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Gkalpakiotis S, Kojanová M, Fialová J, Cetkovská P, Vašků V, Vantuchová Y, Machovcová A, Gkalpakioti P, Hrdá P, Arenberger P. Management of Moderate to Severe Plaque Psoriasis with Brodalumab in Daily Practice: Real-World Evidence from the LIBERO Study in the Czech Republic. Dermatol Ther (Heidelb) 2024; 14:115-130. [PMID: 38032433 PMCID: PMC10828329 DOI: 10.1007/s13555-023-01066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Psoriasis is a chronic, immune-mediated inflammatory skin disease. Despite the availability of several therapies, many patients affected by this disease remain untreated, do not have adequate response, or suffer from treatment-related toxic effects. It has been shown that the interleukin (IL)-17 pathway plays a key role in the immunopathogenesis of psoriasis. Brodalumab, the first human monoclonal IgG2 antibody that selectively binds to subunit A of the human IL-17 receptor, blocking interactions with a number of cytokines of the IL-17 family, has confirmed fast onset of action, high complete clearance rates, and sustained efficacy. Nevertheless, there is only a limited amount of published real-world evidence (RWE) data. METHODS This was an open-label, multicenter, real-world, prospective, non-interventional, non-controlled (single-arm) observational study (LIBERO-CZ) assessing the management of moderate to severe psoriasis with brodalumab in daily practice for up to 52 weeks of treatment. RESULTS Fifty-four patients (70.4% male, mean age 46.9 ± 13.4 years, weight 95.6 ± 22.7 kg, disease duration 18.6 ± 12.7 years) were enrolled and included in the final analysis. Forty-nine of the patients completed the study and five discontinued prematurely; 51.8% of all the enrolled patients were biologic-naïve. At baseline, 28% patients were classified as severe (psoriasis area severity index (PASI) ≥ 20). Overall, the mean PASI decreased by 15.6 from 16.1 (± 5.0) at baseline to 0.5 (± 1.2) at the last visit. The primary endpoint of an absolute PASI ≤ 3 at week 12 (as observed analysis) was achieved by 95.9% of patients. The static Physician's Global Assessment (sPGA) success (defined as clear = 0 and almost clear = 1) at week 52 was achieved by 92.1% of patients. PASI 75, PASI 90, and PASI 100 were achieved by 98.0%, 87.8%, and 75.5% of patients, respectively, after approximately 52 weeks of treatment. The study also recorded very positive results concerning patient-reported outcomes. CONCLUSIONS LIBERO-CZ confirms the fast onset and high clearance rates of brodalumab in real life in both biologic-naïve and biologic-experienced patients.
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Affiliation(s)
- Spyridon Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic.
| | - Martina Kojanová
- Department of Dermatovenereology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jorga Fialová
- Department of Dermatovenereology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Petra Cetkovská
- Department of Dermatovenereology, Faculty of Medicine and University Hospital, Charles University, Pilsen, Czech Republic
| | - Vladimír Vašků
- Department of Dermatovenereology, St. Anne's University Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Yvetta Vantuchová
- Department of Dermatology, Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Alena Machovcová
- Department of Dermatovenereology, Motol University Hospital, Prague, Czech Republic
| | - Petra Gkalpakioti
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | | | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
- Sanatorium of Professor Arenberger, Prague, Czech Republic
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Iversen L, Conrad C, Eidsmo L, Costanzo A, Narbutt J, Pinter A, Kingo K, Rivera Diaz R, Kolbinger F, Nanna M, Frueh JA, Jagiello P. Secukinumab demonstrates superiority over narrow-band ultraviolet B phototherapy in new-onset moderate to severe plaque psoriasis patients: Week 52 results from the STEPIn study. J Eur Acad Dermatol Venereol 2023; 37:1004-1016. [PMID: 36606536 DOI: 10.1111/jdv.18846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Biologic treatments have been studied mainly in patients with a long-term history of psoriasis and previous treatment failures. OBJECTIVES The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new-onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb-UVB) phototherapy. METHODS The STEPIn study is a randomized, open-label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously versus standard treatment with nb-UVB phototherapy in patients with new-onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively. RESULTS In the secukinumab and nb-UVB study arms, 77/80 and 76/80 randomized patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm versus 42.3% (32/76) in the nb-UVB arm (p < 0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm versus 36.8% in the nb-UVB arm (p < 0.0001). The safety data were consistent with the safety profiles of secukinumab and nb-UVB with no new or unexpected safety signals. CONCLUSIONS Secukinumab was superior to nb-UVB in treating patients with new-onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course.
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Affiliation(s)
- Lars Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Liv Eidsmo
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.,Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, Goethe-Universität Frankfurt am Main, Frankfurt, Germany
| | - Külli Kingo
- Department of Dermatology, University of Tartu, Dermatology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Raquel Rivera Diaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frank Kolbinger
- Department of Autoimmunity, Transplantation & Immunology, Novartis Institutes for Biomedical Research, Basel, Switzerland
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Amici JM, Bergqvist C, Ly S, Corgibet F, Seï JF, Seneschal J, Sbidian E, Beylot-Barry M. CITY-PSO: Prescribing behaviour of French private-practice dermatologists in psoriasis management: An observational, multicentre, cross-sectional study. Ann Dermatol Venereol 2022; 149:169-175. [PMID: 35181154 DOI: 10.1016/j.annder.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Information regarding the prescribing behaviour of French private-practice dermatologists (PPDs) is scarce. OBJECTIVES First, to describe the population of PPDs involved in psoriasis management. Second, to describe the population of adult patients treated for psoriasis and their management. METHODS We published a call for participation targeting PPDs; we first asked respondents to complete a form regarding their prescribing behaviour, and then to include consecutive patients consulting for psoriasis during a one-month study period and to collect patient data. RESULTS The 94 participating PPDs included 1022 patients of mean age 52.9±17.9 years. The average body mass index was 28, and 25% had vascular comorbidities. Two thirds of patients had chronic psoriasis, for which 45% had consulted at least 5 times. Psoriasis was mostly with plaques (70.8%) and 11.4% of patients had psoriatic arthritis. The average body surface area (BSA) affected was 10.1%. Among the 679 patients without initial systemic treatment, 159 were started on systemic treatment. The main agents initiated were phototherapy (n=63), methotrexate (n=40), acitretin (n=30) and apremilast (n=20). In multivariate analysis, a higher BSA [Odds Ratio (OR) 1.10, 95% Confidence Interval (CI): 1.07-1.13; P<10-4] and Dermatology Life Quality Index (DLQI) [OR 1.09, 95% CI: 1.03-1.15; P=0.04] were associated with prescription of systemic therapy at the end of the consultation. CONCLUSION The main limitation of our study was that participating PPDs were strongly involved in psoriasis management, which accounts for the high proportion of moderate-to-severe psoriasis and prescription of systemic treatments. Such committed PPDs and the development of psoriasis networks are key factors for improving the quality of care provided to psoriasis patients.
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Affiliation(s)
- J-M Amici
- Association des Dermato-Vénéréologues du Sud-Ouest (ADVSO, Association of Dermatologists and Venerologists of the French South-West), Maison de la Dermatologie, 8, rue Jules Ferry, 33290 Blanquefort, France; Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - C Bergqvist
- CIC 1430 Inserm, Dermatology department, Henri-Mondor hospital, Assistance publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France
| | - S Ly
- Association des Dermato-Vénéréologues du Sud-Ouest (ADVSO, Association of Dermatologists and Venerologists of the French South-West), Maison de la Dermatologie, 8, rue Jules Ferry, 33290 Blanquefort, France; Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - F Corgibet
- Fédération française de formation continue et d'évaluation en dermatologie et vénéréologie (FFFCEDV, French Federation of Continuing Education and Assessment in Dermatology), Maison de la Dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - J-F Seï
- Fédération française de formation continue et d'évaluation en dermatologie et vénéréologie (FFFCEDV, French Federation of Continuing Education and Assessment in Dermatology), Maison de la Dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - J Seneschal
- Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - E Sbidian
- CIC 1430 Inserm, Dermatology department, Henri-Mondor hospital, Assistance publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France; EpiDermE, Paris-Est Créteil university, Val-de-Marne, 94000 Créteil, France
| | - M Beylot-Barry
- Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France.
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Kojanova M, Fialova J, Cetkovska P, Dolezal T, Lomicova I, Arenberger P, Gkalpakiotis S. Demographic data, comorbidities, quality of life, and survival probability of biologic therapy associated with sex-specific differences in psoriasis in the Czech Republic. Dermatol Ther 2021; 34:e14849. [PMID: 33533564 DOI: 10.1111/dth.14849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
BIOREP is a Czech registry of patients with psoriasis undergoing biological treatment. The objective of the study was to compare differences in demographic data, previous therapy, comorbidities, severity of psoriasis, quality of life, drug survival rates, and reasons for discontinuation between men and women. We analyzed a cohort of patients from the registry treated between May 2005 and January 2020. The total study population of 2472 patients (4051 treatment series) included 913 females and 1559 males. Women were significantly older than men at the onset of the biological treatment (47.8 vs 45.4 years, P < .0012) and the mean durations of psoriasis and that from its diagnosis until initiation of biological therapy, were longer in women (29.6 vs 27.2 years and 23.2 vs 20.6 years, P < .0012). Women as compared with men were also more often diagnosed with psoriatic arthritis (43.5% vs 33.0%, P < .0012). The prevalence rate of comorbidities was equivalent for both sexes except for that of depression (11.4% females vs 3.7% males, P < .0012). Both the DLQI and PASI scores were significantly different at baseline (DLQI = 16.0 and PASI = 19.5 for men vs DLQI 17.6 = and PASI = 17.7 for women, P < .0012). The survival probability with biological therapy was significantly lower in women for both biologically naïve and non-naïve patients, and there was more evidence of adverse effects in women. Our research demonstrates significant differences relative to multiple factors associated with psoriasis between men and women.
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Affiliation(s)
- Martina Kojanova
- Department of Dermatovenereology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jorga Fialova
- Department of Dermatovenereology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Charles University, Faculty of Medicine and University Hospital, Pilsen, Czech Republic
| | | | - Iva Lomicova
- Department of Dermatovenereology, Charles University, Faculty of Medicine and University Hospital, Pilsen, Czech Republic
| | - Petr Arenberger
- Department of Dermatovenereology, Charles University, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology, Charles University, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
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Mahe E, Moumane SH, Foist M. Topical medications for chronic plaque psoriasis: A 3-year longitudinal study in France. Dermatol Ther 2021; 34:e14781. [PMID: 33455063 DOI: 10.1111/dth.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
Topical treatments are first-line therapies, prescribed to most patients with chronic plaque psoriasis. This non-interventional, longitudinal study examined data regarding the treatment pathways of French patients with psoriasis vulgaris using a pharmacy database. From this database, patients with an initial prescription of a topical treatment of interest (ie, calcipotriol alone and/or calcipotriol/betamethasone) between March and October 2013 were included in the study. The primary objective was to capture the switch from a topical treatment, from treatment initiation to receipt of a systemic therapy over a period of 3 years. A total of 26 605 patients were included in the study. The mean age was 58.5 years. The majority of patients (94.7%) maintained topical treatment during the 3 years, receiving a mean of 1.1 different therapies. Of 1400 patients who switched to a systemic therapy, 93.1% switched to a non-biological (mean time to switching >400 days), maintaining this for the remainder of the follow-up period. The most commonly prescribed first non-biological systemic therapy was methotrexate (37%). Less than 1% of patients switched to a biological therapy during follow up. Cohort analyses suggest that patients progressing to use of a systemic therapy within 12 months were those with more severe disease. There was a low rate of transition from topical to systemic therapies in patients with chronic plaque psoriasis during the first 3 years of treatment, suggesting stability of disease severity over time with topical therapy alone, potentially due to good patient adherence.
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Affiliation(s)
- Emmanuel Mahe
- Department of Dermatology, Victor Dupouy Hospital, Paris, France
| | | | - Murielle Foist
- Medical Department, LEO Pharma, Voisins-Le-Bretonneux, France
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Merola J, Perez Chada L, Siegel M, Bagel J, Evans C, Lockshin B, Mason M, Guo N, McLean R, Greenberg J, Van Voorhees A. The National Psoriasis Foundation psoriasis treatment targets in real‐world patients: prevalence and association with patient‐reported outcomes in the Corrona Psoriasis Registry. J Eur Acad Dermatol Venereol 2020; 34:2051-2058. [DOI: 10.1111/jdv.16274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/27/2020] [Indexed: 01/12/2023]
Affiliation(s)
- J.F. Merola
- Department of Dermatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
- Department of Medicine Division of Rheumatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - L.M. Perez Chada
- Department of Dermatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - M. Siegel
- National Psoriasis Foundation Portland OR USA
| | - J. Bagel
- Psoriasis Treatment Center of Central New Jersey East Windsor NJ USA
| | - C. Evans
- Evans Dermatology Partners Austin TX USA
| | | | | | - N. Guo
- Corrona LLC Waltham MA USA
| | | | - J.D. Greenberg
- Corrona LLC Waltham MA USA
- NYU School of Medicine New York NY USA
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Warren RB, Hansen JB, Reich K, Paul C, Puig L. Complete clearance and psoriasis area and severity index response for brodalumab and ustekinumab in AMAGINE-2 and -3. J Eur Acad Dermatol Venereol 2020; 35:450-457. [PMID: 32662540 DOI: 10.1111/jdv.16816] [Citation(s) in RCA: 7] [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] [Received: 04/08/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Modern biologics achieve complete skin clearance [100% improvement in psoriasis area and severity index (PASI 100)] in 30-45% of psoriasis patients. Cumulative benefit considering rapidity, frequency and sustainability of response has not been thoroughly investigated. OBJECTIVES Compare the frequency, rapidity and sustainability of PASI 90 and 100 response in patients with moderate-to-severe psoriasis treated with brodalumab or ustekinumab. METHODS Integrated analyses of the brodalumab Phase III AMAGINE-2 (NCT01708603) and -3 (NCT01708629) trials were performed to determine proportion of patients achieving PASI response per visit; corresponding odds ratios (OR) were calculated. Cumulative clinical benefit of treatment was determined with area-under-the-curve (AUC) analysis. Cumulative incidence of response was analysed using a competing risk model of PASI response or rescue. Sustained response was evaluated by time to inadequate response using Kaplan-Meier methods. Proportion of time spent in different response states was descriptively analysed. Association between PASI response and health-related quality of life [Dermatology Life Quality Index (DLQI)] was assessed using data from all treatment groups from AMAGINE-1, -2 and -3. RESULTS A significantly higher proportion of patients treated with brodalumab achieved PASI 100 vs. ustekinumab (Week 52: 51% vs. 28%; OR [95% CI] 2.8 [2.1, 3.7]; P < 0.0001), with significant differences observed from Week 4. Cumulative benefit through 52 weeks was 69% higher with brodalumab (AUC ratio: 1.69; P < 0.001). Brodalumab patients were also significantly more likely to achieve a PASI 100 at least once over 52 weeks vs. ustekinumab (76% vs. 52%; P < 0.0001). Once response was achieved, brodalumab patients had a low likelihood of failure or need for rescue. There was significant positive association between PASI response level and DLQI0/1 achievement (P < 0.0001). CONCLUSION Brodalumab treatment resulted in significantly higher levels of skin clearance, longer sustained response and greater cumulative treatment benefit vs. ustekinumab.
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Affiliation(s)
- R B Warren
- Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, NIHR Manchester BRC Centre, Manchester, UK
| | | | - K Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation® Center, Hamburg, Germany
| | - C Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona School of Medicine, Barcelona, Spain
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Carretero G, Moreno D, González-Domínguez A, Trigos D, Ledesma A, Sarquella E, Merino M, Blanch C. Multidisciplinary approach to psoriasis in the Spanish National Health System: A social return on investment study. Glob Reg Health Technol Assess 2020; 7:50-56. [PMID: 36627964 PMCID: PMC9677591 DOI: 10.33393/grhta.2020.2146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Psoriasis is a chronic disease in which patients feel stigmatization, social rejection, and suffer from low self-esteem. There are still unmet needs that make it necessary to define a new multidisciplinary approach to provide benefits not only to patients and their families but also to the Spanish National Health System (SNHS) and society. The aim was to define a new approach to better address the unmet needs of patients with psoriasis within the SNHS and to measure its impact from a social perspective, that is, in clinical, health care, economic, and social terms. Methods Multidisciplinary experts identified, agreed on, and selected several health care interventions that were feasible for implementation in the SNHS. This process was carried out in four different areas: diagnosis, mild psoriasis, moderate psoriasis, and severe psoriasis. To estimate investment and social return, the social return on investment (SROI) method was used. Results The new approach to psoriasis management in the SNHS comprised 18 proposals. The investment needed for the implementation of this new approach would amount to €222.77 million and its return to €1,123.11 million. This would yield a SROI ratio of €5.04 for every euro invested. Conclusion The new approach to psoriasis management would yield a positive social return. The results will allow optimal strategic planning adapted to each assistance situation, to achieve a comprehensive and multidisciplinary approach.
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Affiliation(s)
| | - David Moreno
- Department of Dermatology, Virgen Macarena Hospital, Seville - Spain
| | | | - David Trigos
- Acción Psoriasis, Psoriasis Patients and Relatives Association, Barcelona - Spain
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Huang YW, Tsai TF. Remission Duration and Long-Term Outcomes in Patients with Moderate-to-Severe Psoriasis Treated by Biologics or Tofacitinib in Controlled Clinical Trials: A 15-Year Single-Center Experience. Dermatol Ther (Heidelb) 2019; 9:553-569. [PMID: 31270683 PMCID: PMC6704191 DOI: 10.1007/s13555-019-0310-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Relapse is common after treatment discontinuation for patients with moderate-to-severe psoriasis. The objective of this study was to understand the remission duration and long-term outcomes in psoriasis patients after biologic withdrawal. METHODS We retrospectively included the follow-up data of 184 patients with moderate-to-severe psoriasis after the end of 11 biologic or tofacitinib trials conducted between 2004 and 2016. RESULTS Among the 232 treatment courses, 95 achieved (psoriasis area and severity index) PASI 75 at the end of the studies. At 6 months after treatment discontinuation, the systemic treatment-free rates of our patients who entered the PRESTA, PRISTINE, PEARL, ERASURE, CLEAR, the global tofacitinib study, and the IXORA-P study were 66.7%, 66.7%, 75.0%, 16.7%, 22.2%, 33.3%, and 29.2%, respectively. Pooled data showed a serious adverse event incidence rate of 1.5/100 person-years. The proportions of systemic treatment-free episodes were 16.8%, 7.4%, 4.3%, 3.2%, and 3.2% at 1, 2, 3, 4, and 5 years, respectively. Biologics were reinitiated in 41.9%, 66.7%, 77.1%, 83.5%, and 86.1% at 1, 2, 3, 4, and 5 years, respectively. Multivariate generalized estimating equation (GEE) regression analysis demonstrated that predictors for a longer relapse-free duration were baseline PASI, PASI improvement, biologic naivety, and early biologic intervention. Patients who received early biologic intervention, who achieved PASI 90, and who were biologic naive showed significantly higher relapse-free rate by Kaplan-Meier analysis with log rank test. CONCLUSIONS Systemic treatment was required in 86.1% of patients within 12 months after biologic withdrawal and biologics were reinitiated in 77.1% of patients after 3 years. However, early biologic administration within 2 years after diagnosis demonstrated a lower risk of relapse in patients with moderate-to-severe psoriasis.
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Affiliation(s)
- Yi-Wei Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Dermatology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Börjesson C, Guinard E, Tauber M, Konstantinou MP, Livideanu CB, Mazereeuw-Hautier J, Meyer N, Paul C. Compounded topical preparations in plaque psoriasis: Still a place for it in 2018? Dermatol Ther 2018; 32:e12780. [PMID: 30387924 DOI: 10.1111/dth.12780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Abstract
Compounded topical preparations (CTP) were used to treat psoriasis until the last century and have disappeared from guidelines. The present authors report two severe psoriasis patients who were treated with CTP. A man had psoriasis with a PASI of 23 and a body surface area (BSA) of 43%. He had been using daily for several weeks a CTP including minoxidil, clobetasol propionate and hydroxyprogesterone formulated in an alcohol based vehicle. A woman suffered from psoriasis with an annular inflammatory pattern and a central healing. The PASI was 20 and the BSA was 30%. She had been using a CTP daily for 4 months including resorcinol, salicylic acid, 0.05% tretinoin cream, bethamethasone dipropionate cream. Until the 1970s, the dermatological textbooks recommended to treat severe psoriasis with CTP. Nowadays, CTP are considered outdated because of the large therapeutic armamentarium. The stability and benefit risks of the CTP used here were not documented. The use of CTP in psoriasis should be regulated and must be evidence based. Strict protocol and stability evaluation for preparations must be confirmed prior to compounding.
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Affiliation(s)
| | - Elisabeth Guinard
- Dermatologie, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - Marie Tauber
- Dermatologie, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | | | | | | | - Nicolas Meyer
- Dermatologie, Université Paul Sabatier, CHU Toulouse, Toulouse, France.,Onco-Dermatologie, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - Carle Paul
- Dermatologie, Université Paul Sabatier, CHU Toulouse, Toulouse, France
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11
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Iversen L, Eidsmo L, Austad J, Rie M, Osmancevic A, Skov L, Talme T, Bachmann I, Kerkhof P, Stahle M, Banerjee R, Oliver J, Fasth A, Frueh J. Secukinumab treatment in new‐onset psoriasis: aiming to understand the potential for disease modification – rationale and design of the randomized, multicenter
STEPI
n study. J Eur Acad Dermatol Venereol 2018; 32:1930-1939. [DOI: 10.1111/jdv.14979] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Iversen
- Aarhus University Hospital Aarhus Denmark
| | - L. Eidsmo
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - J. Austad
- Oslo University Hospital Oslo Norway
| | - M. Rie
- Academisch Medisch Centrum Amsterdam The Netherlands
| | - A. Osmancevic
- Department of Dermatology Sahlgrenska University Hospital Gothenburg Sweden
| | - L. Skov
- Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - T. Talme
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - P. Kerkhof
- Radboud University Nijmegen Medical Centre Nijmegen The Netherlands
| | - M. Stahle
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - R. Banerjee
- Novartis Healthcare Private Limited Hyderabad India
| | - J. Oliver
- Novartis Pharma AG Basel Switzerland
| | | | - J. Frueh
- Novartis Pharma AG Basel Switzerland
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12
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Griffiths C, Augustin M, Naldi L, Romiti R, Guevara-Sangines E, Howe T, Pietri G, Gilloteau I, Richardson C, Tian H, Jo S. Patient-dermatologist agreement in psoriasis severity, symptoms and satisfaction: results from a real-world multinational survey. J Eur Acad Dermatol Venereol 2018. [DOI: 10.1111/jdv.14937] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C.E.M. Griffiths
- Dermatology Centre; Salford Royal Hospital; NIHR Manchester Biomedical Research Centre; University of Manchester; Manchester UK
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - L. Naldi
- Department of Dermatology; AULSS 8, Ospedale san Bortolo; Vicenza Italy
| | - R. Romiti
- Department of Dermatology; Hospital das Clínicas, University of São Paulo (USP); São Paulo Brazil
| | | | | | | | | | | | - H. Tian
- Novartis Pharmaceuticals Corporation; East Hanover NJ USA
| | - S.J. Jo
- Department of Dermatology; Seoul National University Hospital; Seoul Korea
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13
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Polivka L, Oubaya N, Bachelez H, Paul C, Richard MA, Beylot-Barry M, Schmutz JL, Beneton N, Mahé E, Viguier M, Chosidow O, Canoui-Poitrine F, Sbidian E. Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015. J Eur Acad Dermatol Venereol 2018; 32:1920-1929. [PMID: 29729123 DOI: 10.1111/jdv.15044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the late 2000s, the introduction of biologics transformed the prognosis for patients with moderate-to-severe psoriasis. We hypothesized that treatment with biologics may associate with a reduction in the hospitalization rate for psoriasis flares. OBJECTIVE To analyse changes over time in the hospitalization rate for psoriasis flares. METHODS We included inpatient stays in any of nine French hospitals between 2005 and 2015 for a psoriasis flare, as documented in the national inpatient database. In two centres, we also analysed data from the individual patients' electronic medical records. RESULTS A total of 3572 stays were included. The introduction of biologics was not associated with a decrease in the number of hospitalizations for a psoriasis flare; on the contrary, we observed a non-significant increase in the number of hospitalizations (13 hospitalizations for psoriasis flares per quarter per 10 000 beds). In the two-centre study, the introduction of biologics was associated with a significant increase in the hospitalization of patients receiving topical treatments only (520 hospitalizations per year per 10 000 beds) and those with a first psoriasis flare. CONCLUSION The number of hospitalizations for a psoriasis flare tended to increase between 2005 and 2015. The availability of additional treatment options might have increased patient demand and/or broadened the indications in clinical practice.
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Affiliation(s)
- L Polivka
- Department of Dermatology, Necker-Enfants Malades Hospital (AP-HP), Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - N Oubaya
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - H Bachelez
- Department of Dermatology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - M A Richard
- Dermatology Department, Centre de recherche en oncologie biologique et oncophamacologie', UMR 911, INSERM CRO2, Timone Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - M Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - J L Schmutz
- Department of Dermato-Allergology, Brabois Hospital, Nancy University, Vandoeuvre-lès-Nancy, France
| | - N Beneton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - E Mahé
- Department of Dermatology, Victor Dupouy Hospital, Argenteuil, France
| | - M Viguier
- Department of Dermatology, Robert Debré Hospital, University of Reims-Champagne Ardennes, Reims, France
| | - O Chosidow
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
| | - F Canoui-Poitrine
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - E Sbidian
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
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14
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Mahé E, Bursztejn AC, Phan A, Corgibet F, Beauchet A. Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists. Dermatol Ther 2017; 31. [DOI: 10.1111/dth.12567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/18/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Emmanuel Mahé
- Dermatology Department; Hôpital Victor Dupouy; Argenteuil France
| | | | - Alice Phan
- Nephrology-Rheumatology-Dermatology Department; Hôpital Femme Mère Enfant, Hospices Civiles de Lyon; Bron France
| | | | - Alain Beauchet
- Public Health Department; Centre Hospitalier Universitaire Ambroise Paré, Université Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris; Boulogne-Billancourt France
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15
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Mahé E, Maccari F, Beauchet A, Quiles-Tsimaratos N, Beneton N, Parier J, Barthelemy H, Goujon-Henry C, Chaby G, Thomas-Beaulieu D, Géner G, Wagner L, Pallure V, Devaux S, Vermersch-Langlin A, Pfister P, Jégou J, Livideanu C, Sigal ML. Patients atteints de psoriasis : analyse de la population insatisfaite de sa prise en charge. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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16
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Sampogna F, Puig L, Spuls P, Girolomoni G, Radtke M, Kirby B, Brunori M, Bergmans P, Smirnov P, Rundle J, Lavie F, Paul C. Prevalence of alexithymia in patients with psoriasis and its association with disease burden: a multicentre observational study. Br J Dermatol 2017; 176:1195-1203. [DOI: 10.1111/bjd.15243] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- F. Sampogna
- Dermatological Hospital IDI-IRCCS; Rome Italy
| | - L. Puig
- Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - P. Spuls
- Department of Dermatology; University of Amsterdam; Amsterdam the Netherlands
| | | | - M.A. Radtke
- Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
| | - B. Kirby
- St Vincent's University Hospital; Dublin Ireland
| | | | | | | | - J. Rundle
- Janssen-Cilag Ltd; High Wycombe Buckinghamshire, U.K
| | | | - C. Paul
- Department of Dermatology; Toulouse University; Hôpital Larrey; 24 Chemin de Pouvourville 31059 Toulouse France
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17
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Kojanova M, Fialova J, Cetkovska P, Gkalpakiotis S, Jircikova J, Dolezal T, Arenberger P. Characteristics and risk profile of psoriasis patients included in the Czech national registry BIOREP and a comparison with other registries. Int J Dermatol 2017; 56:428-434. [PMID: 28181669 DOI: 10.1111/ijd.13543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/02/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND BIOREP is a Czech registry of psoriatic patients on biological treatment in a clinical setting. We describe the characteristics of patients with psoriasis at the time of enrollment and present comparisons with published data from other national registries. METHODS We analyzed the cohort of patients treated with biologics between May 2005 and May 2015. Demographic data, previous therapies, comorbidities, and severity of psoriasis were compared with data from other registries - DERMBIO, BIOBADADERM, BADBIR, and PSOBEST. RESULTS A total of 1412 psoriatic patients initiating biological treatment were included with a predominance of males (63.4%). The mean patient age was 50.2 years, and approximately 70.5% of patients were either overweight or obese. The mean baseline Psoriasis Area and Severity Index was 19.8, and the Dermatology Life Quality Index was 16.6. More than one-third of patients (41.0%) reported a history of psoriatic arthritis, and a high proportion of patients (49.5%) with cardiovascular risk factors (hypertension [35.2%], hyperlipidemia [27.7%], diabetes mellitus [11.4%], coronary heart disease [4.9%], and obesity [15.2%]) were observed. Most of the patients had been previously treated with phototherapy (85.4%), acitretin (74.0%), methotrexate (65.7%), or cyclosporine (53.1%). CONCLUSION BIOREP is one of the first registries of patients with psoriasis treated with biologics in Central and Eastern Europe. Our results found a similar or higher prevalence of comorbidities, long disease duration, and high impact on the quality of life among patients included in Western European registries.
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Affiliation(s)
- Martina Kojanova
- Department of Dermatovenereology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jorga Fialova
- Department of Dermatovenereology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Charles University, Faculty of Medicine and University Hospital, Pilsen, Czech Republic
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology, Charles University, Third Faculty of Medicine and Faculty Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | | | | | - Petr Arenberger
- Department of Dermatovenereology, Charles University, Third Faculty of Medicine and Faculty Hospital of Kralovske Vinohrady, Prague, Czech Republic
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18
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Augustin M, Blome C, Paul C, Puig L, Luger T, Lambert J, Chimenti S, Girolomoni G, Kragballe K, Naessens D, Bergmans P, Smirnov P, Barker J, Reich K. Quality of life and patient benefit following transition from methotrexate to ustekinumab in psoriasis. J Eur Acad Dermatol Venereol 2016; 31:294-303. [PMID: 27515070 DOI: 10.1111/jdv.13823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND TRANSIT (NCT01059773) compared immediate and gradual transition from methotrexate to ustekinumab in psoriasis patients via multiple measures, including patient-reported outcomes. OBJECTIVE To evaluate patient perception of treatment benefits in TRANSIT. METHODS A total of 489 psoriasis patients received ustekinumab, with immediate cessation of methotrexate (Arm 1) or 4 weeks' overlap with decreasing methotrexate dose (Arm 2). Ustekinumab was administered at weeks 0, 4, 16, 28 and 40. Dermatology Life Quality Index (DLQI), EuroQol 5-item (EQ-5D), visual analogue scale (VAS) valuation technique and patient benefit index (PBI) were employed. Mean global PBI and sub-scores were calculated from the sum of the benefit items weighted by their respective relevance at baseline. Patient-relevant benefit was defined as PBI ≥1 (scale: 0 [no benefit] to 4 [maximum benefit]). Correlations of global PBI with Psoriasis Area and Severity Index (PASI) and DLQI were examined. RESULTS Relationships between PBI and clinical data were evaluable in 340 patients. The most important treatment goals at baseline included: 'be healed of all skin defects', 'have confidence in therapy', 'get better skin quickly' and 'regain control of the disease'. Benefit in PBI global score was achieved at week 4 by 93% of patients in Arm 1 and 91% in Arm 2. Global PBI scores increased in both Arms between weeks 4 and 52. Global PBI correlated weakly with PASI change from baseline (correlation coefficient range: -0.22 to -0.40), and moderately with DLQI (-0.29 to -0.54). Overall DLQI score was lower than baseline at all times; and the percentage of patients with an overall score of 0 or 1 increased with time. Correspondingly, EQ VAS scores increased with time. DLQI and EQ VAS results were similar between arms. CONCLUSIONS Regardless of the strategy for transitioning from methotrexate, ustekinumab was associated with rapid and sustained improvement in patient-reported outcomes. PBI appears a suitable tool for assessing patient-relevant treatment benefits in psoriasis patients.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - L Puig
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Luger
- University of Münster, Münster, Germany
| | - J Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - G Girolomoni
- Department of Dermatology, University of Verona, Verona, Italy
| | | | | | - P Bergmans
- Janssen-Cilag BV, Tilburg, The Netherlands
| | - P Smirnov
- Janssen Pharmaceutica NV, Moscow, Russia
| | - J Barker
- St John's Institute of Dermatology, King's College, London, UK
| | - K Reich
- Dermatologikum, Hamburg, Germany
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19
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Papp KA, Reich K, Paul C, Blauvelt A, Baran W, Bolduc C, Toth D, Langley RG, Cather J, Gottlieb AB, Thaçi D, Krueger JG, Russell CB, Milmont CE, Li J, Klekotka PA, Kricorian G, Nirula A. A prospective phase III, randomized, double-blind, placebo-controlled study of brodalumab in patients with moderate-to-severe plaque psoriasis. Br J Dermatol 2016; 175:273-86. [PMID: 26914406 DOI: 10.1111/bjd.14493] [Citation(s) in RCA: 322] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The interleukin-17 cytokine family plays a central role in psoriasis pathogenesis. OBJECTIVES To evaluate the efficacy and safety of brodalumab, a human anti-interleukin-17 receptor antibody, in treating patients with moderate-to-severe plaque psoriasis. METHODS In this phase III, double-blind, placebo-controlled study (NCT01708590; AMAGINE-1), adult patients in the U.S.A., Canada and Europe were randomized to brodalumab (140 or 210 mg) or placebo every 2 weeks (Q2W), with an additional dose at week 1, for a 12-week induction phase. At week 12, patients receiving brodalumab who achieved static Physician's Global Assessment 0 or 1 (sPGA success) were rerandomized to the placebo or induction dose. After week 16, patients with sPGA ≥ 3 were re-treated with the induction dose. After ≥ 12 weeks of retreatment, patients with sPGA 2 for ≥ 4 weeks or sPGA ≥ 3 were rescued with brodalumab 210 mg Q2W. At week 12, patients randomized to brodalumab with sPGA ≥ 2 or placebo received brodalumab 210 mg Q2W. Coprimary end points were the percentage of patients with ≥ 75% improvement in Psoriasis Area and Severity Index score (PASI 75) and sPGA success at week 12. RESULTS There were 661 patients randomized: 220 placebo, 219 brodalumab 140 mg and 222 brodalumab 210 mg. At week 12, 60% (140 mg) and 83% (210 mg) vs. 3% (placebo) achieved PASI 75, and 54% (140 mg) and 76% (210 mg) vs. 1% (placebo) achieved sPGA success. The safety profile was considered acceptable. CONCLUSIONS Brodalumab therapy resulted in significant clinical benefit and an acceptable safety profile in patients with moderate-to-severe plaque psoriasis.
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Affiliation(s)
- K A Papp
- Probity Medical Research and K Papp Clinical Research, Waterloo, ON, Canada
| | - K Reich
- Dermatologikum Hamburg and SCIderm Research Institute, Hamburg, Germany
| | - C Paul
- Paul Sabatier University, Toulouse, France
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - W Baran
- Wroclaw Medical University, Wroclaw, Poland
| | - C Bolduc
- The University of Montreal and Innovaderm Research, Montreal, QC, Canada
| | - D Toth
- XLR8 Medical Research and Probity Medical Research, Windsor, ON, Canada
| | | | - J Cather
- Modern Research Associates, Modern Dermatology, A Baylor Health Texas Affiliate, and Probity Medical Research, Dallas, TX, U.S.A
| | | | - D Thaçi
- University of Lübeck, Lübeck, Germany
| | - J G Krueger
- The Rockefeller University, New York, NY, U.S.A
| | | | | | - J Li
- Amgen Inc., Thousand Oaks, CA, U.S.A
| | | | | | - A Nirula
- Amgen Inc., Thousand Oaks, CA, U.S.A
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Valenzuela F, Paul C, Mallbris L, Tan H, Papacharalambous J, Valdez H, Mamolo C. Tofacitinib versus etanercept or placebo in patients with moderate to severe chronic plaque psoriasis: patient-reported outcomes from a Phase 3 study. J Eur Acad Dermatol Venereol 2016; 30:1753-1759. [PMID: 27271195 PMCID: PMC5108430 DOI: 10.1111/jdv.13702] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis. Psoriasis impacts on physical and psychological well-being; improvements in health-related quality of life (HRQoL) with etanercept in psoriasis are well documented. OBJECTIVE To evaluate HRQoL with tofacitinib, vs. placebo or etanercept, in the Phase 3, randomized, placebo-controlled, non-inferiority, Oral-treatment Psoriasis Trial (OPT) Compare Study (NCT01241591). METHODS Adults with moderate to severe chronic plaque psoriasis were randomized 3:3:3:1 to tofacitinib 10 or 5 mg twice daily (BID), etanercept 50 mg twice weekly or placebo, for 12 weeks. Patient-reported outcomes (PROs) included Dermatology Life Quality Index (DLQI), Itch Severity Item and Patient Global Assessment of psoriasis. RESULTS At baseline, 83.4% (911/1092) of patients had a DLQI score ranging between 6 and 30, indicating a substantial burden of disease. By Week 12, 47.3%, 43.6% and 30.9% of patients in the tofacitinib 10 mg BID, etanercept and tofacitinib 5 mg BID groups, respectively, had a DLQI score of 0 or 1 (no effect of psoriasis on QoL) vs. 7.8% for placebo (all P < 0.0001). Tofacitinib significantly reduced itch vs. placebo (P < 0.05 both doses) and etanercept (P < 0.0001 both doses) within 1 day of starting treatment. Furthermore, reductions in itch were greater with tofacitinib 10 mg BID, vs. etanercept, at Weeks 2-12 (all time points P < 0.05). At Week 2, an Itch Severity Item score of 'little or no itch' was more frequent with tofacitinib 10 mg (68.6%) vs. etanercept (57.4%) and placebo (12.2%), and the PtGA response rate was significantly greater with tofacitinib 10 mg vs. placebo (P < 0.05). CONCLUSION Oral tofacitinib provided significant improvements across multiple PROs by Week 12. Improvements with tofacitinib 10 mg BID were comparable to etanercept, and improvements in itch were greater and more rapid with tofacitinib 10 mg BID.
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Affiliation(s)
- F Valenzuela
- Department of Dermatology, Faculty of Medicine, University of Chile and Probity Medical Research, Santiago, Chile.
| | - C Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| | | | - H Tan
- Pfizer Inc, Groton, CT, USA
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Mazereeuw-Hautier J, Uthurriague C. [Use of methotrexate in pediatric dermatology]. Ann Dermatol Venereol 2016; 143:154-61. [PMID: 26724843 DOI: 10.1016/j.annder.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/05/2015] [Accepted: 09/08/2015] [Indexed: 11/18/2022]
Affiliation(s)
- J Mazereeuw-Hautier
- Service de dermatologie, CHU Toulouse-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France
| | - C Uthurriague
- Service de dermatologie, CHU Toulouse-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France.
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Saunte D, Boer J, Stratigos A, Szepietowski J, Hamzavi I, Kim K, Zarchi K, Antoniou C, Matusiak L, Lim H, Williams M, Kwon H, Gürer M, Mammadova F, Kaminsky A, Prens E, van der Zee H, Bettoli V, Zauli S, Hafner J, Lauchli S, French L, Riad H, El-Domyati M, Abdel-Wahab H, Kirby B, Kelly G, Calderon P, del Marmol V, Benhadou F, Revuz J, Zouboulis C, Karagiannidis I, Sartorius K, Hagströmer L, McMeniman E, Ong N, Dolenc-Voljc M, Mokos Z, Borradori L, Hunger R, Sladden C, Scheinfeld N, Moftah N, Emtestam L, Lapins J, Doss N, Kurokawa I, Jemec G. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol 2015. [DOI: 10.1111/bjd.14038] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van de Kerkhof PCM, Reich K, Kavanaugh A, Bachelez H, Barker J, Girolomoni G, Langley RG, Paul CF, Puig L, Lebwohl MG. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey. J Eur Acad Dermatol Venereol 2015; 29:2002-10. [PMID: 25885420 PMCID: PMC5029592 DOI: 10.1111/jdv.13150] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/16/2015] [Indexed: 12/21/2022]
Abstract
Background Available literature on psoriasis and psoriatic arthritis (PsA) demonstrates a tremendous burden of disease and suggests underdiagnosis and undertreatment. Objective To obtain real‐world physician perspectives on the impact of psoriasis and PsA and its treatment on patients' daily lives, including perceptions of, and satisfaction with, current therapies. Methods The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) surveyed dermatologists (n = 391) and rheumatologists (n = 390) in North America (Canada and the United States) and Europe (France, Germany, Italy, Spain and United Kingdom). Results Dermatologists classified 20.3% and 25.7% of their patients as having severe psoriasis and severe PsA respectively; rheumatologists indicated that 48.4% of their PsA patients had active disease. Of the psoriasis patients complaining of joint pain, only 33.0% had a diagnosis of PsA. An impact on daily activities or social/emotional well‐being was recognized by 57.2% to 79.3% of physicians. In patients with moderate‐to‐severe psoriasis, dermatologists reported 74.9% were receiving topical therapy, 19.5% conventional oral therapy and 19.6% biologics. Dermatologists and rheumatologists reported similar rates of topical (≈45%) and biologic (≈30%) therapy utilization for their PsA patients; conventional oral therapy was more often prescribed by rheumatologists (63.4%) vs. dermatologists (35.2%). Reasons for not initiating or maintaining systemic therapies were related to concerns about long‐term safety, tolerability, efficacy and costs (biologics). Conclusion Physicians in North America and Europe caring for patients with psoriasis and PsA acknowledge unmet treatment needs, largely concerning long‐term safety/tolerability and efficacy of currently available therapies; evidence suggests underdiagnosis of PsA and undertreatment of psoriasis among dermatologists.
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Affiliation(s)
| | - K Reich
- Dermatologikum Hamburg, Hamburg, Germany
| | - A Kavanaugh
- University of California, San Diego, School of Medicine, La Jolla, CA, USA
| | - H Bachelez
- Sorbonne Paris Cité Univerité Paris Diderot, Saint-Louis Hospital, Paris, France
| | - J Barker
- Division of Genetics and Molecular Medicine, St. John's Institute of Dermatology, King's College, London, UK
| | | | | | - C F Paul
- Hôpital Larrey, Toulouse University, Toulouse, France
| | - L Puig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gilet H, Roborel de Climens A, Arnould B, Bachelez H, Bagot M, Beaulieu P, Joly P, Jullien D, Le Maître M, Ortonne JP, Paul C, Thibout E. Development and psychometric validation of the REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire: a common measure of plaque-type psoriasis severity and treatment efficacy for patients and clinicians. J Eur Acad Dermatol Venereol 2015; 29:498-506. [PMID: 25059687 PMCID: PMC4359024 DOI: 10.1111/jdv.12601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND To date, there is no global consensus on the definition of the severity of psoriasis. The REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire has recently been developed to provide a better understanding of plaque-type psoriasis severity and treatment efficacy from both patient and clinician perspectives. OBJECTIVE This study aimed to develop and psychometrically validate the new REFLETS questionnaire to evaluate patient and clinician perceptions of plaque-type psoriasis severity and treatment efficacy. METHODS Two similar versions of the REFLETS questionnaire were developed following a rigorous methodology for clinicians and patients, referring to 'the psoriasis of your patient' or to 'your psoriasis', respectively. An observational, longitudinal, multicentre study was conducted in France with 34 dermatologists and 430 mild to severe plaque-type psoriasis patients to finalize the questionnaire and evaluate its psychometric properties. RESULTS Two dimensions were defined--severity and treatment efficacy--with three subdimensions within severity (impact of psoriasis, symptoms and disease course), and two individual items on joint pain. The questionnaire was well accepted by clinicians and patients. Excellent internal consistency (Cronbach's alpha = 0.66-0.98) and test-retest reliability (intraclass correlation coefficients = 0.83-0.94) were demonstrated. REFLETS scores were moderately to highly correlated to Psoriasis Area and Severity Index (r = 0.35-0.70), Skindex-29 (r = 0.46-0.82) and DLQI scores (r = 0.36-0.82). Patients with decreased psoriasis severity and those with increased treatment efficacy, according to patient global evaluations, had lower severity and higher treatment efficacy REFLETS scores, respectively. CONCLUSION REFlective evaLuation of psoriasis Efficacy of Treatment and Severity is a promising tool for assessing plaque-type psoriasis severity and treatment efficacy from patient and clinician perspectives. It may help to improve patient and clinician communication in treatment decision making.
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Affiliation(s)
- H Gilet
- HEOR & Strategic Market Access, MapiLyon, France
| | | | - B Arnould
- HEOR & Strategic Market Access, MapiLyon, France
| | - H Bachelez
- Service de Dermatologie, Hôpital Saint LouisParis, France
| | - M Bagot
- Service de Dermatologie, Hôpital Saint LouisParis, France
| | - P Beaulieu
- Dermatologist, Private Clinical PracticePontoise, France
| | - P Joly
- Service de Dermatologie, Hôpital Charles NicolleRouen, France
| | | | - M Le Maître
- Dermatologist, Private Clinical PracticeCaen, France
| | | | - C Paul
- Université Paul Sabatier, UMR CNRS 5165, INSERM 1056Toulouse, France
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Abstract
Objective: Explore the feasibility of Treat to Target in the area of psoriasis as seen in other therapeutic areas such as hypertension, hyperlipidemia, diabetes and rheumatoid arthritis. Methods: Review validated, measurable targets for psoriasis, including physician global assessment (PGA), psoriasis area and severity index (PASI) and dermatology life quality index (DLQI). Examine principles brought forth in the published European consensus on psoriasis and develop a Canadian consensus on Treat to Target in psoriasis. Results: As PASI and DLQI are not routinely used in the community setting, we are recommending target at a PGA of zero (clear). Conclusion: Recommend that the target is a PGA of zero (clear) as it provides a simple and measurable result that the patient and physician can clearly understand.
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Affiliation(s)
- Wayne Gulliver
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Charles Lynde
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Jan P. Dutz
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Ronald B. Vender
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Jensen Yeung
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Marc Bourcier
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Pierre-Luc Dion
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Chi-Ho Hong
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Gordon Searles
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Yves Poulin
- Faculty of Medicine, Division of Dermatology, Memorial University, St. John’s NL
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON and Lynderm Research Inc., Markham, ON
- Department of Dermatology and Skin Science, Child and Family Research Institute, University of British Columbia, Vancouver, BC
- Department of Medicine, McMaster University, Hamilton ON, Service of Dermatology, St. Joseph’s Hospital, Hamilton, ON and Dermatrials Research, Dermatology Centre, Hamilton, ON
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
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Girolomoni G, Griffiths CEM, Krueger J, Nestle FO, Nicolas JF, Prinz JC, Puig L, Ståhle M, van de Kerkhof PCM, Allez M, Emery P, Paul C. Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper. J DERMATOL TREAT 2014; 26:103-12. [DOI: 10.3109/09546634.2014.880396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Nast A, Mrowietz U, Kragballe K, de Jong EM, Puig L, Reich K, Warren RB, Werner R, Kopkow C, Schmitt J. Barriers to the prescription of systemic therapies for moderate-to-severe psoriasis--a multinational cross-sectional study. Arch Dermatol Res 2013; 305:899-907. [PMID: 23748949 DOI: 10.1007/s00403-013-1372-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
Despite the availability of a plethora of approved systemic treatments, high proportions of patients with moderate-to-severe psoriasis do not receive systemic treatment. This study aims at identifying barriers that hinder dermatologists from prescribing systemic treatments for psoriasis. A cross-sectional online survey in six countries (Canada, Germany, Spain, France, Italy, UK) was performed among 300 dermatologists, assessing the relevance of 15 potential barriers towards prescribing acitretin, cyclosporine, methotrexate, adalimumab, etanercept, infliximab and ustekinumab. Multivariate regression analyses were used to explore provider characteristics related to these barriers. Treatment barriers are perceived differently in the countries investigated, with Spanish, Italian and Canadian dermatologists being particularly concerned about the safety of methotrexate and Canadian dermatologists about the safety of cyclosporine. In general, safety concerns were the most important barrier to the use of cyclosporine, (18 % of participants' moderate/9 % strong or very strong barrier). Costs were being perceived as a strong or very strong barrier to the use of the different biologics by 19-24 % of the participants. Overall, country and work place were the most important determinants of treatment barriers. Sex, age, training, position and experience were minor determinants of treatment barriers. Medical reasons such as safety concerns or an inappropriate risk-benefit profile are particularly relevant barriers to the prescription of conventional treatments; whereas for biological treatments, economic reasons such as costs are more prevalent. Country specific analysis showed national differences in the perception of safety. The treatment barriers identified in this exploratory study should be confirmed in further health services research.
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