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Mataix J, García L, Belinchón I, Ruiz Carrascosa JC, de la Cueva P, Carrascosa JM. Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:802-811. [PMID: 37244396 DOI: 10.1016/j.ad.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/29/2023] Open
Abstract
Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.
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Affiliation(s)
- J Mataix
- Departamento de Dermatología, Hospital Marina Baixa de Villajoyosa, Alicante, España
| | - L García
- Departamento de Dermatología, Hospital Universitario San Juan, Alicante, España
| | - I Belinchón
- Departamento de Dermatología, Hospital General Universitario Dr. Balmis- ISABIAL-UMH, Alicante, España.
| | - J C Ruiz Carrascosa
- Departamento de Dermatología, Hospital Universitario Clínico San Cecilio, Granada, España
| | - P de la Cueva
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España
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Mataix J, García L, Belinchón I, Ruiz Carrascosa JC, de la Cueva P, Carrascosa JM. [Translated article] Moderate to Severe Psoriasis in Older Adults: Recommendations on Management From the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T802-T811. [PMID: 37506825 DOI: 10.1016/j.ad.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 07/30/2023] Open
Abstract
Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.
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Affiliation(s)
- J Mataix
- Departamento de Dermatología, Hospital Marina Baixa de Villajoyosa, Alicante, Spain
| | - L García
- Departamento de Dermatología, Hospital Universitario San Juan, Alicante, Spain
| | - I Belinchón
- Departamento de Dermatología, Hospital General Universitario Dr. Balmis - ISABIAL-UMH, Alicante, Spain.
| | - J C Ruiz Carrascosa
- Departamento de Dermatología, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - P de la Cueva
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Gnesotto L, Mioso G, Bardazzi F, Filippi F, Di Lernia V, Motolese A, Di Nuzzo S, Conti A, Arginelli F, Corazza M, Odorici G, Borghi A, Gisondi P, Naldi L, Dapavo P, Parodi A, Burlando M, Piaserico S. Dimethyl Fumarate Treatment in Patients with Moderate-to-Severe Psoriasis: A 52-week Real-life Study. Acta Derm Venereol 2023; 103:adv4526. [PMID: 36987538 PMCID: PMC10077142 DOI: 10.2340/actadv.v103.4526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/17/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, Via Cesare Battisti 206, IT-35128 Padua, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, Via Cesare Battisti 206, IT-35128 Padua, Italy.
| | - Federico Bardazzi
- Department of Experimental, Diagnostic and Specialty Medicine- Division of Dermatology, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Department of Experimental, Diagnostic and Specialty Medicine- Division of Dermatology, University of Bologna, Bologna, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberico Motolese
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Di Nuzzo
- Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Conti
- Section of Dermatology, Department of Specialized Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Arginelli
- Section of Dermatology, Department of Specialized Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Odorici
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Luigi Naldi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Parodi
- University of Genova, DiSSal Section of Dermatology, San Martino Polyclinic Hospital IRCCS, Largo R. Benzi 10 16132 Genova, Italy
| | - Martina Burlando
- University of Genova, DiSSal Section of Dermatology, San Martino Polyclinic Hospital IRCCS, Largo R. Benzi 10 16132 Genova, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
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Burlando M, Campione E, Cuccia A, Malara G, Naldi L, Prignano F, Zichichi L. Real-world use of dimehtyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus. Dermatol Reports 2022. [DOI: 10.4081/dr.2023.9613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderate-to-severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. Seven dermatology experts gathered online for three meetings to identify consensus on use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. Twenty statements were discussed and voted on using a facilitator-mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug–drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and slow titration schedule. Hematologic monitoring throughout treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on optimal use of DMF to treat psoriasis.
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Di Cesare A, Ricceri F, Rosi E, Fastame MT, Prignano F. Therapy of PsO in Special Subsets of Patients. Biomedicines 2022; 10:2879. [PMID: 36359399 PMCID: PMC9687729 DOI: 10.3390/biomedicines10112879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 01/02/2024] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16-20 years of age (early onset) and 57-60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.
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Affiliation(s)
| | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
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Real-Life Effectiveness of Adalimumab Biosimilars in Patients with Chronic Plaque Psoriasis. Dermatol Ther (Heidelb) 2022; 12:1303-1311. [PMID: 35476248 PMCID: PMC9209594 DOI: 10.1007/s13555-022-00732-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The real-life effectiveness of adalimumab biosimilars in patients with psoriasis has rarely been investigated. Objective To investigate drug survival of adalimumab biosimilars in patients with chronic plaque psoriasis and factors associated with its discontinuation. Methods We carried out a retrospective observational study including all consecutive patients with chronic plaque psoriasis who initiated adalimumab biosimilar MSB11022 (Idacio), ABP501 (Amgevita), or SB5 (Imraldi) between 1 January 2018 and 1 January 2021. The 1-year drug survival of adalimumab biosimilar and independent factors associated with its discontinuation were investigated. Cox regression models were fit to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the risk of adalimumab discontinuation. A propensity score matching (PSM) model was adopted as sensitivity analysis. Results The study involved a total of 410 patients with follow-up of 549.84 person-years, 271 (66.1%) men, a mean (SD) age of 51.8 (14.5) years, and a baseline PASI of 14.54 (5.02). Among adalimumab biosimilars, 250 (61%) patients received MSB11022, 98 (24%) received ABP501, and 62 (15%) received SB5. Drug survival of adalimumab biosimilars at 1 year was 81.5% in the overall study population. Obesity was associated with increased risk of adalimumab discontinuation (HR = 2.01; 95% CI 1.33–3.03), whereas psoriatic arthritis (aHR = 0.32; 95% CI 0.16–0.64) and receiving adalimumab as first systemic treatment (aHR = 0.44; 95% CI 0.27–0.70) were associated with lower risk. Conclusion The real-life effectiveness of adalimumab biosimilars in patients with psoriasis is consistent with that previously reported for the originator. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00732-y.
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Campione E, Mazzilli S, Di Prete M, Dattola A, Cosio T, Lettieri Barbato D, Costanza G, Lanna C, Manfreda V, Gaeta Schumak R, Prignano F, Coniglione F, Ciprani F, Aquilano K, Bianchi L. The Role of Glutathione-S Transferase in Psoriasis and Associated Comorbidities and the Effect of Dimethyl Fumarate in This Pathway. Front Med (Lausanne) 2022; 9:760852. [PMID: 35211489 PMCID: PMC8863102 DOI: 10.3389/fmed.2022.760852] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Psoriasis vulgaris is a chronic inflammatory skin disease characterized by well-demarcated scaly plaques. Oxidative stress plays a crucial role in the psoriasis pathogenesis and is associated with the disease severity. Dimethyl fumarate modulates the activity of the pro-inflammatory transcription factors. This is responsible for the downregulation of inflammatory cytokines and an overall shift from a pro-inflammatory to an anti-inflammatory/regulatory response. Both steps are necessary for the amelioration of psoriatic inflammation, although additional mechanisms have been proposed. Several studies reported a long-term effectiveness and safety of dimethyl fumarate monotherapy in patients with moderate-to-severe psoriasis. Furthermore, psoriasis is a chronic disease often associated to metabolic comorbidities, as obesity, diabetes, and cardiovascular diseases, in which glutathione-S transferase deregulation is present. Glutathione-S transferase is involved in the antioxidant system. An increase of its activity in psoriatic epidermis in comparison with the uninvolved and normal epidermal biopsies has been reported. Dimethyl fumarate depletes glutathione-S transferase by formation of covalently linked conjugates. This review investigates the anti-inflammatory role of dimethyl fumarate in oxidative stress and its effect by reducing oxidative stress. The glutathione-S transferase regulation is helpful in treating psoriasis, with an anti-inflammatory effect on the keratinocytes hyperproliferation, and in modulation of metabolic comorbidities.
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Affiliation(s)
- Elena Campione
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Sara Mazzilli
- Italy State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Rome, Italy.,Anatomic Pathology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | | | - Terenzio Cosio
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Lettieri Barbato
- Department of Biology, University of Rome Tor Vergata, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | | | - Caterina Lanna
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Francesca Prignano
- Unit of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Filadelfo Coniglione
- Department of Surgical Sciences, University Nostra Signora del Buon Consiglio, Tirana, Albania
| | - Fabrizio Ciprani
- Italy State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Katia Aquilano
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
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