Real-life management of psoriasis with biological agents during pregnancy

BACKGROUND

French guidelines recommend stopping biologic treatment of psoriasis between 3 and 24 weeks before conception in accordance with the relevant Summary of Product Characteristics (SmPC). The aim of this study was to evaluate the real-life practice of dermatologists in the management of pregnant women with psoriasis previously treated with biologic agents. We wished to assess the level of practitioner adherence to the relevant SmPCs.

MATERIAL AND METHODS

We conducted a study in collaboration with GRPso and Resopso. A computerized questionnaire was completed by the practitioners. We performed descriptive statistics and studied the profile of the practitioners, their level of confidence with continuation of biological agents during pregnancy, and their reported practices on the use of biological agents in pregnancy. Statistical analyses were performed using XLSTAT. A p-value of less than 0.05 was considered significant.

RESULTS

A total of 63 dermatologists (women: 71%; mean age 43.8 years) participated in this study, the majority of whom were hospital-based (87%). Recommendations were followed by 36.5% of practitioners, while 44% reported discontinuing biologic agents on diagnosis of pregnancy, and 20.5% reported using these agents during pregnancy. Among dermatologists with more than ten years of experience, 19% reported following the SmPC. Among dermatologists with a patient base >200 (patients treated with biologic agents for psoriasis), 19% reported following the SmPC compared to 54% of practitioners with less than 50 patients. The mean age of dermatologists following the SmPC was 41 years vs. 47 years for those not following the SmPC.

DISCUSSION

The majority of practitioners do not follow recommendations on discontinuation of biologic agents before the planning of pregnancy by patients.

Long-term continuation with secukinumab in psoriasis: association with patient profile and initial psoriasis clearance

BACKGROUND

There are limited data regarding the long-term continuation with biological therapy for patients with psoriasis. In particular, the reasons for secukinumab discontinuation have not been thoroughly investigated.

AIM

To better ascertain the real-life continuation of secukinumab in psoriasis, we conducted a retrospective study to evaluate the incidence, causes and factors of secukinumab discontinuation in patients with psoriasis.

METHODS

All patients treated with secukinumab for psoriasis in the Department of Dermatology (Toulouse University and Larrey Hospital, Toulouse, France), between September 2011 and June 2017, were enrolled in the study.

RESULTS

Of the 91 patients in the study, 22 (24.2%) discontinued secukinumab. In 14 (15%) patients, the discontinuation was due to loss of efficacy. Two patients stopped treatment because they planned a pregnancy and five patients stopped because of adverse events. A longer disease duration (P = 0.01) and presence of palmoplantar psoriasis (P = 0.01) seem to be predictive factors for treatment failure. Patients reaching 90 or 100% improvement in Psoriasis Area and Severity Index (PASI90 and PASI100, respectively) at weeks 12-16 had a lower risk of long-term treatment discontinuation compared with patients who had less complete clearance (P = 0.04).

CONCLUSION

Long-term persistence of secukinumab appears to be good, as only 24.2% (n = 22) of the patients in this study discontinued secukinumab over the follow-up period. Loss of efficacy prompted discontinuation in about 14% of patients by the 2-year follow-up. Persistence appears to be lower in patients with palmoplantar psoriasis and in patients previously exposed to many systemic treatments. Optimal therapeutic response at 12-16 weeks as defined by reaching PASI90-100 seems to be predictive of long-term treatment persistence.

[Syphilis in Montpellier, France, from 2002 to 2011: Survey in a free hospital screening centre for venereal disease and in the dermatology unit of a regional public hospital]

BACKGROUND

In a context of resurgent syphilis in France since 2000, we conducted a retrospective study in two different centres in Montpellier, France: the dermatology department of a public hospital and an anonymous and free centre for provision of information, diagnosis and treatment of venereal diseases (CDAG-CIDDIST).

PATIENTS AND METHODS

All patients with syphilis seen from January 2002 to December 2011 were included with the collaboration of the National Health Institute (InVS) and the Bacteriology Department of the public hospital. Epidemiology, clinical presentation, serological data, and treatment and monitoring data for up to 2 years were recorded.

RESULTS

One hundred and seventy-five cases of syphilis were diagnosed: 154 at the CDAG and 21 at the dermatology unit. Ninety-six percent of cases concerned men with a median age of 36 years. Eighty-two percent of these cases involved men having sex with men (MSM). Forty-nine percent of cases were diagnosed in the secondary stage, 22% in the primary stage and 28% in the latent stage. The treatment administered in the majority of cases (73%) was benzathine-penicillin G. The numbers of patients showing incomplete follow-up were equal at both centres, with 31 patients (17.7%) failing to attend the follow-up visit. A decrease of at least 2 dilutions in VDRL score occurred in the year following treatment for 93 of 103 patients (90%). Patients managed at the dermatology department were older than their counterparts managed at the CDAG and exhibited more frequent cutaneous eruptions (58% vs. 3%, P<0.0001) but were less frequently bisexual. However, no significant differences were seen concerning sex and associated infections (hepatitis, gonococcal infection, HPV or herpes).

DISCUSSION

Syphilis is on the rise, especially in the MSM population. The epidemiological characteristics of our cohort were consistent with those of other Western European countries. Although the reasons for consultation differed between CDAG/CIDDIST and the dermatology department, the two centres are complementary. Benzathine-penicillin G was the most commonly used treatment, in accordance with the recommendations. Measures must be introduced to improve patient monitoring without compromising anonymity.