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Mason KJ, Burden AD, Barker JNWN, Lunt M, Ali H, Kleyn CE, McElhone K, Soliman MM, Green AC, Griffiths CEM, Reynolds NJ, Ormerod AD. Risks of basal cell and squamous cell carcinoma in psoriasis patients after treatment with biologic vs non-biologic systemic therapies. J Eur Acad Dermatol Venereol 2021; 35:e496-e498. [PMID: 33866626 DOI: 10.1111/jdv.17282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/18/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K J Mason
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,School of Medicine, Keele University, Staffordshire, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - J N W N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - H Ali
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - C E Kleyn
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A C Green
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - N J Reynolds
- Institute of Translation and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, UK
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- British Association of Dermatologists, London, UK
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Mason KJ, Burden AD, Barker JNWN, Lunt M, Ali H, Kleyn CE, McElhone K, Soliman MM, Green AC, Griffiths CEM, Reynolds NJ, Ormerod AD. Characteristics and skin cancer risk of psoriasis patients with a history of skin cancer in BADBIR. J Eur Acad Dermatol Venereol 2021; 35:e498-e501. [PMID: 33725378 DOI: 10.1111/jdv.17230] [Citation(s) in RCA: 2] [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] [Received: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- K J Mason
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,School of Medicine, Keele University, Staffordshire, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - J N W N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - H Ali
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - C E Kleyn
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A C Green
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - N J Reynolds
- Institute of Translation and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, UK
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- British Association of Dermatologists, London, UK
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3
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Lamb RC, Matcham F, Turner MA, Rayner L, Simpson A, Hotopf M, Barker JNWN, Jackson K, Smith CH. Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting. Br J Dermatol 2016; 176:1028-1034. [PMID: 27363600 DOI: 10.1111/bjd.14833] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well-being in people with psoriasis. OBJECTIVES To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at-risk groups for psychiatric morbidity. METHODS Consecutive patients attending a single, tertiary centre over a 10-month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at-risk groups for psychiatric morbidity. RESULTS Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5-12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4-15·8%) for generalized anxiety disorder (GAD; GAD-7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only. CONCLUSIONS Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.
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Affiliation(s)
- R C Lamb
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, U.K
| | - F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 9RJ, U.K
| | - M A Turner
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, U.K
| | - L Rayner
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 9RJ, U.K
| | - A Simpson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 9RJ, U.K
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 9RJ, U.K
| | - J N W N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, U.K
| | - K Jackson
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, U.K
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Hébert HL, Bowes J, Smith RL, Flynn E, Parslew R, Alsharqi A, McHugh NJ, Barker JNWN, Griffiths CEM, Barton A, Warren RB. Identification of loci associated with late-onset psoriasis using dense genotyping of immune-related regions. Br J Dermatol 2015; 172:933-9. [PMID: 25124732 DOI: 10.1111/bjd.13340] [Citation(s) in RCA: 13] [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] [Accepted: 08/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic plaque psoriasis can be subdivided into two groups according to the age of onset: type 1 (early onset, before 40 years) and type 2 (late onset, at or beyond 40 years). So far, 36 genetic loci have been associated with early-onset psoriasis in genome-wide association studies of white populations, while few studies have investigated genetic susceptibility to late-onset psoriasis. OBJECTIVES To characterize the genetics underpinning late-onset psoriasis. METHODS We genotyped 543 cases of late-onset psoriasis and 4373 healthy controls using the Immunochip array, a dense genotyping chip containing single-nucleotide polymorphisms previously associated with autoimmune diseases. Imputation using SNP2HLA and stepwise logistic regression analysis was performed for markers spanning the human leucocyte antigen gene region. RESULTS Two loci (HLA-C and IL12B) previously associated with early-onset psoriasis showed significant association at a genome-wide threshold in the current study (P < 5 × 10(-8)). Six more loci (TRAF3IP2, IL23R, RNF114, IFIH1, IL23A and HLA-A) showed study-wide significant association (P < 2·3 × 10(-5); calculated using Genetic type 1 error calculator). Additionally, we identified an association at IL1R1 on chromosome 2q13, which is not associated with early-onset disease. CONCLUSIONS This is the largest study to date of genetic loci in late-onset psoriasis, and demonstrates the overlap that exists with early-onset psoriasis. It also suggests that some loci are associated exclusively with late-onset psoriasis.
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Affiliation(s)
- H L Hébert
- The Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K; Arthritis Research U.K. Centre for Genetics and Genomics, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, U.K
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Ryan C, Kelleher J, Fagan MF, Rogers S, Collins P, Barker JNWN, Allen M, Hagan R, Renfro L, Kirby B. Genetic markers of treatment response to tumour necrosis factor-α inhibitors in the treatment of psoriasis. Clin Exp Dermatol 2014; 39:519-24. [DOI: 10.1111/ced.12323] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 02/01/2023]
Affiliation(s)
- C. Ryan
- Department of Dermatology; Baylor University Medical Center; Dallas TX USA
| | - J. Kelleher
- National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation; Beaumont Hospital; Dublin Ireland
| | - M. F. Fagan
- National Histocompatibility and Immunogenetics Reference Laboratory; Irish Blood Transfusion Service; Dublin Ireland
| | - S. Rogers
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
| | - P. Collins
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
| | - J. N. W. N. Barker
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; King's College; London UK
| | - M. Allen
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; King's College; London UK
| | - R. Hagan
- National Histocompatibility and Immunogenetics Reference Laboratory; Irish Blood Transfusion Service; Dublin Ireland
| | - L. Renfro
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester MN USA
| | - B. Kirby
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
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Wee JS, Petrof G, Jackson K, Barker JNWN, Smith CH. Infliximab for the treatment of psoriasis in the U.K.: 9 years' experience of infusion reactions at a single centre. Br J Dermatol 2012; 167:411-6. [PMID: 22404545 DOI: 10.1111/j.1365-2133.2012.10931.x] [Citation(s) in RCA: 18] [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: 01/08/2023]
Abstract
BACKGROUND Infliximab is an antitumour necrosis factor-α chimeric monoclonal antibody that is an established treatment for severe chronic plaque psoriasis. The recommended administration of a 2-h infusion followed by 2 h of monitoring is practised due to the potential occurrence of infusion reactions. However, accelerated infusions and shortened monitoring periods are used in patients with rheumatological disorders and inflammatory bowel disease without an increase in adverse events. OBJECTIVES To review the standard infliximab infusion protocol, the incidence of acute infusion reactions, the use of concomitant methotrexate and the clinical relevance of the 2-h postinfusion monitoring period. METHODS A retrospective case note and pharmacy database review of all infliximab infusions administered to patients with psoriasis at a tertiary dermatology centre was carried out. RESULTS Fifty-nine consecutive patients received a total of 858 infliximab infusions (range 1-43 infusions per patient) between January 2001 and June 2010. The incidence of infusion reactions was 1.5%, affecting 16.9% of patients and occurring between the first and eleventh infusions. Mild, moderate and severe acute reactions occurred in 0.6% (n=5), 0.3% (n=3) and 0.3% (n=3) of infliximab infusions, respectively. Thirty-three patients (56%) received concomitant systemic treatments during part of or throughout the infliximab treatment, including 24 (41%) on methotrexate (5-20 mg weekly). The prevalence of infusion reactions in patients receiving infliximab alone was 27% compared with 4% in those receiving concomitant methotrexate (P=0.05). All infusion reactions were managed as per our trust protocol with only one infusion reaction occurring in the postinfusion period (10 min after infusion completion). CONCLUSION The risk of infusion reactions in our cohort of patients was low, with the majority occurring early in the treatment cycle. Concomitant methotrexate may reduce this risk. A shortened postinfusion monitoring period can be safely considered.
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Affiliation(s)
- J S Wee
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, U.K
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7
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Wee JS, Petrof G, Jackson K, Barker JNWN, Smith CH. Infliximab for the treatment of psoriasis in the U.K.: 9 years' experience of infusion reactions at a single centre. Br J Dermatol 2012. [PMID: 22404545 DOI: 10.1111/j.1365-2133.2012.10931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infliximab is an antitumour necrosis factor-α chimeric monoclonal antibody that is an established treatment for severe chronic plaque psoriasis. The recommended administration of a 2-h infusion followed by 2 h of monitoring is practised due to the potential occurrence of infusion reactions. However, accelerated infusions and shortened monitoring periods are used in patients with rheumatological disorders and inflammatory bowel disease without an increase in adverse events. OBJECTIVES To review the standard infliximab infusion protocol, the incidence of acute infusion reactions, the use of concomitant methotrexate and the clinical relevance of the 2-h postinfusion monitoring period. METHODS A retrospective case note and pharmacy database review of all infliximab infusions administered to patients with psoriasis at a tertiary dermatology centre was carried out. RESULTS Fifty-nine consecutive patients received a total of 858 infliximab infusions (range 1-43 infusions per patient) between January 2001 and June 2010. The incidence of infusion reactions was 1.5%, affecting 16.9% of patients and occurring between the first and eleventh infusions. Mild, moderate and severe acute reactions occurred in 0.6% (n=5), 0.3% (n=3) and 0.3% (n=3) of infliximab infusions, respectively. Thirty-three patients (56%) received concomitant systemic treatments during part of or throughout the infliximab treatment, including 24 (41%) on methotrexate (5-20 mg weekly). The prevalence of infusion reactions in patients receiving infliximab alone was 27% compared with 4% in those receiving concomitant methotrexate (P=0.05). All infusion reactions were managed as per our trust protocol with only one infusion reaction occurring in the postinfusion period (10 min after infusion completion). CONCLUSION The risk of infusion reactions in our cohort of patients was low, with the majority occurring early in the treatment cycle. Concomitant methotrexate may reduce this risk. A shortened postinfusion monitoring period can be safely considered.
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Affiliation(s)
- J S Wee
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, U.K
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Affiliation(s)
- J N W N Barker
- St John's Institute of Dermatology, King's College London, London SE1 9RT, UK.
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Fonia A, Jackson K, Lereun C, Grant DM, Barker JNWN, Smith CH. A retrospective cohort study of the impact of biologic therapy initiation on medical resource use and costs in patients with moderate to severe psoriasis. Br J Dermatol 2011; 163:807-16. [PMID: 20662837 DOI: 10.1111/j.1365-2133.2010.09944.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Biologic therapy has become established as an important treatment option in patients with severe psoriasis, but is significantly more expensive in terms of drug costs than traditional treatment options. Relatively little is known about the total healthcare cost of treating severe psoriasis in daily clinical practice and what the budgetary impacts of such high-cost drugs are when compared with standard systemic therapy. OBJECTIVES To describe the impact of biologic therapy introduction on the use of medical resources, costs and where available, outcomes in patients with moderate to severe psoriasis. METHODS Data were extracted from case notes of a sequential patient cohort with psoriasis attending a tertiary referral severe psoriasis service and initiated on biologics (adalimumab, efalizumab, etanercept or infliximab) for treatment of their psoriasis. Data on hospital resource use (inpatient, outpatient, day ward, accident and emergency visits and phototherapy sessions) and drug usage (systemic nonbiologic and biologic psoriasis therapies and supportive drugs) were collected for 12 months prior to, and at least 6 months following initiation of biologic therapy. Outcome was measured using the Psoriasis Area and Severity Index (PASI). Differences in resource use and associated costs and outcomes, between 12 months before and after initiation of biologic therapy, were tested using Wilcoxon paired sign tests for continuous data and the McNemar test for categorical data. Confidence intervals (CI) around treatment costs were constructed using a 5000-sample bootstrap analysis. RESULTS The primary analysis population comprised 76 patients completing 12 months of biologic therapy: 71% males; mean age at time of study 47·3 years (range 23-74); mean duration of psoriasis 24·7 years (range 5·3-45·5). Significant reductions (P < 0·05) in the year following initiation of biologic therapy were observed for all hospital resource use categories, with mean annual costs reduced by £1682 (95% CI -3182 to -182·2; P = 0·05). Mean annual drug costs increased by £9456 (95% CI 8732-10,182; P < 0·001). Mean PASI fell by 8·9 points from 18·7 to 9·8 (95% CI -10·8 to -7·1; P < 0·001). CONCLUSIONS Total healthcare costs associated with treatment of severe psoriasis with biologic therapy are significantly greater than with traditional systemic therapy. However, some of these are offset by substantial reductions in the number and length of hospital admissions and use of photo- and systemic therapy, and result in significantly improved patient outcome (as inferred by improvement in PASI).
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Affiliation(s)
- A Fonia
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and Division of Genetics and Molecular Medicine, King's College London, London, UK
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Martyn-Simmons CL, Ranawaka RR, Chowienczyk P, Crook MA, Marber MS, Smith CH, Barker JNWN. A prospective case-controlled cohort study of endothelial function in patients with moderate to severe psoriasis. Br J Dermatol 2010; 164:26-32. [PMID: 20819085 DOI: 10.1111/j.1365-2133.2010.10031.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is well-documented evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular disease (CVD). While this risk can, at least in part, be attributed to the high prevalence of traditional risk factors in the population with psoriasis, some epidemiological evidence suggests it may be independent of these. OBJECTIVES This prospective, case-controlled study investigates whether psoriasis is a risk factor for CVD using two, validated, sensitive markers of CVD, endothelial dysfunction and high-sensitivity C-reactive protein (hsCRP). METHODS Patients were recruited from a tertiary referral psoriasis clinic and exclusion criteria included established CVD and/or conventional risks for CVD. Preclinical CVD was assessed using flow-mediated brachial artery dilatation, which measures endothelial dysfunction, and hsCRP, a serological marker of atherosclerosis. RESULTS Sixty-four patients (22%) out of a total of 285 consecutive patients attending the severe psoriasis clinic were entered into the study. One hundred and sixty-one (56%) were excluded following identification of cardiovascular risk; 39 of the 161 (24%) had at least two cardiovascular risk factors. A further 16 (6%) patients were excluded because of established CVD. No statistically significant difference in endothelial dysfunction was observed between patients with psoriasis (n = 60) and healthy controls (n = 117) (P = 0·508). The hsCRP level was, however, significantly elevated in the psoriasis group (2·828 mg L(-1), SEM 0·219; controls 0·728 mg L(-1), SEM 0·142; P < 0·05). CONCLUSION This large, investigative study is the first to assess endothelial function in patients with psoriasis after exclusion of traditional risk factors for CVD. These data suggest that psoriasis per se is not a risk factor for CVD and that elevated hsCRP is possibly independent of atheroma risk. There was a high prevalence of traditional risk factors in our population with severe psoriasis.
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Affiliation(s)
- C L Martyn-Simmons
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, King's College London, Guy's Hospital, London SE1 9RT, UK
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Woolf RT, Smith CH, Robertson K, Barker JNWN. Switching to adalimumab in patients with moderate to severe psoriasis who have failed on etanercept: a retrospective case cohort study. Br J Dermatol 2010; 163:889-92. [PMID: 20854408 DOI: 10.1111/j.1365-2133.2010.09893.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith CH, Anstey AV, Barker JNWN, Burden AD, Chalmers RJG, Chandler DA, Finlay AY, Griffiths CEM, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD. British Association of Dermatologists' guidelines for biologic interventions for psoriasis 2009. Br J Dermatol 2010; 161:987-1019. [PMID: 19857207 DOI: 10.1111/j.1365-2133.2009.09505.x] [Citation(s) in RCA: 347] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Martyn-Simmons CL, Green L, Ash G, Groves RW, Smith CH, Barker JNWN. Adalimumab for psoriasis patients who are non-responders to etanercept: open-label prospective evaluation. J Eur Acad Dermatol Venereol 2009; 23:1394-7. [DOI: 10.1111/j.1468-3083.2009.03325.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pink AE, Fonia A, Allen MH, Smith CH, Barker JNWN. Antinuclear antibodies associate with loss of response to antitumour necrosis factor-alpha therapy in psoriasis: a retrospective, observational study. Br J Dermatol 2009; 162:780-5. [PMID: 19863499 DOI: 10.1111/j.1365-2133.2009.09563.x] [Citation(s) in RCA: 70] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increasing number of patients with severe psoriasis are failing to respond to antitumour necrosis factor (TNF)-alpha therapy (etanercept, infliximab and adalimumab). OBJECTIVES We observed that many of these patients developed antinuclear antibodies (ANA) and antidouble-stranded DNA (anti-dsDNA) antibodies while on treatment prompting us to investigate whether their development is associated with anti-TNF treatment failure. METHODS All patients with psoriasis who had received anti-TNF therapies were identified and their blood results and treatment histories were obtained from electronic patient records and case notes. RESULTS A total of 97 patients had been treated with anti-TNF agents (60 were on their first agent, 22 had been on and stopped one agent, nine had been on and stopped two agents and six had been on and stopped all three agents). ANA developed in 17% of patients on their first treatment, 54% of patients who had failed one treatment, 78% of patients who had failed two treatments and 83% of patients who had failed all three treatments. Anti-dsDNA antibodies developed in 2%, 27%, 33% and 83% of patients from the same respective groups. Significantly, the antibodies developed before treatment had failed with all three agents and their development was not related to the total time that patients had been on anti-TNF therapy. CONCLUSIONS This study suggests that the development of ANA and anti-dsDNA antibodies on anti-TNF treatment may act as a marker of forthcoming treatment failure. Large-scale prospective studies are required to assess the importance of this observation.
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Affiliation(s)
- A E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and Division of Genetics and Molecular Medicine, King's College London, 9th Floor Guy's Tower, Great Maze Pond, London SE1 9RT, U.K
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Christophers E, Barker JNWN, Griffiths CEM, Daudén E, Milligan G, Molta C, Sato R, Boggs R. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol 2009; 24:548-54. [PMID: 19874432 DOI: 10.1111/j.1468-3083.2009.03463.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Estimates of psoriatic arthritis (PsA) prevalence among psoriasis patients vary widely (5-40%). The time to development of PsA in patients with plaque psoriasis also remains unclear. OBJECTIVES To examine whether length of time since diagnosis of psoriasis affects risk of developing PsA, and to assess differences in quality of life (QoL), work-related issues, comorbidities and healthcare resource utilization (HCRU) for patients with PsA vs. psoriasis. METHODS This large cross-sectional observational study was conducted in the UK, Italy, France, Spain and Germany in 2006. Dermatologists who actively treated patients with psoriasis recruited 10 consecutive patients with psoriasis. Presence of PsA, body surface area (BSA) affected with psoriasis and HCRU were recorded; patients completed EUROQoL (EQ5D) and employment disadvantages questionnaires. RESULTS Patients with psoriasis (n = 1560) included 126 with PsA. Ninety per cent of these patients with PsA were seen by dermatologists who involved a rheumatologist in the care of their patients with PsA. Survival analysis indicated that the incidence of PsA among psoriasis patients remained constant (74 per 1000 person-years), while the prevalence increased with time since diagnosis of psoriasis, reaching 20.5% after 30 years. In addition, those with high BSA currently affected by psoriasis were more likely to have developed PsA (P < 0.028). PsA patients reported reduced QoL compared with psoriasis patients (EQ5D score: 0.56 vs. 0.82: P < 0.0005), as well as more work problems. PsA patients were more likely to be hospitalized (0.27 +/- 0.84 vs. 0.14 +/- 0.71 per year; P < 0.0005) and have additional comorbidities than those without PsA. CONCLUSIONS The incidence of PsA was constant after initial diagnosis of psoriasis, leading to a higher prevalence of concomitant PsA over time. PsA is associated with decreased QoL and increased work-related problems, HCRU and comorbidities. Dermatologists should screen for PsA in their patients, especially long-standing patients who did not initially present with PsA.
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Affiliation(s)
- E Christophers
- Department of Dermatology, University of Kiel, Kiel, Germany.
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Wain EM, Darling MI, Pleass RD, Barker JNWN, Smith CH. Treatment of severe, recalcitrant, chronic plaque psoriasis with fumaric acid esters: a prospective study. Br J Dermatol 2009. [PMID: 19519838 DOI: 10.1111/j.1365-2133.2009.09267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fumaric acid esters (FAE) are used in Germany as a first-line systemic treatment for chronic plaque psoriasis, with proven efficacy and low toxicity. Their use in the U.K. is variable, and they remain unlicensed. Consequently, efficacy and safety data from U.K. patients is limited and their place in the psoriasis treatment armamentarium is unclear. OBJECTIVES To examine the efficacy and safety of FAE in a prospective cohort of U.K. patients with severe, treatment-recalcitrant, chronic plaque psoriasis. METHODS A single-centre, open, nonrandomized, prospective study was performed in a regional referral centre for patients with severe psoriasis. Outcomes were measured by the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), blood investigations and adverse events monitoring. RESULTS Eighty patients were recruited. Fifty-nine per cent were taking a concomitant oral antipsoriatic agent; 20% achieved a PASI-50, 8% a PASI-75 and 4% a PASI-90 on intention-to-treat analysis at 3 months with an overall, statistically significant, reduction in PASI from 13.9 + or - 9.0 to 11.3 + or - 9.2 (P < 0.0001). At 3 months, lymphopenia was seen in 33% of the cohort with significantly lower counts in patients responsive to FAE (P = 0.008). In addition, by 3 months, 36% of concomitant antipsoriatic medication had been stopped and 25% of doses had been reduced without loss of disease control. Side-effects (most commonly diarrhoea, abdominal pain and flushing) were reported by 74% of patients resulting in cessation of FAE in 36%. CONCLUSIONS FAE is a useful alternative treatment option in patients with severe, treatment-resistant, chronic plaque psoriasis and can allow dose reduction, and subsequent cessation, of other, potentially more toxic agents.
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Affiliation(s)
- E M Wain
- Skin Therapy Research Unit, St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, King's College, St Thomas' Hospital, London SE1 7EH, London
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Wain EM, Darling MI, Pleass RD, Barker JNWN, Smith CH. Treatment of severe, recalcitrant, chronic plaque psoriasis with fumaric acid esters: a prospective study. Br J Dermatol 2009; 162:427-34. [PMID: 19519838 DOI: 10.1111/j.1365-2133.2009.09267.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fumaric acid esters (FAE) are used in Germany as a first-line systemic treatment for chronic plaque psoriasis, with proven efficacy and low toxicity. Their use in the U.K. is variable, and they remain unlicensed. Consequently, efficacy and safety data from U.K. patients is limited and their place in the psoriasis treatment armamentarium is unclear. OBJECTIVES To examine the efficacy and safety of FAE in a prospective cohort of U.K. patients with severe, treatment-recalcitrant, chronic plaque psoriasis. METHODS A single-centre, open, nonrandomized, prospective study was performed in a regional referral centre for patients with severe psoriasis. Outcomes were measured by the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), blood investigations and adverse events monitoring. RESULTS Eighty patients were recruited. Fifty-nine per cent were taking a concomitant oral antipsoriatic agent; 20% achieved a PASI-50, 8% a PASI-75 and 4% a PASI-90 on intention-to-treat analysis at 3 months with an overall, statistically significant, reduction in PASI from 13.9 + or - 9.0 to 11.3 + or - 9.2 (P < 0.0001). At 3 months, lymphopenia was seen in 33% of the cohort with significantly lower counts in patients responsive to FAE (P = 0.008). In addition, by 3 months, 36% of concomitant antipsoriatic medication had been stopped and 25% of doses had been reduced without loss of disease control. Side-effects (most commonly diarrhoea, abdominal pain and flushing) were reported by 74% of patients resulting in cessation of FAE in 36%. CONCLUSIONS FAE is a useful alternative treatment option in patients with severe, treatment-resistant, chronic plaque psoriasis and can allow dose reduction, and subsequent cessation, of other, potentially more toxic agents.
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Affiliation(s)
- E M Wain
- Skin Therapy Research Unit, St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, King's College, St Thomas' Hospital, London SE1 7EH, London
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Warren RB, Smith RL, Campalani E, Eyre S, Smith CH, Barker JNWN, Worthington J, Griffiths CEM. Outcomes of methotrexate therapy for psoriasis and relationship to genetic polymorphisms. Br J Dermatol 2008; 160:438-41. [PMID: 19016697 PMCID: PMC2680291 DOI: 10.1111/j.1365-2133.2008.08898.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [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] [Indexed: 11/28/2022]
Abstract
Background The use of methotrexate is limited by interindividual variability in response. Previous studies in patients with either rheumatoid arthritis or psoriasis suggest that genetic variation across the methotrexate metabolic pathway might enable prediction of both efficacy and toxicity of the drug. Objectives To assess if single nucleotide polymorphisms (SNPs) across four genes that are relevant to methotrexate metabolism [folypolyglutamate synthase (FPGS), gamma-glutamyl hydrolase (GGH), methylenetetrahydrofolate reductase (MTHFR) and 5-aminoimidazole-4-carboxamide ribonucleotide transformylase (ATIC)] are related to treatment outcomes in patients with psoriasis. Methods DNA was collected from 374 patients with psoriasis who had been treated with methotrexate. Data were available on individual outcomes to therapy, namely efficacy and toxicity. Haplotype-tagging SNPs (r2 > 0·8) for the four genes with a minor allele frequency of > 5% were selected from the HAPMAP phase II data. Genotyping was undertaken using the MassARRAY spectrometric method (Sequenom®). Results There were no significant associations detected between clinical outcomes in patients with psoriasis treated with methotrexate and SNPs in the four genes investigated. Conclusions Genetic variation in four key genes relevant to the intracellular metabolism of methotrexate does not appear to predict response to methotrexate therapy in patients with psoriasis.
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Affiliation(s)
- R B Warren
- Dermatological Sciences, Salford Royal Hospital, The University of Manchester, Manchester M6 8HD, UK.
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Smith RL, Warren RB, Eyre S, Ke X, Young HS, Allen M, Strachan D, McArdle W, Gittins MP, Barker JNWN, Griffiths CEM, Worthington J. Polymorphisms in the PTPN22 region are associated with psoriasis of early onset. Br J Dermatol 2008; 158:962-8. [PMID: 18341666 PMCID: PMC2342636 DOI: 10.1111/j.1365-2133.2008.08482.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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] [Indexed: 12/16/2022]
Abstract
Background Psoriasis, a chronic inflammatory skin disease, affects approximately 2% of the population worldwide. Although the aetiology of psoriasis is poorly understood, patients with disease of early onset (Type I, age of onset ≤ 40 years) usually have a strong genetic component to the disease. Objectives The purpose of this study was to investigate the role of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene region in susceptibility to Type I psoriasis. Patients and methods Thirteen single nucleotide polymorphisms (SNPs) mapping to the PTPN22 region were genotyped in 647 patients with Type I psoriasis and 566 normal controls. Results The rs2476601 (R620W) SNP, widely associated with other inflammatory autoimmune diseases, showed no evidence of association with susceptibility to Type I psoriasis. Two SNPs (rs1217414 and rs3789604) demonstrated significant association with Type I psoriasis and were subsequently genotyped in a further 253 unrelated patients and 2024 normal controls. rs1217414 and rs3789604 were also significantly associated with Type I psoriasis in the combined datasets (P = 0·003 and P = 0·0002, respectively); furthermore carriage of both risk alleles was also significantly associated (P = 0·002). Conclusions This study demonstrates evidence of association of two SNPs (rs1217414 and rs3789604) in the PTPN22 region with Type I psoriasis, providing evidence for a role of this gene in Type I psoriasis that is not conferred by the R620W variant previously associated with a number of inflammatory diseases.
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Affiliation(s)
- Rh Ll Smith
- arc Epidemiology Unit, The University of Manchester, and Dermatological Sciences, Hope Hospital, Manchester M6 8HD, UK.
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Abstract
We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) to efalizumab. A 52-year-old man developed a widespread papulovesicular rash after 4 weeks of treatment with efalizumab (1.0 mg/kg/week) for treatment-resistant severe psoriasis. Histology revealed a subepidermal blister with eosinophil-rich inflammatory cell infiltrate. Subsequently, the patient developed high peripheral eosinophilia, abnormal liver function, malaise and fever, all requiring inpatient admission. Efalizumab was discontinued immediately, but the rash persisted for 4 months and was only controlled by oral prednisolone at a dose of 30 mg/day. To our knowledge, this is the first reported case of DRESS caused by efalizumab.
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Affiliation(s)
- J M L White
- Skin Therapy Research Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
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Griffiths CEM, Christophers E, Barker JNWN, Chalmers RJG, Chimenti S, Krueger GG, Leonardi C, Menter A, Ortonne JP, Fry L. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol 2007; 156:258-62. [PMID: 17223864 DOI: 10.1111/j.1365-2133.2006.07675.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
For nearly 200 years it has been appreciated that plaque psoriasis consists of a number of distinct clinical phenotypes. However, a reliable and simple stratification of clinical presentation of psoriasis is lacking. In the era of immunogenetic association studies and an advanced understanding of the pathomechanisms of psoriasis it is important that a classification of the disease according to phenotype is readily available. Such a classification would facilitate clinically relevant interpretation of investigational data. A meeting of the International Psoriasis Council produced a consensus on clinical phenotypes of psoriasis equally relevant to clinical practitioners and psoriasis researchers.
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Affiliation(s)
- C E M Griffiths
- Dermatology Centre, The University of Manchester, Hope Hospital, Salford, Manchester, UK
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Affiliation(s)
- Catherine H Smith
- Skin Therapy Research Unit, St Johns Institute of Dermatology, Kings College London, St Thomas' Hospital, London SE1 7EH.
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Smith CH, Jackson K, Bashir SJ, Perez A, Chew AL, Powell AM, Wain M, Barker JNWN. Infliximab for severe, treatment-resistant psoriasis: a prospective, open-label study. Br J Dermatol 2006; 155:160-9. [PMID: 16792769 DOI: 10.1111/j.1365-2133.2006.07316.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infliximab, a mouse-human chimeric monoclonal antibody directed against tumour necrosis factor-alpha, has been shown to be effective for moderate to severe psoriasis, but there are few data published on its use in recalcitrant, treatment-resistant disease or in combination with other antipsoriatic therapies. OBJECTIVES To report our experience with infliximab in the treatment of patients attending a tertiary referral service with severe recalcitrant disease. METHODS All patients attending a tertiary referral service for severe psoriasis who were treated with infliximab between 2002 and July 2005 were entered into a prospective, open-label study. Details on disease phenotype, clinical course and adverse events were recorded together with measures of disease severity [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, clinical photography] at baseline, weeks 2 and 6, and then at 2-monthly intervals throughout the treatment period. RESULTS Twenty-three patients were treated with infliximab during the study; one patient had pustular psoriasis and was therefore excluded from statistical analysis. All had severe disease (baseline PASI 26.5+/-6.7, mean+/-SD, n=22) and had received at least two systemic therapies for psoriasis in the past; 16 were taking one or more concomitant therapies at the time of treatment initiation. At week 10, 95% had achieved a 50% or greater improvement in baseline PASI (PASI 50), and 77% had achieved a 75% or greater improvement (PASI 75). Efficacy was sustained in the longer term, with eight of 10 patients on treatment for more than 11 months maintaining at least a PASI 50. Only one patient had treatment withdrawn due to lack of efficacy, two suffered severe systemic infections including extrapulmonary tuberculosis (splenic abscess) and cellulitis, and six have discontinued due to adverse effects including infusion reactions (two), severe thrombocytopenia (one), hepatitis (one) and malignancy (two). CONCLUSIONS Data from this open-label study suggest that infliximab is a rapidly effective treatment for patients with severe, treatment-resistant disease, although approximately 25% of patients had to discontinue therapy due to the development of serious adverse effects. Long-term follow-up, continued pharmacovigilance, and further controlled comparative studies will be required to evaluate fully the risks associated with infliximab in the context of this already difficult to treat population.
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Affiliation(s)
- C H Smith
- Skin Therapy Research Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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Campalani E, Allen MH, Fairhurst D, Young HS, Mendonca CO, Burden AD, Griffiths CEM, Crook MA, Barker JNWN, Smith CH. Apolipoprotein E gene polymorphisms are associated with psoriasis but do not determine disease response to acitretin. Br J Dermatol 2005; 154:345-52. [PMID: 16433808 DOI: 10.1111/j.1365-2133.2005.06950.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psoriasis is associated with abnormal plasma lipid metabolism and a high frequency of cardiovascular events. Increased lipid levels are also seen in patients with psoriasis treated with acitretin. Apolipoprotein E (ApoE) variants have been linked to hypertriglyceridaemia and hypercholesterolaemia in normal individuals. Two coding single nucleotide polymorphisms at +3937 and +4075 define the three common ApoE alleles e2, e3 and e4. OBJECTIVES To test the hypothesis that particular ApoE polymorphism(s) are associated with psoriasis and that specific ApoE allelic variant(s) may be a marker for predicting disease response to acitretin. METHODS DNA was genotyped for ApoE polymorphisms using a radioactive hybridization technique in cohorts of patients with psoriasis, including patients with chronic plaque psoriasis (CPP, n = 212), guttate psoriasis (GP, n = 94), palmoplantar pustulosis (PPP, n = 101), controls (n = 137), acitretin responders (n =106) and acitretin nonresponders (n = 84). RESULTS The frequency of the e4 allele (+3937C/+4075C) was significantly higher in patients with CPP and GP than in controls (P = 0.008 and P = 0.02, respectively). There was no significant difference in allele frequencies between patients with PPP and controls. Allelic distribution was similar in acitretin responders and nonresponders. CONCLUSIONS These data demonstrate an association between the Apo e4 allele and CPP and GP, suggesting a possible pathogenic role for ApoE in psoriasis. Our results do not support a link between disease response to acitretin and the e2, e3 or e4 allelic variants of ApoE.
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Affiliation(s)
- E Campalani
- The Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK.
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Smith CH, Anstey AV, Barker JNWN, Burden AD, Chalmers RJG, Chandler D, Finlay AY, Griffiths CEM, Grifitths CEM, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 2005; 153:486-97. [PMID: 16120132 DOI: 10.1111/j.1365-2133.2005.06893.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, GKT School of Medicine, St Thomas' Hospital, London SE1 7EH, UK.
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Ameen M, Allen MH, Fisher SA, Lewis CM, Cuthbert A, Kondeatis E, Vaughan RW, Murakami H, Nakagawa H, Barker JNWN. Corneodesmosin (CDSN) gene association with psoriasis vulgaris in Caucasian but not in Japanese populations. Clin Exp Dermatol 2005; 30:414-8. [PMID: 15953084 DOI: 10.1111/j.1365-2230.2005.01789.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PSORS1 on chromosome 6p21.3, which contains the MHC, is a major susceptibility locus for psoriasis vulgaris. This region is characterized by strong linkage disequilibrium and contains the corneodesmosin (CSDN) gene, an attractive candidate for psoriasis susceptibility based on its putative biological function in keratinocyte adhesion, and HLA-Cw6, an established marker for psoriasis susceptibility. We compared two genetically independent populations in order to define the major psoriasis susceptibility gene, a British Caucasian population comprising parent-offspring trios analysed by the transmission disequilibrium test (TDT) and a Japanese case-control population. All individuals were investigated for CDSN polymorphism (+619, +1236, +1240 and +1243) and HLA-C association. Our data confirms strong association with HLA-Cw6 and CDSN allele 5 (+619T, +1240G, +1243C) in the Caucasian cohort (TDT, P = 5.4 x 10(-6)) and in addition defines this region further by identifying a high-risk CDSN haplotype (allele 5 and +1236T, P = 8.5 x 10(-8)). In contrast no association was observed in the Japanese cohort for any HLA-C or CDSN alleles. This data supports a role for the CDSN gene in Caucasian populations with psoriasis. However the lack of association with HLA-Cw6 and CDSN alleles in Japanese psoriasis patients may be because Japanese patients exhibit a form of psoriasis similar to late onset or Type II psoriasis vulgaris in contrast to early onset or Type I disease characterizing our Caucasian population.
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Affiliation(s)
- M Ameen
- St. John's Institute of Dermatology, Kings College, London, UK
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Stover C, Barrett S, Lynch NJ, Barker JNWN, Burden D, Trembath R, Schwaeble W, Veal C. Functional MASP2 single nucleotide polymorphism plays no role in psoriasis. Br J Dermatol 2005; 152:1313-5. [PMID: 15948998 DOI: 10.1111/j.1365-2133.2005.06547.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psoriasis is a heritable disease and genome-wide scans have implicated several loci of susceptibility. The gene for MASP-2, a protease involved in complement activation, is located within one of these loci on chromosome 1p. OBJECTIVES To assess whether partial or total MASP-2 deficiency is a risk factor for developing psoriasis. METHODS We screened a cohort of patients affected by plaque psoriasis and their parents by restriction fragment length polymorphism analyses. RESULTS We detected a single nucleotide polymorphism that leads to an amino acid exchange, which results in dissociation of MASP-2 from a carbohydrate recognition complex. CONCLUSIONS We show that this mutant allele is not associated with psoriasis. There was no favoured transmission from parents to affected offspring. The calculated allele frequency in this psoriasis group (Scottish and English) was 0.0326, and in the unaffected group 0.0379.
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Affiliation(s)
- C Stover
- Department Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 9HN, UK.
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Abstract
Three children with severe atopic dermatitis were noted at routine follow-up to have developed multiple small pigmented macules during long-term therapy with topical tacrolimus 0.1% (Protopic, Fujisawa). Representative lesions in two of the three cases were confirmed histologically as simple lentigines. The focal distribution of lentigines to sites of tacrolimus use, and the temporal association between use of tacrolimus and development of lesions, suggest that topical tacrolimus is of direct aetiological relevance to their development. Careful long-term follow-up will be required to assess the clinical implications of these findings and whether they represent an increase in risk for melanocytic neoplasia.
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Affiliation(s)
- J R Hickey
- Skin Therapy Research Unit and Department of Dermatopathology, St Thomas' Hospital, London SE1 7EH, UK.
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Barker JNWN. A review of recent journal highlights. Clin Exp Dermatol 2004. [DOI: 10.1111/j.1365-2230.2004.01622.x] [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: 11/27/2022]
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Young C, Allen MH, Cuthbert A, Ameen M, Veal C, Leman J, Burden AD, Kirby B, Griffiths CEM, Trembath RC, Mathew CG, Barker JNWN. A Crohn's disease-associated insertion polymorphism (3020insC) in the NOD2 gene is not associated with psoriasis vulgaris, palmo-plantar pustular psoriasis or guttate psoriasis. Exp Dermatol 2003; 12:506-9. [PMID: 12930309 DOI: 10.1034/j.1600-0625.2002.120420.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A C-insertion polymorphism in the NOD2 gene (3020insC) on chromosome 16 is a rare mutation associated with Crohn's disease. Crohn's disease and psoriasis are more commonly observed together than expected by chance. Furthermore a susceptibility locus for psoriasis has been identified on chromosome 16q which overlaps the recently identified susceptibility locus for Crohn's disease. Thus, NOD2 may potentially be important as a candidate susceptibility gene for psoriasis. We tested this hypothesis by genotyping psoriasis patients for the C-insertion polymorphism using the Taqman ABI 7700 sequencing system. No statistically significant differences were observed between psoriasis vulgaris (n = 216), palmo-plantar pustular psoriasis (PPP) (n = 100), guttate psoriasis (n = 118) and the control group (n = 283). In both patient and control groups, no mutant homozygotes were observed and approximately 4% were heterozygotes. This particular insertion mutation in the NOD2 gene does not appear to contribute to the genetic susceptibility of psoriasis vulgaris, PPP or guttate psoriasis. However, other mutations exist in the NOD2 gene, which may potentially have a role in psoriasis susceptibility.
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Affiliation(s)
- C Young
- St. John's Institute of Dermatology, Guy's, Kings & St Thomas' School of Medicine, London, UK
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Capon F, Toal IK, Evans JC, Allen MH, Patel S, Tillman D, Burden D, Barker JNWN, Trembath RC. Haplotype analysis of distantly related populations implicates corneodesmosin in psoriasis susceptibility. J Med Genet 2003; 40:447-52. [PMID: 12807967 PMCID: PMC1735499 DOI: 10.1136/jmg.40.6.447] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barker JNWN, Berth-Jones J, Groves R, Omerod AD, Rizova E, Griffiths CEM. Calcium homeostasis remains unaffected after 12 weeks' therapy with calcitriol 3 microg/g ointment; no correlation with extent of psoriasis. J DERMATOL TREAT 2003; 14:14-21. [PMID: 12745850 DOI: 10.1080/09546630305543] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the systemic safety of calcitriol 3 microg/g ointment (Silkis) ointment) in relation to body surface area (BSA) affected by chronic plaque psoriasis. METHODS In this open-label, multicentre study, patients were divided into three parallel groups: 5% to <15% (n=23), 15% to <25% (n=18), 25% to 35% (n=18) based on BSA involvement. Ointment was applied topically twice daily for 12 weeks; patients were followed up for a further 8 weeks. RESULTS There was no alteration of calcium homeostasis: the mean values of albumin-adjusted serum total calcium, as well as 24-hour urinary calcium and serum calcitriol levels, remained within normal ranges throughout treatment. No changes in calcium or phosphate homeostasis related to the area of psoriasis being treated with calcitriol ointment were detected. CONCLUSIONS Reductions in the global severity score and BSA involvement, as well as results of the assessment of improvement, attested to the clinical efficacy of calcitriol 3 microg/g ointment in psoriasis. The study confirms the systemic safety of calcitriol 3 microg/g in psoriatic patients with 5-35% BSA involvement.
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Affiliation(s)
- J N W N Barker
- St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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Bhushan M, Bleiker TO, Ballsdon AE, Allen MH, Sopwith M, Robinson MK, Clarke C, Weller RPJB, Graham-Brown RAC, Keefe M, Barker JNWN, Griffiths CEM. Anti-E-selectin is ineffective in the treatment of psoriasis: a randomized trial. Br J Dermatol 2002; 146:824-31. [PMID: 12000379 DOI: 10.1046/j.1365-2133.2002.04743.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin-homing, memory T lymphocytes play an important role in the pathogenesis of psoriasis by interacting with the vascular addressin, E-selectin and trafficking into lesional skin. Thus an attractive option for targeted therapy of the disease would be blockade of skin-homing T cells with an antibody directed at E-selectin. OBJECTIVE We performed a multicentre, randomized, placebo-controlled trial to investigate the clinical efficacy and side-effect profile of a humanized monoclonal antibody to E-selectin, CDP850, in the treatment of moderate to severe chronic plaque psoriasis. METHODS Patients with moderate/severe chronic plaque psoriasis were selected for study. Nine male subjects (mean age 37 years, range 25-47) were given 20 mg kg-1 CDP850 intravenously as a single dose and four subjects (three males, one female; mean age 40 years, range 23-50) received placebo infusion. Clinical response to treatment was assessed using the psoriasis area and severity index (PASI). Skin biopsies were taken for immunohistochemical analysis at the baseline, pretreatment, visit and also at day 2 and weeks 1 and 4 postinfusion. RESULTS The treatment was well-tolerated with a minimal side-effect profile. Plasma E-selectin levels were significantly decreased in those subjects who received CDP850 compared with those who had placebo for the entire study period. At the end of study (8 weeks postinfusion), there was no significant reduction in PASI from baseline for either the CDP850 or placebo-treated groups. Immunohistochemical analysis of biopsies taken from lesional psoriatic skin showed that 2 days after dosing with CDP850, staining for E-selectin was decreased, although not absent, on dermal vascular endothelial cells when compared with baseline (P < 0.01). This decrease in E-selectin expression was maintained 4 weeks after infusion (P < 0.05). It was not, however, accompanied by a significant reduction in numbers of neutrophils or lymphocytes in the dermis. There was a statistically significant increase in CD1a-positive epidermal Langerhans cells compared with pre-dose levels at week 1 (P < 0.05). CONCLUSIONS This clinicopathological study shows that anti-E-selectin (CDP850), although a well-tolerated, logical and safe therapy, does not appear to possess a therapeutic role in the treatment of chronic plaque psoriasis.
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Affiliation(s)
- M Bhushan
- The Dermatology Centre, Irving Building, University of Manchester, Hope Hospital, Salford, Manchester M6 8HD, UK
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Abstract
Systemic therapies are increasingly used in the management of common skin diseases, and drug toxicity and relative lack of efficacy remain significant problems. In addition, we are unable to predict life-threatening adverse reactions such as toxic epidermal necrolysis. Pharmacogenetics, the study of how genetic differences influence the variability of individual patient responses to drugs, aims to distinguish responders from non-responders and predict those in whom toxicity is likely. Successful application of pharmacogenetics should lead to rationalized drug therapy. Recent advances in molecular genetic techniques such as high-throughput genotyping and microarrays have the potential to provide a practicable and economical approach to future pharmacogenetic testing. Pharmacogenetics will change not only the way drugs are selected but will also impact on clinical trial design and the costs of healthcare delivery.
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Affiliation(s)
- M Ameen
- Skin Therapy Research Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
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Smith CH, Barker JNWN, Hay RJ. Clinicopathological features of Chromoblastomycosis—a case report. Br J Dermatol 1992. [DOI: 10.1111/j.1365-2133.1992.tb01274.x] [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: 11/30/2022]
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Morgan JG, Pereira HA, Sukiennicki T, Spitznagel JK, Larrick JW, Forsdyke DR, Blum S, Sideris DP, Forsdyke RE, Yu H, Carstens E, Hattori T, Yamamura Y, Ohmoto Y, Nishida T, Takatsuki K, Tekamp-Olson P, Gallegos C, Bauer D, McClain J, Sherry B, Fabre M, van Deventer S, Cerami A, Napolitano M, Modi WS, Seuanez VH, Cevario SJ, Leonard WJ, Schall T, Toy K, Goeddel DV, Hébert CA, Luscinskas FW, Kiely JM, Luis EA, Darbonne WC, Bennett GT, Liu CC, Obin MS, Gimbrone MA, Baker JB, Brown KA, Le Roy F, Noble G, Bacon K, Camp R, Vora A, Dumonde DC, Collins PD, Jose PJ, Williams TJ, Rampart M, Van Damme J, Fiers W, Herman AG, Pos O, Geertsma MF, Stevenhagen A, Nibbering PN, van Furth R, Bacon KB, Camp RDR, Millar AB, Meager A, Semple SJG, Rook GAW, Stein M, Gordon S, Morrison K, Jones DB, Jones EY, Stuart DI, Walker NPC, Thomsen MK, Larsen CG, Thestrup-Pedersen K, Kristensen M, Paludan K, Deleuren B, Kragballe K, Matsushima K, Wang JM, Taraboletti G, Mantovani A, Sica A, Zachariae K, Colditz I, Baggiolini M, Cunha FQ, Lorenzetti BB, Ferreira SH, Standiford TJ, Kunkel SL, Strieter RM, Chensue SW, Westwick J, Kasahara K, Ribeiro RA, Faccioli LH, Souza GEP, Flores CA, Kasahara K, Quinn DG, Haslberger A, Foster C, Ceska M, Ryder N, Kugler E, Lindley I, Barker JNWN, Jones ML, Mitra RS, Swenson C, Johnson K, Fantone JC, Dixit VM, Nickoloff BJ, Lam C, Klein L, Tuschil A, Shyy JY, Li YS, Massop DW, Cornhill JF, Kolattukudy PE, Pleass R, Brown Z, Fairbanks L, Thomas R. Abstracts. Chemotactic Cytokines 1991. [DOI: 10.1007/978-1-4684-6009-4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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