023; 15:e46568. [PMID: 37937040 PMCID: PMC10626207 DOI: 10.7759/cureus.46568] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Patients with androgenetic alopecia (AGA), who use alcohol-based topical minoxidil solutions, frequently experience localized irritation, dryness, and scalp redness. In this study, we compared the safety and effectiveness of topical 5% cetosomal minoxidil solution to those of topical 5% alcohol-based minoxidil solution in Indian men with AGA. Methods In this randomized, open-label study, male patients with AGA were randomized 1:1 to receive either solutions twice daily for 16 weeks. Efficacy endpoints included changes in basic and specific (BASP) grading, improvement in the trichoscopy score, and global photography at week 16 from baseline, whereas safety was evaluated by adverse events reported by patients and hair-related quality of life (QoL) using the Hairdex-29 questionnaire. Results Of the 80 patients, only 40 completed the study and were considered for complete analysis. Twelve out of 23 patients (52%) in the cetosomal minoxidil group and four out of 17 patients (24%) in the alcohol-based minoxidil group showed a positive increase in hair growth according to the trichoscopy score (p=0.1). According to the BASP grading system, nine patients (39%) and five patients (29%) in the cetosomal and alcohol-based minoxidil groups, respectively, showed improvement (p=0.73). Similarly, 19 (83%) and 10 (59%) patients in the cetosomal and alcohol-based minoxidil groups, respectively, reported positive hair growth on the global photography assessment (p=0.15). All the patients tolerated the treatment well, with no discontinuation in either group. There were four adverse events in the cetosomal minoxidil group, reported by two (9%) patients, whereas in the alcohol-based minoxidil group, 10 adverse events were reported by seven (41%) patients (p=0.02). In addition, the mean Hairdex-29 score of 40.26±4.71 at baseline improved to 32.32±3.35 in the cetosomal group, whereas it improved to 34.64±3.41 from 39.64±4.98 in the other group (p=0.03). Conclusions The 5% cetosomal minoxidil group showed improved safety but similar efficacy when administered twice daily. Therefore, cetosomal minoxidil may be a better option for treating AGA in males who are sensitive or nontolerant to alcoholic formulations.
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Affiliation(s)
- Sandeep Sattur
- Department of Hair Restoration, Hairrevive - Center for Hair Restoration and Skin Rejuvenation, Mumbai, IND
- Department of Hair Restoration Surgery, Wockhardt Hospital, Mumbai, IND
| | | | | | - Shehnaz Arsiwala
- Dermatology, Renewderm Skin Hair Laser Aesthetics Centre, Mumbai, IND
| | - Rickson Pereira
- Dermatology, Dr. Rickson's Dermatherapie Clinic, Mumbai, IND
- Dermatology, Holy Family Hospital, Mumbai, IND
| | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, IND
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Shenoy M, De A, Shah B, Das A, Saraswat A, Lahiri K, Yadav S, Sarda A, Chakraborty D, J D, Kamat S, Doshi Y, Gonsalves N, Choudhary A, Dhoot D, Mahadkar N, Bhushan S, Gadkari R, Barkate H. Erratum: Efficacy of Super-Bioavailable Itraconazole and Conventional Itraconazole at Different Dosing Regimens in Glabrous Tinea Infection - A Randomized Clinical Trial [Corrigendum]. Drug Des Devel Ther 2023; 17:3033-3034. [PMID: 37789967 PMCID: PMC10544158 DOI: 10.2147/dddt.s442147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
[This corrects the article DOI: 10.2147/DDDT.S421583.].
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Shenoy MM, De A, Shah B, Das A, Saraswat A, Lahiri K, Yadav S, Sarda A, Chakraborty D, J D, Kamat S, Doshi Y, Gonsalves N, Choudhary A, Dhoot D, Mahadkar N, Bhushan S, Gadkari R, Barkate H. Efficacy of Super-Bioavailable Itraconazole and Conventional Itraconazole at Different Dosing Regimens in Glabrous Tinea Infection - A Randomized Clinical Trial. Drug Des Devel Ther 2023; 17:2899-2908. [PMID: 37766823 PMCID: PMC10520254 DOI: 10.2147/dddt.s421583] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Itraconazole follows non-linear pharmacokinetics and hence is recommended once daily, but in real-world practice, is commonly prescribed as twice daily. Hence, this study aimed to evaluate the efficacy and safety of super-bioavailable-itraconazole-130 mg (SB-130) and conventional-itraconazole-200 mg (CITZ-200) once daily compared with conventional-itraconazole-100 mg (CITZ-100) twice daily in glabrous tinea. Methods A total of 261 eligible patients were enrolled in this prospective, randomized, clinical study from December-2021 to August-2022 at seven centers in India. Efficacy and safety assessments were done at week-3 and 6, with follow-up at week-10 for relapse. The primary objective was to assess the proportion of patients who achieved complete cure at week-6 following treatment in all itraconazole groups. The secondary outcomes were safety and clinical and mycological cure rates. Results Of 261 patients, 240 were included in the analysis. At week-6, 140 patients were completely cured; thus, overall cure rate was 58.33%. Fifty-five patients (69%) in SB-130 while 47/77 (61%) and 38/83 (46%) patients were completely cured in CITZ-200 and CITZ-100 groups respectively (p<0.05; SB-130: CITZ-100, p=0.32; SB-130: CITZ-200, p=0.058; CITZ-200: CITZ-100). There was no statistical difference in the mycological cure rate and area clearance rate between any of the groups (p=0.14); however, a statistically significant difference was noted for OD dosing over BD dosing in achieving clinical cure rates (p<0.05). A total of 13/140 patients (9%) relapsed following complete cure, with no statistically significant difference between any of the groups (p=0.50). All treatments were safe and well-tolerated, with no discontinuation. Conclusion In this clinical study, moderate efficacy with all doses of ITZ was reported but was better with OD dosing. Although there was no statistical difference between SB-130 and CITZ-200, SB-130 may be preferred over CITZ-200 owing to the advantage of SB over the conventional ITZ.
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Affiliation(s)
| | - Abhishek De
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Bela Shah
- Department of Dermatology, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Anupam Das
- Department of Dermatology, Iris Multispecialty Hospital, Kolkata, West Bengal, India
| | - Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, Uttar Pradesh, India
| | - Koushik Lahiri
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Sheetal Yadav
- Department of Dermatology, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Disha Chakraborty
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Dharmender J
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Shruti Kamat
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Yashika Doshi
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Nelry Gonsalves
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Ankita Choudhary
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Namrata Mahadkar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sumit Bhushan
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Rujuta Gadkari
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Shah B, Mistry D, Gonsalves N, Vasani P, Dhoot D, Barkate H. A Prospective, Randomized, Comparative Study of Topical Minocycline Gel 4% with Topical Clindamycin Phosphate Gel 1% in Indian Patients with Acne Vulgaris. Antibiotics (Basel) 2023; 12:1455. [PMID: 37760751 PMCID: PMC10526007 DOI: 10.3390/antibiotics12091455] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Acne vulgaris is characterized by inflammatory and non-inflammatory skin lesions with a high prevalence among adolescents in India. Not enough studies are reported on the use of topical antibiotics for the management of acne in the Indian population. The proposed study aims to compare the efficacy and safety of topical minocycline gel 4% with topical clindamycin gel 1% in the Indian population. A randomized, open-label, double-arm study was planned at two centers in India. One hundred patients were enrolled and randomized equally to two treatment arms. The drugs were applied once daily, preferably at the same time each day. The number of inflammatory and non-inflammatory lesions, as well as the investigator's global assessment (IGA), were obtained at the baseline and on weeks 3, 6, 9, and 12. The change in these parameters from baseline to week 12 was compared between the two treatment arms. A tolerability assessment was also performed on selected parameters. The age of patients ranged between 14 and 31 years, with female preponderance in each arm. On week 12, the percent change in inflammatory and non-inflammatory lesions in the minocycline 4% arm was significantly higher than in the clindamycin 1% arm (p < 0.0001). The IGA treatment success was significantly higher in the minocycline arm compared to the clindamycin arm on weeks 9 and 12, with p-values of 0.001 and 0.015, respectively. Tolerability assessment revealed significantly improved parameter performance in the minocycline arm compared to the clindamycin arm. On subgroup analysis, in adolescents, minocycline was found to be more efficacious than clindamycin. The comparative assessment resulted in a significantly improved performance of minocycline gel 4% compared to clindamycin gel 1% in the Indian population, thus making it a preferred choice for the treatment of moderate-to-severe acne in India.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad 380016, Gujarat, India; (B.S.); (N.G.); (P.V.)
| | - Deval Mistry
- Consultant Dermatologist, Mistry Skin Clinic, Ahmedabad 301302, Gujarat, India;
| | - Nelry Gonsalves
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad 380016, Gujarat, India; (B.S.); (N.G.); (P.V.)
| | - Presha Vasani
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad 380016, Gujarat, India; (B.S.); (N.G.); (P.V.)
| | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai 400099, Maharashtra, India;
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai 400099, Maharashtra, India;
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Kerure A, Ghalla M, Mahajan S, Dhoot D, Barkate H. Real-World Effectiveness, Safety, and Tolerability of Cetosomal Minoxidil 5% Alone and a Fixed Drug Combination of Cetosomal Minoxidil 5% With Finasteride 0.1% in the Management of Androgenetic Alopecia (Inbilt Study). Cureus 2023; 15:e41681. [PMID: 37575862 PMCID: PMC10413304 DOI: 10.7759/cureus.41681] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Topical minoxidil 5% is a widely used medication in the treatment of androgenetic alopecia (AGA) but is usually associated with adverse events (AE) such as scalp irritation, dryness, and itching. This prompted the development of nonalcoholic solutions, and cetosomal minoxidil was the most recent one. Methods Retrospective multicenter data analysis was conducted at 66 centers across India for adult AGA patients. Patients treated with either cetosomal minoxidil 5% alone (Group I) or a fixed drug combination of cetosomal minoxidil 5% and finasteride 0.1% (Group II) were analyzed for the effectiveness and safety of either formulation. The Physician Global Assessment (PGA) and Patient Global Assessment (PtGA) were used to assess each treatment's effectiveness. Safety was reported by records of AE and a product tolerability assessment with subjective cosmetic acceptability as recorded by physicians. Results Of the 261 patients, 132 were in Group I, and 129 were in Group II. At 16 weeks, in PGA, mild to moderate improvement was noted in 48% and 32% of patients in Groups I and II, respectively, whereas significant to excellent improvement was seen in 52% and 68% of patients in Groups I and II, respectively. Similar results were noted for PtGA. In Group I, 64% of patients rated the product's tolerability as excellent, and 69% reported the same in Group II. Meanwhile, 64% of patients in Group I and 74% in Group II rated the product as excellent in subjective cosmetic acceptability. Conclusions From real-world analysis, cetosomal-based minoxidil solutions were found to be effective and tolerable in AGA and could serve as therapeutic alternatives to alcoholic formulations for AGA management.
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Affiliation(s)
- Amit Kerure
- Dermatology, Dr Amit Kerure Skin Clinic, Mumbai, IND
| | | | | | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, IND
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Shenoy M, Poojari S, Rengasamy M, Vedmurthy M, Barua S, Dhoot D, Barkate H. Management of Dermatophytosis: Real-World Indian Perspective. Indian Dermatol Online J 2023; 14:347-356. [PMID: 37266073 PMCID: PMC10231727 DOI: 10.4103/idoj.idoj_643_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/21/2023] [Indexed: 06/03/2023] Open
Abstract
Background In spite of the availability of multiple consensus statements on dermatophytosis management, different treatment approaches have been experienced in India and require more scrutiny to further update guidelines and improve patient care. Aim To determine the different approaches in dermatophytosis diagnosis and management among dermatologists in India. Materials and Methods A web-based questionnaire was created and validated by five panelists with experience of >15 years in dermatophytosis and then circulated to about 2,000 dermatologists in India in September 2021 for a real-world management scenario. Results Out of 2,000 dermatologists, 459 responded. About half of the dermatologists (51%) routinely conduct potassium hydroxide mount (KOH) at the initiation of therapy. Similarly, about 53% of dermatologists initiate the management of dermatophytosis with combination therapy in all types of dermatophytosis for 4-6 weeks depending upon severity. Different types of combinations are being practiced, such as either two systemic and one topical, two topicals and one systemic, but the combination of one systemic and one topical (69%) is the most commonly practiced. Itraconazole (100 mg twice a day) and luliconazole are the most commonly prescribed antifungal medications. In case of non-response to routine dose of systemic anti-fungals, about 72% of dermatologists up dose them. Most of them continue these drugs for additional 1-2 weeks after clearance of the disease. Additionally, keratolytics and moisturizers are commonly prescribed. Additionally, 62% advise liver function tests (LFTs) at the initiation of therapy, whereas 72% advise monitoring adverse effects due to systemic antifungal drugs during treatment. Conclusion Combination therapy stood out as the need of the hour in the current menace of dermatophytosis with timely monitoring of laboratory tests for adverse events due to the use of systemic antifungals for a longer duration.
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Affiliation(s)
- Manjunath Shenoy
- Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Shital Poojari
- Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India
| | - Madhu Rengasamy
- Department of Dermatology, Venerology and Leprosy, Madras Medical College, Chennai, Tamil Nadu, India
| | - Maya Vedmurthy
- Consultant Dermatologist, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Shyamanta Barua
- Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Jain GK, Chitnis KR, Singhal P, Mahadkar N, Dhoot D, Barkate H. The Optimal Dosing Regimen of Super Bioavailable Itraconazole in Obesity: An Experimental Rat Model Study. Cureus 2023; 15:e37462. [PMID: 37187635 PMCID: PMC10175893 DOI: 10.7759/cureus.37462] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/17/2023] Open
Abstract
Background Obesity may alter tissue distribution and clearance of several drugs, especially lipophilic ones. Itraconazole, a lipophilic drug, has been recently introduced in a super-bioavailable formulation (SB-ITZ) for the treatment of dermatophytosis. Evidence regarding optimal dosing of SB-ITZ in obesity is lacking. A current experimental study was planned to analyze tissue concentrations of SB-ITZ at different doses in obese and non-obese rats. Materials and methods Thirty-six Wistar albino rats of either sex were divided into obese and non-obese rats equally. Further, rats in both categories were divided into three dosing groups. Group 1 received SB-ITZ 13 mg once daily in the morning, group 2 received SB-ITZ 13 mg in the morning and 6.5 mg in the evening, while Group 3 rats received SB-ITZ 13 mg twice daily, orally. Concentrations of SB-ITZ in the skin, serum, and fatty tissue were assessed in each group on days 7, 14, 21, and 28. Comparison of SB-ITZ concentrations in various tissues in obese and non-obese rats and inter-group comparison of tissue concentrations across the three dosing regimens was done at day 28 and expressed as Mean ± SD.36 Wistar rats were divided into obese and non-obese rats equally. Results At day 28, skin concentrations of SB-ITZ were 5.36±1.1, 8.9±1.7 and 10.13±1.7 µg/g in Groups 1, 2, and 3, respectively, in non-obese rats, which was statistically significant (p<0.05) than skin concentration of obese rats (2.72±0.6, 4.2±0.7 and 4.66±0.5 µg/g) for the corresponding dosing groups respectively. Skin concentration of SB-ITZ was statistically significant for Groups 2 and 3 as compared to Group 1. Still, no statistically significant difference was noted between Groups 2 and 3 in non-obese and obese rats. Fatty tissue concentration of SB-ITZ was comparable in all 3 dosing regimens in non-obese and obese rats. But on the intergroup comparison, a statistically significant difference was observed for Groups 2 and 3 against Group 1 (p<0.05). Increasing the dose of SB-ITZ increased serum concentration. In non-obese rats, a statistically significant difference was noted between Group 2 (74.33±6.6 ng/ml) and Group 1 (52.5±9.9 ng/ml); p<0.01 and also in Group 3 (81.33±6.8 ng/ml) against Group 1; p<0.01. Group 3 achieved significantly higher concentration than the other two groups in obese rats (Group 3; 72±5.3, Group 2; 60.5±4.3, and Group 1; 45±7 ng/ml; p<0.01). Conclusion Overall, skin, fatty tissue, and serum concentrations of SB-ITZ were higher in non-obese rats compared to obese rats in all three dosing groups. Moreover, skin and fatty tissue concentrations were proportionately higher than serum in all the groups in non-obese and obese rats. Though the skin concentration of non-obese rats was significantly higher than obese rats, skin concentration in obese rats was within the minimum inhibitory concentration (MIC) range, demonstrating the efficacy of all dosing regimens.
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Affiliation(s)
- Gaurav K Jain
- Centre for Advanced Formulation Technology, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, IND
| | | | - Payal Singhal
- Centre for Advanced Formulation Technology, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, IND
| | - Namrata Mahadkar
- Global Medial Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Dhiraj Dhoot
- Global Medial Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medial Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Dhoot D, Jain GK, Manjhi M, Kesharwani P, Mahadkar N, Barkate H. Pharmacokinetic and clinical comparison of super-bioavailable itraconazole and conventional itraconazole at different dosing in dermatophytosis. Drugs Context 2023; 12:dic-2022-8-1. [PMID: 36660014 PMCID: PMC9835899 DOI: 10.7573/dic.2022-8-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/03/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Background Due to changing face of dermatophytosis in India, many dermatologists practice different dosing patterns of itraconazole (ITZ). Recently, a new form of ITZ, super-bioavailable ITZ (SBITZ), has been commercialized to overcome the pharmacokinetic challenges of conventional ITZ (CITZ). Serum and sebum concentration of ITZ plays an important role in the management of dermatophytosis. Hence, the current study compares the rate and extent of serum and sebum concentration of SBITZ and CITZ at different dosing to determine their efficacy and safety in patients with dermatophytosis. Methods This was an open-label, randomized, four-arm study including 40 adult patients diagnosed with glabrous tinea who were randomized equally into four groups to receive either CITZ-100-BD or CITZ-200-OD (2×100 mg capsules) or SBITZ-130-OD or SBITZ-100-OD (2×SBITZ-50 mg capsules) for 4 weeks. Serum and sebum samples were analysed at different time intervals along with clinical efficacy and safety. Results For serum concentration, on day 28, the arithmetic mean and standard deviation (SD) for CITZ-100-BD, CITZ-200-OD, SB-130-OD and SB100-OD were 1262±233.5 ng/mL, 1704±261.6 ng/mL, 1770±268.9 ng/mL and 1520±231.7 ng/mL, respectively, which was statistically significant for OD dosing of ITZ/SBITZ over CITZ-100-BD. Similarly, for sebum concentration, the arithmetic mean and SD for CITZ-100-BD, CITZ-200-OD, SB-130-OD and SB-100-OD were 1042±163.45 ng/mg, 1423±192.46 ng/mg, 1534±227.55 ng/mg and 1107±182.35 ng/mg, respectively, which was statistically significant for SB-130-OD and CITZ-200-OD over CITZ-100-BD and SBITZ-100-OD dosing. No significant difference was noted between SBITZ-130 and CITZ-200 (p=0.25). Only two patients achieved complete cure in the SBITZ-130 group, whereas no patients achieved the same in other groups (p=0.47). All the dosages were very well tolerated with only 12 adverse events reported by ten patients in all groups. Conclusion All formulations achieved desired serum and sebum concentrations required for efficacy in dermatophytosis, but SB 130 mg OD and CITZ 200 mg OD were statistically significant than other ITZ doses in achieving sebum concentration. Additionally, SBITZ 130 mg OD was bioequivalent to CITZ 200 mg OD and achieved similar results to those of CITZ 200 mg OD but at 35% lower drug concentrations.
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Affiliation(s)
- Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Gaurav Kumar Jain
- Center of Advanced Formulation Technology, Delhi Pharmaceutical Science and Research University, New Delhi, India
| | - Mukesh Manjhi
- Department of Dermatology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Namrata Mahadkar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Shah B, Mistry D, Jairam D, Kansara K, Pandya R, Vasani P, Dhoot D, Mahadkar N, Bhushan S, Barkate H. Comparative Efficacy of Super Bioavailable Itraconazole Capsules 50 mg vs 65 mg Twice Daily in the Management of Glabrous Tinea. Infect Drug Resist 2023; 16:2409-2416. [PMID: 37125212 PMCID: PMC10146068 DOI: 10.2147/idr.s407946] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Owing to pharmacokinetic challenges of itraconazole, super-bioavailable itraconazole (SB) was developed and recently approved in strengths of 50mg and 65mg. But comparative study was lacking between these two strengths in glabrous tinea (dermatophytosis) management. Hence, this study was planned to compare the efficacy of both these strengths in dermatophytosis. Methods One hundred eligible patients were enrolled in this prospective, randomized, clinical study during May-2022 to September-2022 at tertiary hospital in Ahmedabad in adults. Efficacy and safety assessments were done at week-3 and 6 with follow up at week-10 for relapse. Primary objective was to assess the proportion of patients achieving complete cure at week-6 following treatment in both the groups. Secondary outcomes compared safety, clinical and mycological cure rates. Results Of the 100 patients enrolled, 98 patients (50 in SB-50mg and 48 in SB-65mg group) included in the final analysis. At week 6, 20 patients (40%) and 30 patients (62.5%) achieved complete cure (p < 0.05) in SB-50mg and SB-65mg groups, respectively. In completely cured patients, relapse was reported in 3 (15%) and 5 (17%) patients of SB-50mg and SB-65mg groups, respectively (p = 1). A significant difference was noted in clearance of symptoms and lesions in SB-65mg group (p < 0.05). Moreover, similar results were also obtained in sub-group analysis of recalcitrant dermatophytosis. Both the treatments were found to be safe and well tolerated with no discontinuation. Conclusion Study result concluded the superiority of SB-65mg over SB-50mg in terms of cure rate and resolution of symptoms in dermatophytosis management.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | | | - Dharmender Jairam
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Kajal Kansara
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Rutvi Pandya
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Presha Vasani
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
- Correspondence: Dhiraj Dhoot, Glenmark Pharmaceuticals Ltd., B D Sawant Marg, Near Bisleri Plant, Chakala, Andheri (E), Mumbai, 400099, India, Tel +919619811219, Email
| | - Namrata Mahadkar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sumit Bhushan
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Viswanath V, Joshi P, Dhakne M, Dhoot D, Mahadkar N, Barkate H. Evaluation of the Efficacy and Safety of Apremilast in the Management of Lichen Planus. Clin Cosmet Investig Dermatol 2022; 15:2593-2600. [DOI: 10.2147/ccid.s390591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
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15
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Muacevic A, Adler JR, Ghia D, Gandhi MR, Dhoot D, Barkate H. Prospective, Open-Label, Multi-Centre, Randomized Study to Compare the Effectiveness, Safety, and Tolerability of Lulican™ Shampoo Versus Ketoconazole Shampoo in Indian Adult Patients With Mild to Moderate Scalp Seborrheic Dermatitis (LEAD Study). Cureus 2022; 14:e32035. [PMID: 36600812 PMCID: PMC9801137 DOI: 10.7759/cureus.32035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Although seborrheic dermatitis (SD) is not lethal, it has a significant impact on the quality of life. Many cases of SD are managed with ketoconazole, but luliconazole has shown an equivalent or lower minimum inhibitory concentration (MIC), but not many studies have been done for its efficacy and safety in SD. With this in mind, we set out to conduct a study comparing the effectiveness, safety, and tolerability of Lulican™ (luliconazole 1% + salicylic acid 3% + ZPTO 1%) shampoo and Ketoconazole (Ketoconazole 2% + ZPTO 1%) shampoo in the treatment of SD. Materials and methods In this prospective, randomized, multi-center study, mild to moderate scalp SD patients were prescribed Lulican™ or Ketoconazole shampoo three times a week for a duration of four weeks. Effectiveness assessment was done with the Seborrheic-Dermatitis-Severity-Score (SDSS) and Physician-Global-Assessment (PGA), and quality of life was assessed with the help of the Scalpdex-23 questionnaire. Results At four weeks, 68% and 57.9% reduction was seen in SDSS in Lulican™ and Ketoconazole shampoo, respectively. Moreover, 58% and 44% of patients achieved excellent to moderate responses as per PGA with Lulican™ and ketoconazole shampoo, respectively. For safety, no statistical difference was reported, but product tolerability and subjective cosmetic acceptability were significantly better in the Lulican™ group as compared to the Ketoconazole group at the end of four weeks. The mean Scalpdex-23 score at week four was reduced by 35.7% and 21.1% in Lulican™ and ketoconazole groups, respectively (p<0.05). Conclusion While both treatments were successful in alleviating SD symptoms and were well tolerated, Lulican™ stood out as a preferred treatment option due to better quality of life (QoL) improvement in SD.
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Viswanath V, Joshi P, Lawate P, Tare D, Dhoot D, Mahadkar N, Barkate H. An Open-Label, Randomized, Prospective, Comparative, Three-Arm Clinical Trial to Evaluate the Safety and Effectiveness of Apremilast with Three Different Titration Methods in Patients with Chronic Plaque Psoriasis in India. Psoriasis (Auckl) 2022; 12:53-61. [PMID: 35496380 PMCID: PMC9041601 DOI: 10.2147/ptt.s357184] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/14/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To minimize adverse effects (AEs), apremilast is recommended to titrate at the initiation of therapy. But still, many patients experience AEs, resulting in discontinuation of therapy. As a result, many dermatologists have adapted to further titrate apremilast in different ways. The present study was planned to evaluate the safety and effectiveness of apremilast in different dose titration methods as initiation therapy in the treatment of plaque psoriasis. Patients and Methods In this open-label, randomized, prospective, comparative, three-arm, single center study, 128 plaque psoriasis patients were included. Patients were randomized into three groups. Group I received standard titration for the first 6 days; Group II received all tablets in a starter pack as once a day (OD) total for 13 days; and Group III received two starter packs as 8 tablets each of apremilast 10 mg and 20 mg as OD and 10 tablets of 30 mg as OD, in total for 26 days. All groups received apremilast 30 mg as twice a day after initial titration. The total duration of apremilast therapy in all groups was 16 weeks. Results In safety assessment, AEs were reported in 50%, 41.3% and 25% in Groups I, II and III, respectively (p <0.05) with nausea being the most common AE. In Group I, 10.53% of patients discontinued apremilast whereas 6.52% and 2.27% discontinued in Groups II and III respectively. Maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups. At week 16, on the Psoriasis Area and Severity Index, PASI 75 was achieved in 31.43%, 42.4% and 33.3% of patients in Groups I, II and III, respectively with no statistical difference between any groups. Conclusion It can be concluded that slower titration is a useful strategy for minimizing AEs while at the same time maintaining effectiveness of apremilast.
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Affiliation(s)
| | - Pradnya Joshi
- Department of Dermatology, Rajiv Gandhi Medical College, Thane, Mumbai, India
| | - Prakash Lawate
- Department of Dermatology, Rajiv Gandhi Medical College, Thane, Mumbai, India
| | - Dakshata Tare
- Department of Dermatology, Rajiv Gandhi Medical College, Thane, Mumbai, India
| | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
- Correspondence: Dhiraj Dhoot, Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, B D Sawant Marg, Andheri (E), Mumbai, Maharashtra, 400099, India, Tel +91 9619811219, Email
| | - Namrata Mahadkar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H. A Comparative, Three-Arm, Randomized Clinical Trial to Evaluate the Effectiveness and Tolerability of Bilastine vs Fexofenadine vs Levocetirizine at the Standard Dose and Bilastine vs Fexofenadine at Higher Than the Standard Dose (Up-Dosing) vs Levocetirizine and Hydroxyzine (in Combination) in Patients with Chronic Spontaneous Urticaria. Clin Cosmet Investig Dermatol 2022; 15:261-270. [PMID: 35221703 PMCID: PMC8867222 DOI: 10.2147/ccid.s350122] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Though second-generation antihistamines (SGAH) are first-line drugs in chronic spontaneous urticaria (CSU), 50% of patients do not respond to them. In such patients, guidelines recommend either up-dosing of SGAH or combination of different antihistamines. However, the studies comparing these treatment regimens are limited. Methods In this comparative, three-arm study, CSU patients were randomized to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life, and somnolence. Results A total of 110 patients with CSU were recruited. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups showed improvement in urticaria symptoms. At week 2, there was no statistical difference in urticaria activity score (UAS7) improvement between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. No major adverse events were reported during study period; however, bilastine was associated with significantly lower levels of AEs compared to levocetirizine (p<0.05). Conclusion Two-fold up-dosing of bilastine improves CSU symptoms without compromising safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Dhiraj Dhoot
- DGM, Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Ankita Choudhary
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Neha Jangid
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Deval Mistry
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shikha Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shruti Kamat
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Dhoot D, Mahajan H, Jain G, Deshmukh G, Barkate H. Serum and sebum pharmacokinetics evaluation of a novel formulation of itraconazole in healthy volunteers. Indian J Drugs Dermatol 2022. [DOI: 10.4103/ijdd.ijdd_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Talathi A, Talathi P, Kapadia Rachh J, Khan K, Dhoot D, Deshmukh G. Bilastine in pruritus associated with dermatological conditions. Indian J Drugs Dermatol 2022. [DOI: 10.4103/ijdd.ijdd_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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20
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Shenoy M, Dhoot D, Mahajan H, Barkate H. An Open-Label, Randomized, Double-Arm Clinical Trial to Compare the Effectiveness and Safety of Super Bioavailable Itraconazole Capsules and Itraconazole Capsules in the Management of Dermatophytosis in India. Clin Cosmet Investig Dermatol 2021; 14:1367-1376. [PMID: 34611418 PMCID: PMC8485852 DOI: 10.2147/ccid.s326642] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022]
Abstract
Purpose A new oral formulation of itraconazole, called super bioavailable itraconazole (SBITZ), has been launched in India, exhibiting greater bioavailability than conventional itraconazole (CITZ). No clinical studies on its effectiveness and safety in dermatophytosis in comparison with CITZ have been conducted in India. Hence, the aim of this clinical study was to compare the effectiveness and safety of SBITZ capsules and CITZ capsules in dermatophytosis. Patients and Methods This was an open-label, randomized, double-arm clinical study in which 70 patients (≥18 years of age) of either gender and diagnosed with tinea cruris, tinea corporis, and/or tinea faciei were included. The study was divided into two parts, the first part comprising a treatment period of 4 weeks and the second part an observation period for recurrence, comprised of another 4 weeks, thus making an entire study duration of 8 weeks. Results Of the 70 patients enrolled in this study, 59 (33 patients in the CITZ group and 26 patients in the SBITZ group) were included in the final analysis. In both groups, most patients were diagnosed with tinea cruris et corporis, with five or more lesions. At week 4, 11 patients (33.33%) and 17 patients (65.38%) had achieved complete cure (p<0.05), whereas 22 patients (66.67%) and 22 patients (84.61%) had achieved mycological cure (p=0.14), in the CITZ and SBITZ groups, respectively. During the observation period, recurrence was seen in 1/11 and 4/17 completely cured patients in the CITZ and SBITZ groups, respectively (p=0.15). A significant difference was noted in resolution of symptoms as well as lesions of dermatophytosis in the SBITZ group (p<0.05). Both treatments were found to be safe and well tolerated. Conclusion In the light of real-world evidence on effectiveness and safety, SBITZ should be considered as a potent therapeutic choice to effectively control the current menace of dermatophytosis in India.
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Affiliation(s)
- Manjunath Shenoy
- Department of Dermatology, Yenepoya Medical College, Deralakatte, Mangalore, India.,Omega Hospital, Mangalore, Karnataka, India
| | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Harshal Mahajan
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Dhoot D, Barkate H, Deshmukh G. 26572 Effect of bilastine on chronic spontaneous urticaria (CSU) refractory to fexofenadine: Real world experience from India. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De A, Godse K, Dhoot D, Sarda A. Real-Life Experience of Efficacy and Safety of Bilastine in the Refractory Cases of Chronic Spontaneous Urticaria and its Effect on the Quality of Life of Patients. Indian J Dermatol 2021; 66:159-164. [PMID: 34188271 PMCID: PMC8208247 DOI: 10.4103/ijd.ijd_771_20] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Second-generation H1-antihistamines (SGAHs) are the mainstay of treatment of chronic spontaneous urticaria (CSU). Bilastine, newer non-sedating SGAHs, was recently introduced in India after the approval of the Drugs Controller General of India. There is a paucity of evidence about the long-term efficacy and safety of Bilastine in Indian patients. We undertook this study to find the long-term efficacy and tolerability of Bilastine in patients with CSU in India. Materials and Methods: This retrospective chart analysis was conducted by analyzing electronic medical records from May 1, 2019, to March 20, 2020, to identify patients of CSU who were prescribed Bilastine. Adult patients, with CSU >6 months were included, who had an unsatisfactory response as per Urticaria Activity Score 7 (UAS7) to previous antihistamine therapies, and who continued treatment for at least 6 months were included. Treatment effectiveness was determined by retrospectively reviewing their UAS7 scores from their medical records and evaluating their scores at weeks 4, 8, 12, 16, 20, and 24. Also, DLQI was assessed and compared at baseline and week 24. Result: Forty-nine patients were found to fulfill the criteria and included in the study. At the end of 24 weeks, 51% of patients (n = 25) achieved complete treatment response (UAS = 0), whereas 49% of patients (n = 24) were labeled as well-controlled urticaria (UAS<6). At 24 weeks, the mean UAS7 score (1.35 ± 1.61) was statistically significant compared to the baseline score (20.2 ± 5.73). The mean score of DLQI was also reduced to 1.63 ± 1.18 at 24 weeks from 8.39 ± 2.49 at baseline (P-value <0.001). Conclusion: The study showed that in patients who had an inadequate response with commonly used antihistamines at a double dose or combined use, switching over to Bilastine resulted not only in relieving the symptoms of CSU but also improved the quality of life of the patients with CSU.
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Affiliation(s)
- Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, Department of Dermatology, DY Patil, Navi, Department of Global Medical Affairs, Glenmark, Pharmaceuticals Limited, Mumbai, Maharashtra, Department of Dermatology, Wizderm, Kolkata, West Bengal, India
| | - Kiran Godse
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, Department of Dermatology, DY Patil, Navi, Department of Global Medical Affairs, Glenmark, Pharmaceuticals Limited, Mumbai, Maharashtra, Department of Dermatology, Wizderm, Kolkata, West Bengal, India
| | - Dhiraj Dhoot
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, Department of Dermatology, DY Patil, Navi, Department of Global Medical Affairs, Glenmark, Pharmaceuticals Limited, Mumbai, Maharashtra, Department of Dermatology, Wizderm, Kolkata, West Bengal, India
| | - Aarti Sarda
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, Department of Dermatology, DY Patil, Navi, Department of Global Medical Affairs, Glenmark, Pharmaceuticals Limited, Mumbai, Maharashtra, Department of Dermatology, Wizderm, Kolkata, West Bengal, India
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Shah B, De A, Sarda A, Kochhar AM, Dhoot D, Deshmukh G, Barkate H. Effect of bilastine on chronic spontaneous urticaria refractory to levocetrizine: Real world experience in India. Dermatol Ther 2020; 34:e14557. [PMID: 33210404 DOI: 10.1111/dth.14557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Bela Shah
- Department of Dermatology, Venereology, and Leprosy, B.J. Medical College, Civil Hospital, Ahmedabad
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Calcutta, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Skin and Hair Clinic, Calcutta, India
| | - Atul M Kochhar
- Department of Dermatology & STD, Lok Nayak Hospital and Maulana Azad Medical College & GB Pant Hospital, New Delhi, India
| | - Dhiraj Dhoot
- Global Medical Affairs (IF), Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Gaurav Deshmukh
- Global Medical Affairs (IF), Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Hanmant Barkate
- Global Medical Affairs (IF), Glenmark Pharmaceuticals Ltd, Mumbai, India
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Abstract
Introduction: Psoriasis is an immune-mediated inflammatory skin disorder, which follows a chronic course. Apremilast is a novel phosphodiesterase 4 (PDE4) inhibitor, approved by US-FDA for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis. A majority of the data related to the effectivity and safety of apremilast use in psoriasis is extracted from clinical trials. The present study was planned to get an insight into real-world experience with the use of apremilast in patients with moderate-to-severe plaque psoriasis related to its effectiveness and safety in India. Materials and Methods: The present study was a retrospective one, wherein a review of the medical records of patients with psoriasis was conducted at one center in Kolkata, who were prescribed apremilast for 16 weeks in a community dermatology practice, from December 2017 to May 2018. Results: Out of 39 patients, two patients discontinued treatment due to diarrhea. Only three patients were treatment naïve; the rest had taken some form of systemic therapy before apremilast. At the end of 16 weeks of treatment with apremilast, PASI 100 was achieved in one patient (2.7%), PASI 90 in one (2.7%), PASI 75 in 18 patients (48%), while 14 patients (38%) achieved PASI 50. Eighteen (46%) experienced adverse events, diarrhea being the most common (29.7%). Conclusion: The findings of the present study indicate that apremilast is effective in a real-world setting, as compared with clinical trials in achieving certain endpoints like PASI 75, as was found in other real-world studies in other countries, as well.
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Affiliation(s)
- Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, India
| | - Sudip Das
- Department of Dermatology, Calcutta National Medical College, Kolkata, India
| | - Dhiraj Dhoot
- Department of Medical Services, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Aarti Sarda
- Wizderm Skin and Hair Clinic, Kolkata, West Bangal, India
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Pande S, Deshmukh G, Dhoot D, Andhorikar N. An open-label, prospective, comparative, double-arm clinical trial to evaluate the safety and effectiveness of minocycline extended-release formulation compared with minocycline immediate-release formulation in the management of patients with papulopustular acne. Indian J Drugs Dermatol 2020. [DOI: 10.4103/ijdd.ijdd_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dhoot D, Amin S, Kapadia A, Barkate H. Apremilast generic for the treatment of active psoriatic arthritis: A single-center real-life experience from India. Indian J Rheumatol 2020. [DOI: 10.4103/injr.injr_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De A, Das S, Dhoot D, Sarda A. Apremilast Coadministered with Secukinumab for Safe and Effective Control of Psoriasis with Resultant Reduction of Maintenance Dose of the Biologic. Indian J Dermatol 2019; 64:239-241. [PMID: 31148865 PMCID: PMC6537682 DOI: 10.4103/ijd.ijd_548_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Psoriasis is a chronic immune-mediated inflammatory condition, affecting 2–3% of the population. In recent years, advent of biologics, including secukinumab, have been a major advancement in the management of difficult-to-treat plaque psoriasis. However, high cost of biologics is often a deterrent, especially for Indian socioeconomic condition. Apremilast is an oral phosphodiesterase 4 inhibitor that is safe for use along with many other systemic therapies of psoriasis, including biologics. We report two cases of psoriasis on secukinumab therapy for long duration with good response to therapy. Later, addition of apremilast, allowed halving the dose of secukinumab with maintenance of improvement.
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Affiliation(s)
- Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Das
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Dhiraj Dhoot
- Medical Services, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Skin and Hair Clinic, Kolkata, West Bengal, India
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Dhoot D, Parasramani S, Thomas J, Budamakuntla L, Barkate H. Real-world experience on the effectiveness and tolerability of apremilast in patients with plaque psoriasis in India. Indian J Drugs Dermatol 2019. [DOI: 10.4103/ijdd.ijdd_16_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Babu PR, S Pravin AJ, Deshmukh G, Dhoot D, Samant A, Kotak B. Author's reply. Indian J Dermatol 2017; 62:667-669. [PMID: 29263546 PMCID: PMC5724320 DOI: 10.4103/ijd.ijd_496_17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P Ravindra Babu
- Consultant Dermatologist, Raga Skin Care, Bengaluru, Karnataka, India
| | - A J S Pravin
- Department of Dermatology and Venerology, Kanyakumari Government Medical College, Nagercoil, Tamil Nadu, India
| | - Gaurav Deshmukh
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Dhiraj Dhoot
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Aniket Samant
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Bhavesh Kotak
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
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Babu PR, Pravin AJS, Deshmukh G, Dhoot D, Samant A, Kotak B. Efficacy and Safety of Terbinafine 500 mg Once Daily in Patients with Dermatophytosis. Indian J Dermatol 2017; 62:395-399. [PMID: 28794551 PMCID: PMC5527721 DOI: 10.4103/ijd.ijd_191_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. Objective: The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. Materials and Methods: It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A – terbinafine 500 mg for 2 weeks, Group B – terbinafine 500 mg for 4 weeks, and Group C – terbinafine 500 mg for 6 weeks. Results: Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% (n = 169) patients showed very good response. In Group B, out of 211 patients, 92% (n = 194) of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% (n = 30) patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Conclusion: Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.
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Affiliation(s)
- P Ravindra Babu
- Consultant Dermatologist, Raga Skin Care, Bengaluru, Karnataka, India
| | - A J S Pravin
- Department of Dermatology and Venerology, Kanyakumari Government Medical College, Nagercoil, Tamil Nadu, India
| | - Gaurav Deshmukh
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Dhiraj Dhoot
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Aniket Samant
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Bhavesh Kotak
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
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Dhoot D, Teter B, Cole G. 86 EFFECTS OF DOCOSAHEXAENOIC ACID ON THE EXPRESSION OF LR11 IN MICE; IMPLICATIONS FOR ALZHEIMER'S DISEASE. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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