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Kamrani P, Flamm A. Expanding and Strengthening Your Referral Network. Dermatol Clin 2023; 41:619-626. [PMID: 37718019 DOI: 10.1016/j.det.2023.06.001] [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] [Indexed: 09/19/2023]
Abstract
Dermatology referral utilization is increasing, with 15% of dermatology-related visits by primary care resulting in a dermatology referral. Given this, both strengthening an expanding a referral is a key component of a successful dermatology practice. In particular, effective communication is essential for efficient patient-oriented coordinated care. Written and/or verbal communication can help build a strong communication network and, in some instances, can be applied toward Merit-based Incentive Payment System (MIPS) reporting and billing for coding families that incorporate the coordination of care. Reaching out directly to referring clinics has also been shown to increase the quantity of referrals. This can include providing clinics with patient handouts on your clinic, education on what information is prioritized within the referral, and educating staff on how to complete their referrals effectively and efficiently. Social media can play an important role in referrals, especially for patients looking for cosmetic care. There are many different platforms, and these can serve as a marketing tool for physicians looking to bring in new patients.
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Affiliation(s)
- Payvand Kamrani
- Department of Dermatology, Penn State Health, 200 Campus Drive, Suite 100, Hershey, PA 17033, USA
| | - Alexandra Flamm
- Department of Dermatology, NYU Grossman School of Medicine, 222 East 41st Street, 25th Floor, New York, NY 10017, USA.
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2
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Membrive-Jiménez C, Vieira-Maroun S, Márquez-Pete N, Cura Y, Pérez-Ramírez C, Tercedor-Sánchez J, Jiménez-Morales A, Ramírez-Tortosa MDC. ABCC1, ABCG2 and FOXP3: Predictive Biomarkers of Toxicity from Methotrexate Treatment in Patients Diagnosed with Moderate-to-Severe Psoriasis. Biomedicines 2023; 11:2567. [PMID: 37761008 PMCID: PMC10526923 DOI: 10.3390/biomedicines11092567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Methotrexate (MTX) is one of the most extensively used drugs in the treatment of moderate-to-severe psoriasis (PS). However, it frequently must be suspended owing to the toxicity in certain patients. OBJECTIVE To evaluate the influence of ABCC1, ABCG2, and FOXP3 in the development of MTX toxicity in PS. METHODS Retrospective cohort study with 101 patients. Five single-nucleotide polymorphisms (SNPs) were genotyped using real-time polymerase chain reaction with TaqMan probes. RESULTS Patients carrying ABCC1 rs2238476-AG genotype (AG vs. GG: OR = 8.04; 95% CI = 1.48-46.78; p = 0.015); FOXP3 rs376154-GT and GG genotypes (GT vs. TT/GG: OR = 3.86; 95% CI = 1.17-13.92; p = 0.031) and ABCG2 rs13120400-T allele (T vs. CC: OR = 8.33; 95% CI = 1.24-164.79; p = 0.059) showed a higher risk of developing more than one adverse effect. The toxicity analysis by subtypes showed that the ABCC1 rs2238476-AG genotype (AG vs. GG: OR = 8.10; 95% CI = 1.69-46.63; p = 0.011) and FOXP3 rs376154-GT genotype (OR = 4.11; 95% CI = 1.22-15.30; p = 0.027) were associated with the appearance of asthenia. No association of the other ABCC1 polymorphisms (rs35592 and rs246240) with MTX toxicity was found. CONCLUSION ABCC1, ABCG2, and FOXP3 polymorphisms can be considered to be risk biomarkers of toxicities in PS patients treated with MTX.
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Affiliation(s)
- Cristina Membrive-Jiménez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain (N.M.-P.)
| | - Sayleth Vieira-Maroun
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain (N.M.-P.)
| | - Noelia Márquez-Pete
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain (N.M.-P.)
| | - Yasmin Cura
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain (N.M.-P.)
| | - Cristina Pérez-Ramírez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain (N.M.-P.)
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, University of Granada, 18011 Granada, Spain;
| | | | - Alberto Jiménez-Morales
- Hospital Pharmacy Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain
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Membrive Jiménez C, Pérez Ramírez C, Sánchez Martín A, Vieira Maroun S, Arias Santiago SA, Ramírez Tortosa MDC, Jiménez Morales A. Influence of Genetic Polymorphisms on Response to Biologics in Moderate-to-Severe Psoriasis. J Pers Med 2021; 11:jpm11040293. [PMID: 33921427 PMCID: PMC8069496 DOI: 10.3390/jpm11040293] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin pathology of autoimmune origin and unknown etiology. There are various therapies for treating it, including a wide range of biopharmaceuticals indicated in moderate-to-severe psoriasis. Depending on their therapeutic target, they are classified as tumor necrosis factor inhibitors (anti-TNF) or cytokine inhibitors (interleukin-12, 23, and 17 antagonists). Although they have proved effective and safe, in clinical practice, many patients show a short- and long-term suboptimal response and even varying degrees of toxicity. This variability in response may be influenced by genetic factors, such as polymorphisms in the genes involved in the pathological environment, metabolism or mechanism of action of the drug that could affect the effectiveness and toxicity of biological therapies. This review assesses pharmacogenetic studies of the impact of genetic factors on response to biopharmaceuticals and toxicity in patients diagnosed with moderate-to-severe psoriasis. The results suggest that polymorphisms detected in the HLA genes, in genes that encode cytokines (TNF, IL genes, TNFAIP3), transporters (PDE3A-SLCO1C1, SLC12A8), receptors (TNFRSF1B, CD84, FCGR2A and FCGR3A, IL17RA, IL23R, TLR genes, PGLYRP4) and associated proteins (TNFAIP3, LY96, TIRAP, FBXL19), as well as other genes implicated in the pathogenesis of psoriasis (CDKAL1, CARD14, PTTG1, MAP3K1, ZNF816A, GBP6, CTNNA2, HTR2A, CTLA4, TAP1) can be used in the future as predictive markers of treatment response and/or toxicity with biological therapies in patients diagnosed with moderate-to-severe psoriasis, tailoring treatment to the individual patient.
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Affiliation(s)
- Cristina Membrive Jiménez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Cristina Pérez Ramírez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
- Department of Biochemistry, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain;
- Correspondence:
| | - Almudena Sánchez Martín
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Sayleth Vieira Maroun
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | | | | | - Alberto Jiménez Morales
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
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4
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D'Urso DF, Chiricozzi A, Pirro F, Calabrese L, Caldarola G, Fossati B, De Simone C, Peris K. New JAK inhibitors for the treatment of psoriasis and psoriatic arthritis. GIORN ITAL DERMAT V 2020; 155:411-420. [PMID: 32545945 DOI: 10.23736/s0392-0488.20.06658-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Psoriasis is a common inflammatory skin disease that can be associated with various pathological conditions among which arthritis is a frequent comorbidity. Based on the current pathogenetic model, development of psoriasis is mainly driven by the IL-23/IL-17A axis. Though the therapeutic armamentarium is expanding in the latest years, new therapies are needed because of the lack or loss of response or intolerance/contraindication to the currently approved drugs. The most recently developed drugs for the treatment of psoriasis and psoriatic arthritis specifically target cytokines, cytokine receptors, and intracellular signaling transducers that are involved in the pathogenesis of psoriasis. Janus kinase (JAK) pathway transduces signals of multiple cytokines, such as TNF-α, IL-23, IL-12, IFN, IL-6, IL-17, that have resulted crucial in the induction and maintenance of psoriasis inflammation. Thereby, JAK-1, JAK-3, TYK-2 belonging to the JAK family, have been identified as valid therapeutic targets in the treatment of psoriasis. Nowadays, different JAK inhibitors have been investigated in clinical trials showing promising results in terms of efficacy and safety. In this review, we systematically collected publications and data related to JAK inhibitors used in psoriasis and psoriatic arthritis providing the state-of-the-art on this new class of molecules in the treatment of these diseases.
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Affiliation(s)
- Dario F D'Urso
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Chiricozzi
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy - .,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Federico Pirro
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Laura Calabrese
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giacomo Caldarola
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Barbara Fossati
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Clara De Simone
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy.,IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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5
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Rencz F, Gulácsi L, Péntek M, Szegedi A, Remenyik É, Bata‐Csörgő Z, Bali G, Hidvégi B, Tamási B, Poór A, Hajdu K, Holló P, Kinyó Á, Sárdy M, Brodszky V. DLQI‐R scoring improves the discriminatory power of the Dermatology Life Quality Index in patients with psoriasis, pemphigus and morphea. Br J Dermatol 2019; 182:1167-1175. [DOI: 10.1111/bjd.18435] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Affiliation(s)
- F. Rencz
- Department of Health Economics Corvinus University of Budapest Fővám tér 8 H‐1093 Budapest Hungary
- Hungarian Academy of Sciences Premium Postdoctoral Research Programme Nádor u 7 H‐1051 Budapest Hungary
| | - L. Gulácsi
- Department of Health Economics Corvinus University of Budapest Fővám tér 8 H‐1093 Budapest Hungary
| | - M. Péntek
- Department of Health Economics Corvinus University of Budapest Fővám tér 8 H‐1093 Budapest Hungary
| | - A. Szegedi
- Department of Dermatological AllergologyFaculty of Medicine University of Debrecen Nagyerdei krt 98 H‐4032 Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Nagyerdei krt 98 H‐4032 Debrecen Hungary
| | - É. Remenyik
- Department of Dermatology Faculty of Medicine University of Debrecen Nagyerdei krt 98 H‐4032 Debrecen Hungary
| | - Z. Bata‐Csörgő
- Department of Dermatology and Allergology Albert Szent‐Györgyi Medical Centre University of Szeged Korányi fasor 6 H‐6720 Szeged Hungary
| | - G. Bali
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - B. Hidvégi
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - B. Tamási
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - A.K. Poór
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - K. Hajdu
- Department of Dermatological AllergologyFaculty of Medicine University of Debrecen Nagyerdei krt 98 H‐4032 Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Nagyerdei krt 98 H‐4032 Debrecen Hungary
| | - P. Holló
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - Á. Kinyó
- Department of Dermatology, Venereology and Oncodermatology University of Pécs Akác u 1 H‐7632 Pécs Hungary
| | - M. Sárdy
- Department of Dermatology, Venereology and Dermatooncology Faculty of Medicine Semmelweis University Mária u 41 H‐1085 Budapest Hungary
| | - V. Brodszky
- Department of Health Economics Corvinus University of Budapest Fővám tér 8 H‐1093 Budapest Hungary
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Anstey A, Finlay A. Dermatology outpatient care in the U.K.: modernizing services requires patients as our partners. Br J Dermatol 2019; 180:968-970. [DOI: 10.1111/bjd.17688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A.V. Anstey
- Cardiff University, School of Medicine Heath Park Cardiff CF14 4XN U.K
- Betsi Cadwaladr University Heath Board Ysbyty Gwynedd Bangor Gwynedd LL57 2PW U.K
| | - A.Y. Finlay
- Cardiff University, School of Medicine Heath Park Cardiff CF14 4XN U.K
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7
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Ho P, Lin I, Yang X, Cho Y, Chu C. Using a novel scoring system for paronychia related to oncologic treatments (SPOT) for assessing paronychia severity and its correlation with pain index and quality of life. J Eur Acad Dermatol Venereol 2018; 33:204-212. [DOI: 10.1111/jdv.15121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- P.‐H. Ho
- Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - I.‐C. Lin
- Department of Dermatology National Cheng Kung University Hospital Tainan Taiwan
| | - X. Yang
- Department of Pharmacology Koo Foundation Sun Yat‐Sen Cancer Center Taipei Taiwan
| | - Y.‐T. Cho
- Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - C.‐Y. Chu
- Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
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Svendsen MT, Andersen F, Andersen KH, Pottegård A, Johannessen H, Möller S, August B, Feldman SR, Andersen KE. A smartphone application supporting patients with psoriasis improves adherence to topical treatment: a randomized controlled trial. Br J Dermatol 2018; 179:1062-1071. [PMID: 29654699 DOI: 10.1111/bjd.16667] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Adherence to topical psoriasis treatments is low, which leads to unsatisfactory treatment results. Smartphone applications (apps) for patient support exist but their potential to improve adherence has not been systematically evaluated. OBJECTIVES To evaluate whether a study-specific app improves adherence and reduces psoriasis symptoms compared with standard treatment. METHODS We conducted a randomized controlled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once-daily medication [calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app intervention (n = 68) groups. In total, 122 patients (91%) completed the 22-week follow-up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS-PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits. RESULTS Intention-to-treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/BD cutaneous foam than those in the nonintervention group at week 4 (65% vs. 38%, P = 0·004). The intervention group showed a greater LS-PGA reduction than the nonintervention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance. CONCLUSIONS This RCT demonstrates that the app improved short-term adherence to Cal/BD cutaneous foam treatment and psoriasis severity.
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Affiliation(s)
- M T Svendsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology (CIMT), Clinical Institute, University of Southern Denmark, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Dermatological Investigations Scandinavia, University of Southern Denmark, Odense, Denmark
| | - K H Andersen
- Dermatological Investigations Scandinavia, University of Southern Denmark, Odense, Denmark
| | - A Pottegård
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy, Odense University Hospital, Odense, Denmark
| | - H Johannessen
- Research Unit of User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - S Möller
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - S R Feldman
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology (CIMT), Clinical Institute, University of Southern Denmark, Odense, Denmark.,Dermatological Investigations Scandinavia, University of Southern Denmark, Odense, Denmark
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