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Walsh JA, Carroll C, Callis Duffin K, Wang J, Krueger GG, Feng BJ. PAPRIKA: A Question Bank for Assessing Psoriatic Arthritis Risk in Individuals of Diverse Ancestries. Arthritis Care Res (Hoboken) 2024; 76:421-425. [PMID: 37691268 DOI: 10.1002/acr.25232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We aimed to create a question bank about clinical factors for predicting the diagnoses of psoriatic arthritis in patients with psoriasis of various ancestries and skin tones, which can be completed entirely by patients. METHODS Utah Psoriasis Initiative participants without a psoriatic arthritis diagnosis at enrollment were observed for diagnosis during the study period. We inferred ancestry from exome sequencing data and performed Cox proportional hazards regression to identify clinical predictors of psoriatic arthritis in different ancestry groups. Based on results and literature review, we developed a question bank for assessing psoriatic arthritis risk among patients with psoriasis in various ancestries. RESULTS Patient-reported untreated psoriasis induration and history of fingernail psoriasis were associated with psoriatic arthritis in participants of European and non-European ancestry. We developed the Psoriatic Arthritis Prediction and Identification Question Bank for Diverse Ancestries (PAPRIKA) version 1.0, which included questions regarding psoriasis characteristics, arthritis symptoms, comorbidities, family history, and demographics. PAPRIKA is accessible at http://bjfenglab.org/. CONCLUSION The clinical features (untreated psoriasis induration and history of fingernail psoriasis) that can predict psoriatic arthritis in European individuals also work for non-European individuals. PAPRIKA can be used to gather psoriatic arthritis predictive data from patients with psoriasis without provider assistance and is relevant for patients across ancestries.
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Affiliation(s)
- Jessica A Walsh
- University of Utah School of Medicine, Salt Lake City
- Salt Lake City Veterans Affairs Health, Salt Lake City, USA
| | | | | | - Jing Wang
- University of Utah School of Medicine, Salt Lake City
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Carroll C, Aðalsteinsson J, Prouty M, Duffin KC, Krueger GG, Walsh JA, Feng BJ. Measuring Psoriasis Severity at Home. J Vis Exp 2024. [PMID: 38497631 DOI: 10.3791/66065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent development of psoriatic arthritis (PsA) among cutaneous-only psoriasis patients (patients with skin or nail psoriasis but no psoriatic arthritis). These metrics can be used for PsA screening. However, a key challenge in PsA screening is to optimize accessibility and minimize costs for patients, while also reducing the burden on healthcare systems. Therefore, an ideal screening tool consists of questions that patients can answer without a physician's assistance. Although reference images can be used to help a patient self-assess erythema and desquamation severity, a patient would need a tactile induration reference card to self-assess induration severity. This protocol describes how to create an induration reference card, the Psoriasis Thickness Reference Card, as well as how to use it to assess lesion induration severity. Administration of reference images for erythema and desquamation and a Psoriasis Thickness Reference Card for induration to 27 psoriasis patients showed that patients were moderately successful at self-assessing the severity of these three metrics. These findings support the feasibility of a future PsA screening test that patients can complete without the need for physician assistance.
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Affiliation(s)
| | | | | | | | | | - Jessica A Walsh
- University of Utah School of Medicine; Salt Lake City Veterans Affairs Health
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Harris KM, Smilek DE, Byron M, Lim N, Barry WT, McNamara J, Garcet S, Konrad RJ, Stengelin M, Bathala P, Korman NJ, Feldman SR, Boh EE, Barber K, Laumann AE, Helfrich YR, Krueger GG, Sofen H, Bissonnette R, Krueger JG. Effect of Costimulatory Blockade With Abatacept After Ustekinumab Withdrawal in Patients With Moderate to Severe Plaque Psoriasis: The PAUSE Randomized Clinical Trial. JAMA Dermatol 2021; 157:1306-1315. [PMID: 34643650 PMCID: PMC8515260 DOI: 10.1001/jamadermatol.2021.3492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Question Does blockade of CD28/B7 costimulatory signaling with abatacept suppress the psoriasis molecular signature and prevent psoriasis relapse after ustekinumab withdrawal? Findings In this parallel-design, double-blind randomized clinical trial of 91 adults with moderate to severe plaque psoriasis, costimulatory blockade with abatacept did not prevent psoriasis relapse and did not maintain suppression of the pathogenic psoriasis molecular signature following ustekinumab withdrawal. Meaning In this study, abatacept did not prevent psoriasis relapse, which may rely on alternative, compensatory mechanisms of residual T-cell activation in skin. Importance Psoriasis relapse may involve compensatory T-cell activation pathways in the presence of CD28-CD80/CD86 blockade with abatacept. Objective To determine whether costimulatory signaling blockade with abatacept prevents psoriasis relapse after ustekinumab withdrawal. Design, Setting, and Participants Psoriasis Treatment with Abatacept and Ustekinumab: a Study of Efficacy (PAUSE), a parallel-design, double-blind, placebo-controlled randomized clinical trial, was conducted at 10 sites in the US and Canada. Participant enrollment opened on March 19, 2014, and concluded on April 11, 2016. Participants were adults with moderate to severe plaque psoriasis and received ustekinumab in a lead-in phase. Those who responded to ustekinumab at week 12 were randomized 1:1 to either the continued with ustekinumab group (ustekinumab group) or the switched to abatacept group (abatacept group). Treatment was discontinued at week 39, and participants were followed up for psoriasis relapse until week 88. Statistical analyses were performed in the intention-to-treat (ITT) and safety samples from May 3, 2018, to July 6, 2021. Interventions Participants received subcutaneous ustekinumab at weeks 0 and 4 (45 mg per dose for those ≤100 kg; 90 mg per dose for those >100 kg). Participants randomized to the abatacept group at week 12 received subcutaneous abatacept, 125 mg weekly, from weeks 12 to 39 and ustekinumab placebo at weeks 16 and 28. Participants randomized to the ustekinumab group received ustekinumab at weeks 16 and 28 and abatacept placebo weekly from weeks 12 to 39. Main Outcomes and Measures The primary end point was the proportion of participants with psoriasis relapse (loss of ≥50% of the initial Psoriasis Area and Severity Index improvement) between weeks 12 and 88. Secondary end points included time to psoriasis relapse, proportion of participants with psoriasis relapse between weeks 12 and 40, and adverse events. The psoriasis transcriptome and serum cytokines were evaluated. Results A total of 108 participants (mean [SD] age, 46.1 [12.1] years; 73 [67.6%] men) were treated with open-label ustekinumab; 91 were randomized to blinded treatment. Similar proportions of participants in the abatacept group and the ustekinumab group relapsed between weeks 12 and 88 (41 of 45 [91.1%] vs 40 of 46 [87.0%]; P = .41). Median time to relapse from the last dose of ustekinumab was similar between groups as well: 36 weeks (95% CI, 36-48 weeks) in the abatacept group vs 32 weeks (95% CI, 28-40 weeks) in the ustekinumab group. Similar numbers and rates of adverse events occurred. Abatacept did not maintain suppression of the pathogenic IL-23-mediated psoriasis molecular signature in lesions after ustekinumab withdrawal, and serum IL-19 levels increased. Conclusions and Relevance This parallel-design, double-blind randomized clinical trial found that abatacept did not prevent psoriasis relapse that occurred after ustekinumab withdrawal because it did not completely block the pathogenic psoriasis molecular pathways that led to relapse. Trial Registration ClinicalTrials.gov Identifier: NCT01999868
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Affiliation(s)
- Kristina M Harris
- Biomarker and Discovery Research, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | - Dawn E Smilek
- Clinical Trials Group, Clinical and Translational Medicine, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | | | - Noha Lim
- Biomarker and Discovery Research, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | | | - James McNamara
- Autoimmunity and Mucosal Immunology Branch, Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | | | - Robert J Konrad
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Neil J Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin E Boh
- Health Sciences Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kirk Barber
- Department of Medicine (Dermatology), University of Calgary, Calgary, Alberta, Canada
| | - Anne E Laumann
- Department of Dermatology, Northwestern University, Colorado Springs, Colorado
| | | | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Howard Sofen
- Dermatology, David Geffen UCLA (University of California, Los Angeles) School of Medicine, Los Angeles
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Papp KA, Lebwohl MG, Kircik LH, Pariser DM, Strober B, Krueger GG, Berk DR, Navale L, Higham RC. The Proposed PASI-HD Provides More Precise Assessment of Plaque Psoriasis Severity in Anatomical Regions with a Low Area Score. Dermatol Ther (Heidelb) 2021; 11:1079-1083. [PMID: 34236691 PMCID: PMC8322185 DOI: 10.1007/s13555-021-00572-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/27/2022] Open
Abstract
The Psoriasis Area and Severity Index (PASI) is the most widely used clinical measure in clinical trials to assess disease severity of plaque psoriasis. However, the PASI is not a precise measure of severity with less precision when the regional area of involvement is < 10% of the BSA of a specific anatomical region. Degradation of precision results from the area score defaulting to ‘1’ when the area of involvement within an anatomical region falls between 0% and 10% of the BSA for a given anatomical region. We describe a modification to the PASI, termed PASI-high discrimination (PASI-HD), for determination of more accurate psoriasis severity in body regions where < 10% of the body surface area is affected. The methodology for assessing disease severity in these conditions is described.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research and K. Papp Clinical Research, Waterloo, ON, Canada
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leon H Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Indiana Medical Center, Indianapolis, IN, USA
- Physicians Skin Care, PLLC and Skin Sciences, Louisville, KY, USA
| | - David M Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc., Norfolk, VA, USA
| | - Bruce Strober
- Yale University School of Medicine, New Haven, CT, USA
- Central Connecticut Dermatology, Cromwell, CT, USA
| | | | - David R Berk
- Arcutis Biotherapeutics, Inc., 3027 Townsgate Road, Suite 300, Westlake Village, CA, 91361, USA
| | - Lynn Navale
- Arcutis Biotherapeutics, Inc., 3027 Townsgate Road, Suite 300, Westlake Village, CA, 91361, USA
| | - Robert C Higham
- Arcutis Biotherapeutics, Inc., 3027 Townsgate Road, Suite 300, Westlake Village, CA, 91361, USA.
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Belman S, Walsh JA, Carroll C, Milliken M, Haaland B, Duffin KC, Krueger GG, Feng BJ. Psoriasis Characteristics for the Early Detection of Psoriatic Arthritis. J Rheumatol 2021; 48:1559-1565. [PMID: 33858978 DOI: 10.3899/jrheum.201123] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Delays in the diagnosis and treatment of psoriatic arthritis (PsA) are common. These delays contribute to impairments in quality of life and joint damage. This study aims to calculate the incidence rate of PsA over time and identify clinical features that may be used for PsA prediction in patients with psoriasis (PsO). METHODS The study population for PsA incidence analysis included 1128 participants enrolled in the Utah Psoriasis Initiative between 2002 and 2014. Clinical evaluation and medical record review were performed to identify new cases of PsA after enrollment. To identify PsO features associated with PsA, the population was restricted to 627 participants who did not have PsA before PsO phenotyping and had been followed up for subsequent PsA diagnosis. We conducted Cox proportional hazard regressions to estimate the HR of PsA associated with PsO characteristics and other health-related features. RESULTS PsA incidence rate increased for > 60 years following PsO onset (trend P < 0.0001). There was a significant association between PsA and induration severity in untreated lesions (P < 0.001, HR 1.46), history of fingernail involvement (P < 0.001, HR 2.38), pustular PsO (P < 0.001, HR 3.32), fingernail involvement at enrollment (P < 0.001, HR 2.04), and Koebner phenomenon (P < 0.001, HR 1.90). Multivariate analysis yielded a model that included a history of fingernail involvement (P < 0.001, HR 2.16) and untreated induration (P < 0.001, HR 1.41). CONCLUSION Risk of PsA increases steadily for > 60 years following PsO onset. Patient-reported history of PsO characteristics has greater predictive power than physician-measured features at enrollment visits. The characteristics identified in this study provide guidance for screening for PsA risk in patients with PsO.
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Affiliation(s)
- Sophie Belman
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Jessica A Walsh
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Courtney Carroll
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Michael Milliken
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Benjamin Haaland
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Kristina C Duffin
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Gerald G Krueger
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Bing-Jian Feng
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
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Menter A, Krueger GG, Paek SY, Kivelevitch D, Adamopoulos IE, Langley RG. Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities. Dermatol Ther (Heidelb) 2021; 11:385-400. [PMID: 33512665 PMCID: PMC8019008 DOI: 10.1007/s13555-021-00483-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.
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Affiliation(s)
| | | | | | | | - Iannis E Adamopoulos
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Sacramento, CA, USA
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Belman S, Walsh J, Carroll C, Milliken M, Haaland B, Callis-Duffin K, Krueger GG, Feng B. 15928 Reduced time to onset of psoriatic arthritis is associated with specific phenotypes and psoriatic characteristics. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Armstrong AW, Blauvelt A, Crowley JJ, Gordon KB, Krueger GG, Krueger JG, Sobell JM, Strober BE, Srivastava B, Menter A. Defining drug-free remission of skin disease in patients with plaque psoriasis. Br J Dermatol 2019; 182:1484-1487. [PMID: 31705649 DOI: 10.1111/bjd.18694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A W Armstrong
- University of Southern California, Los Angeles, CA, U.S.A
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - J J Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, U.S.A
| | - K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - G G Krueger
- University of Utah Medical Center, Salt Lake City, UT, U.S.A
| | | | - J M Sobell
- Tufts University School of Medicine, Boston, MA, U.S.A
| | - B E Strober
- Yale University, New Haven, CT, U.S.A.,Central Connecticut Dermatology Research, Cromwell, CT, U.S.A
| | - B Srivastava
- Janssen Scientific Affairs, LLC, Horsham, PA, U.S.A
| | - A Menter
- Baylor Scott & White at Dallas, Dallas, TX, U.S.A
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9
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Secrest AM, Elkeeb DM, Petron B, Elsensohn A, Edwards LD, Krueger GG, Duffin KC. Systemic corticosteroid use in psoriasis: a national survey of board-certified dermatologists. J Eur Acad Dermatol Venereol 2018; 33:e116-e117. [PMID: 30317662 DOI: 10.1111/jdv.15291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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]
Affiliation(s)
- A M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - D M Elkeeb
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - B Petron
- California Polytechnic State University, San Luis Obispo, CA, USA
| | - A Elsensohn
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - L D Edwards
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Department of Dermatology, Vanderbilt University, Nashville, TN, USA
| | - G G Krueger
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - K C Duffin
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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10
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Walsh JA, Jones H, Mallbris L, Duffin KC, Krueger GG, Clegg DO, Szumski A. The Physician Global Assessment and Body Surface Area composite tool is a simple alternative to the Psoriasis Area and Severity Index for assessment of psoriasis: post hoc analysis from PRISTINE and PRESTA. Psoriasis (Auckl) 2018; 8:65-74. [PMID: 30324088 PMCID: PMC6181091 DOI: 10.2147/ptt.s169333] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The product of Physician Global Assessment and Body Surface Area (PGA × BSA) is a new outcome measure for psoriasis severity and response to therapy. The objective of this study was to evaluate PGA × BSA as an alternative to Psoriasis Area and Severity Index (PASI) for psoriasis assessments. Methods The relationship between PASI and PGA × BSA was assessed in a post hoc analysis of pooled data from the PRISTINE (NCT00663052) and PRESTA (NCT00245960) trials in patients with moderate-to-severe psoriasis who received etanercept 50 mg/week. Data were analyzed using Spearman and intra-class correlation coefficients, effect sizes, scatterplots, Bland–Altman plots, and Kappa statistics. Results Spearman correlations at baseline, week 12, and week 24 were strong for PGA × BSA versus PASI (r=0.78, 0.87, and 0.90, respectively; all P<0.0001) as were intra-class correlations (0.76 [95% confidence interval 0.73–0.80], 0.80 [0.76–0.83], and 0.85 [0.82–0.87], respectively). The effect size was −1.53 for PASI and −0.94 for PGA × BSA (baseline to week 24). Scatterplots and Bland–Altman plots detected a trend across the range of measurement. Kappa statistics (at 12 and 24 weeks) between PASI50/75/90 and 50/75/90% improvement in PGA × BSA showed good agreement (0.58–0.69 at week 12 and 0.63–0.67, respectively; all P<0.0001). At baseline, the Spearman correlation coefficients were 0.96, 0.51, 0.19, and 0.17 for PGA × BSA versus BSA, PGA, Patient Global Assessment, and Dermatology Life Quality Index, respectively (all P<0.001). Conclusion PGA × BSA has advantages over PASI for measuring moderate-to-severe psoriasis; it is intuitive, sensitive, and easy to use.
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Affiliation(s)
- Jessica A Walsh
- Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA,
| | - Heather Jones
- Inflammation and Immunology,Global Medical Affairs, Pfizer, Collegeville, PA, USA
| | - Lotus Mallbris
- Inflammation and Immunology,Global Medical Affairs, Pfizer, Collegeville, PA, USA
| | - Kristina Callis Duffin
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel O Clegg
- Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA,
| | - Annette Szumski
- Pfizer Business Unit (PBU) Syneos Health, Princeton, NJ, United States
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11
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Dand N, Mucha S, Tsoi LC, Mahil SK, Stuart PE, Arnold A, Baurecht H, Burden AD, Callis Duffin K, Chandran V, Curtis CJ, Das S, Ellinghaus D, Ellinghaus E, Enerback C, Esko T, Gladman DD, Griffiths CEM, Gudjonsson JE, Hoffman P, Homuth G, Hüffmeier U, Krueger GG, Laudes M, Lee SH, Lieb W, Lim HW, Löhr S, Mrowietz U, Müller-Nurayid M, Nöthen M, Peters A, Rahman P, Reis A, Reynolds NJ, Rodriguez E, Schmidt CO, Spain SL, Strauch K, Tejasvi T, Voorhees JJ, Warren RB, Weichenthal M, Weidinger S, Zawistowski M, Nair RP, Capon F, Smith CH, Trembath RC, Abecasis GR, Elder JT, Franke A, Simpson MA, Barker JN. Exome-wide association study reveals novel psoriasis susceptibility locus at TNFSF15 and rare protective alleles in genes contributing to type I IFN signalling. Hum Mol Genet 2017; 26:4301-4313. [PMID: 28973304 PMCID: PMC5886170 DOI: 10.1093/hmg/ddx328] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a common inflammatory skin disorder for which multiple genetic susceptibility loci have been identified, but few resolved to specific functional variants. In this study, we sought to identify common and rare psoriasis-associated gene-centric variation. Using exome arrays we genotyped four independent cohorts, totalling 11 861 psoriasis cases and 28 610 controls, aggregating the dataset through statistical meta-analysis. Single variant analysis detected a previously unreported risk locus at TNFSF15 (rs6478108; P = 1.50 × 10-8, OR = 1.10), and association of common protein-altering variants at 11 loci previously implicated in psoriasis susceptibility. We validate previous reports of protective low-frequency protein-altering variants within IFIH1 (encoding an innate antiviral receptor) and TYK2 (encoding a Janus kinase), in each case establishing a further series of protective rare variants (minor allele frequency < 0.01) via gene-wide aggregation testing (IFIH1: pburden = 2.53 × 10-7, OR = 0.707; TYK2: pburden = 6.17 × 10-4, OR = 0.744). Both genes play significant roles in type I interferon (IFN) production and signalling. Several of the protective rare and low-frequency variants in IFIH1 and TYK2 disrupt conserved protein domains, highlighting potential mechanisms through which their effect may be exerted.
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Affiliation(s)
- Nick Dand
- Division of Genetics and Molecular Medicine, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sören Mucha
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Lam C Tsoi
- Department of Dermatology
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Satveer K Mahil
- St John's Institute of Dermatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Andreas Arnold
- Clinic and Polyclinic of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - Hansjörg Baurecht
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A David Burden
- Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | | | - Vinod Chandran
- Department of Medicine
- Department of Laboratory Medicine and Pathobiology
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Charles J Curtis
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sayantan Das
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Charlotta Enerback
- Division of Cell Biology and Dermatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tõnu Esko
- Estonian Biobank, Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Dafna D Gladman
- Department of Medicine
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Per Hoffman
- Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gerald G Krueger
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | | | - Sang Hyuck Lee
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Sabine Löhr
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Mrowietz
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Markus Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Annette Peters
- Institute of Genetic Epidemiology, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - André Reis
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nick J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
- Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elke Rodriguez
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carsten O Schmidt
- Institute for Community Medicine, Study of Health in Pomerania/KEF, University Medicine Greifswald, Greifswald, Germany
| | - Sarah L Spain
- Division of Genetics and Molecular Medicine, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum Munich, Neuherberg, Germany
| | | | | | - Richard B Warren
- Dermatology Centre, Salford Road NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Michael Weichenthal
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stephan Weidinger
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthew Zawistowski
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Francesca Capon
- Division of Genetics and Molecular Medicine, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Richard C Trembath
- Division of Genetics and Molecular Medicine, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Goncalo R Abecasis
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James T Elder
- Department of Dermatology
- Ann Arbor Veterans Hospital, Ann Arbor, MI, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael A Simpson
- Division of Genetics and Molecular Medicine, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
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12
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Tsoi LC, Stuart PE, Tian C, Gudjonsson JE, Das S, Zawistowski M, Ellinghaus E, Barker JN, Chandran V, Dand N, Duffin KC, Enerbäck C, Esko T, Franke A, Gladman DD, Hoffmann P, Kingo K, Kõks S, Krueger GG, Lim HW, Metspalu A, Mrowietz U, Mucha S, Rahman P, Reis A, Tejasvi T, Trembath R, Voorhees JJ, Weidinger S, Weichenthal M, Wen X, Eriksson N, Kang HM, Hinds DA, Nair RP, Abecasis GR, Elder JT. Large scale meta-analysis characterizes genetic architecture for common psoriasis associated variants. Nat Commun 2017; 8:15382. [PMID: 28537254 PMCID: PMC5458077 DOI: 10.1038/ncomms15382] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 03/27/2017] [Indexed: 12/21/2022] Open
Abstract
Psoriasis is a complex disease of skin with a prevalence of about 2%. We conducted the largest meta-analysis of genome-wide association studies (GWAS) for psoriasis to date, including data from eight different Caucasian cohorts, with a combined effective sample size >39,000 individuals. We identified 16 additional psoriasis susceptibility loci achieving genome-wide significance, increasing the number of identified loci to 63 for European-origin individuals. Functional analysis highlighted the roles of interferon signalling and the NFκB cascade, and we showed that the psoriasis signals are enriched in regulatory elements from different T cells (CD8+ T-cells and CD4+ T-cells including TH0, TH1 and TH17). The identified loci explain ∼28% of the genetic heritability and generate a discriminatory genetic risk score (AUC=0.76 in our sample) that is significantly correlated with age at onset (p=2 × 10-89). This study provides a comprehensive layout for the genetic architecture of common variants for psoriasis.
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Affiliation(s)
- Lam C Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA.,Department of Computational Medicine &Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Philip E Stuart
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Chao Tian
- 23andMe, Inc., Mountain View, California 94041, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Sayantan Das
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Matthew Zawistowski
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel 24105, Germany
| | - Jonathan N Barker
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada M5S 1A8.,Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada M5T 2S8
| | - Nick Dand
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | | | - Charlotta Enerbäck
- Department of Dermatology, Linköping University, Linköping SE-581 83, Sweden
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu 51010, Estonia.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel 24105, Germany
| | - Dafna D Gladman
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada M5S 1A8.,Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada M5T 2S8
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn 53127, Germany.,Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel 4031, Switzerland
| | - Külli Kingo
- Dermatology Clinic, Tartu University Hospital, Department of Dermatology and Venereology, University of Tartu, Tartu 50417, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, Centre of Translational Medicine and Centre for Translational Genomics, University of Tartu, Tartu 50411, Estonia.,Department of Reproductive Biology, Estonian University of Life Sciences, Tartu 51006, Estonia
| | - Gerald G Krueger
- Department of Dermatology, University of Utah, Salt Lake City, Utah 84132, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Tartu 51010, Estonia
| | - Ulrich Mrowietz
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
| | - Sören Mucha
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel 24105, Germany
| | - Proton Rahman
- Memorial University, St. John's, Newfoundland, Newfoundland and Labrador, Canada A1B 3X9
| | - Andre Reis
- Institute of Human Genetics, FAU Erlangen-Nürnberg, Erlangen 91054, Germany
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan 48105, USA
| | - Richard Trembath
- Department of Medical and Molecular Genetics, King's College London, London WC2R 2LS, UK
| | - John J Voorhees
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Stephan Weidinger
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
| | - Xiaoquan Wen
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | - Hyun M Kang
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | - Rajan P Nair
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Gonçalo R Abecasis
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan 48105, USA
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13
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Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD, Callis Duffin K, Eichenfield LF, Garg A, Gelfand JM, Gottlieb AB, Koo JY, Korman NJ, Krueger GG, Lebwohl MG, Leonardi CL, Mandelin AM, Menter MA, Merola JF, Pariser DM, Prussick RB, Ryan C, Shah KN, Weinberg JM, Williams MO, Wu JJ, Yamauchi PS, Van Voorhees AS. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol 2017; 76:290-298. [DOI: 10.1016/j.jaad.2016.10.017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 02/03/2023]
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14
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Abstract
Background: Retinoids plus PUVA (re-PUVA) may be used in the treatment of lichen planus in cases that do not respond to monotherapy. Hyperpigmentation is a potential side effect of re-PUVA therapy. Objective: A case of remarkably intense transient hyperpigmentation secondary to re-PUVA therapy is presented. Methods and Results: An 18-year-old male with lichen planus who had been taking isotretinoin 80 mg per day for seven days developed an exaggerated hyperpigmentation following the third dose of PUVA. Conclusion: As the hyperpigmentary reaction did not occur until the third PUVA dose, which was near the steady state of isotretinoin, this case may illustrate a case of photosensitization secondary to isotretinoin alone or isotretinoin in combination.
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Affiliation(s)
| | - Scott R. Florell
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Gerald G. Krueger
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
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15
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Krueger GG, Jorgensen CM. Defined System to Assess the in Vitro Induction of a Psoriasis Phenotype on Normal Keratinocytes by Fibroblasts from Psoriatic Subjects. J Cutan Med Surg 2016. [DOI: 10.1177/120347549700200105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Research has shown that involved as well as uninvolved skin of psoriatic subjects have an inherent defect that manifests, at a minimum, as nonapparent epidermal hyperplasia. Fibroblasts have been shown to regulate epidermal proliferation and differentiation; furthermore, fibroblasts from patients with psoriasis have altered growth, response, and mediator release when compared with normal. Objective: We conjectured that it might be possible to generate the enhanced epidermal proliferation inherent to psoriatic skin in vitro using a defined interactive culture system with cellular components from the skin of normal and psoriatic subjects. Methods: To reduce the variables whereby fibroblasts stimulate keratinocyte proliferation in vitro, a system was developed that does not permit direct contact between keratinocytes and fibroblasts, but does permit the exchange of media and mediators as well as an assessment of keratinocyte growth as a function of time. Fibroblasts from involved and uninvolved sites from biopsies of seven untreated psoriatic subjects were assessed for their effect on the growth of keratinocytes from normal subjects. Results: Analysis shows that five of seven fibroblast sources from involved sites and six of seven from uninvolved sites of psoriatic subjects induce normal keratinocytes to display enhanced outgrowth. Three of 14 fibroblast sources consistently do not induce this change. Fibroblasts from uninvolved sources are particularly effective, with a mean of 40 ± 8% (SD) more growth than with normal fibroblasts. Conclusion: It is concluded that fibroblasts from psoriatics can induce the phenotype of increased epidermal proliferation on normal keratinocytes via a soluble mediator in a defined system.
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Affiliation(s)
- Gerald G. Krueger
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Cynthia M. Jorgensen
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
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16
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Abstract
The duration of response to treatment with alefacept has been assessed in patients with moderate to severe chronic plaque psoriasis who responded to alefacept therapy in phase 2 and phase 3 clinical studies. In a phase 2 trial, duration of response was based on time to retreatment with alefacept. In two phase 3 studies, the more objective measure of maintenance of a ≥50% reduction from baseline Psoriasis Area and Severity Index (PASI 50) was used. Two patient subsets were analyzed: (1) those who achieved a PASI 75 at any time during the trials and (2) those who achieved a Physician Global Assessment of “clear” or “almost clear” at any time during the trials. Regardless of the criterion used or the route of alefacept administration (intravenous or intramuscular), the median duration of response to alefacept therapy ranged from 7 to 10 months across the three studies. Alefacept is a remittive therapy for psoriasis.
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Affiliation(s)
- Gerald G. Krueger
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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17
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Krueger GG, Pitcher C, Liimatta AP, Knapp TL, Miller KJ, Wilkins DG, Rollins DE. Insights into the Passive Partitioning of Amino Acids and Codeine into Human Hair. J Cutan Med Surg 2016. [DOI: 10.1177/120347549600100202] [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] [Indexed: 11/16/2022]
Abstract
Background: Cells that form hair are among the body's most rapidly dividing cells, with each daughter cell becoming part of the hair shaft as it differentiates and lengthens. It follows that hair might contain concentrations of xenobiotics (environmental chemicals, therapeutic drugs, illicit substances, etc.) reflective of the concentration in blood at the time of division and onset of differentiation of cells that give rise to hair. Objective: This study was designed to gain insight into the passive incorporation of xenobiotics into hair. Methods: This study focused on the parameters of the passive partitioning of three agents, two water-soluble amino acids (cysteine and glutamine) and codeine into hair. Undamaged black hair from various ethnic groups was incubated in solutions containing the three agents as a function of time and concentration. Hair was washed extensively; time and dose to steady state as well as partitioning coefficients were determined for each agent. Codeine washing with a pH gradient also was carried out. Results: Data show that the partitioning coefficient of the agents is linear but not stoichiometric. At low doses passive partitioning into hair is efficient, a 1 minute exposure leading to significant retention. Washing extensively with deionized water, the fluid used for passive partitioning of the test agent, will not reversibly extract all of the agent, regardless of race. Conclusion: Hair can effectively absorb and retain agents of the environment, and this retention occurs via mechanisms other than those inherent to an ion exchange column.
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Affiliation(s)
- Gerald G. Krueger
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Carla Pitcher
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Andrew P. Liimatta
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Todd L. Knapp
- Resident Trainee, Department of Radiology, Washington University, St. Louis, Missouri
| | - Kenneth J. Miller
- Associate Director of the Dermatopharmacology Laboratory, Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Diana G. Wilkins
- Center of Human Toxicology, Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Douglas E. Rollins
- Center of Human Toxicology, Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah Health Sciences Center, Salt Lake City, Utah
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18
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Kavanaugh A, van der Heijde D, Beutler A, Gladman D, Mease P, Krueger GG, McInnes IB, Helliwell P, Coates LC, Xu S. Radiographic Progression of Patients With Psoriatic Arthritis Who Achieve Minimal Disease Activity in Response to Golimumab Therapy: Results Through 5 Years of a Randomized, Placebo-Controlled Study. Arthritis Care Res (Hoboken) 2016; 68:267-74. [PMID: 25779603 PMCID: PMC5066795 DOI: 10.1002/acr.22576] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/22/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
Objective To evaluate long‐term outcomes in psoriatic arthritis (PsA) patients who achieved or did not achieve minimal disease activity (MDA) through 5 years of golimumab treatment in the GO‐REVEAL trial. Methods The GO‐REVEAL trial was a phase III, randomized, double‐blind trial with placebo‐control through week 24 followed by an open‐label extension of golimumab 50/100 mg treatment up to 5 years. In these post‐hoc analyses, MDA was defined by the presence of ≥5 of 7 PsA outcome measures (≤1 swollen joint, ≤1 tender joint, Psoriasis Area and Severity Index [PASI] ≤1, patient pain score ≤15, patient global disease activity score ≤20 [range 0–100], Health Assessment Questionnaire disability index [HAQ DI] ≤0.5, and ≤1 tender enthesis point). Results Treatment with golimumab yielded significantly higher MDA response rates versus patients randomized to placebo at week 14 (23.5% versus 1.0%; P < 0.0001), week 24 (28.1% versus 7.7%; P < 0.0001), and week 52 (42.4% versus 30.2%; P = 0.037). MDA was achieved at least once by ∼50% of golimumab‐treated patients overall. Irrespective of treatment randomization, achievement of MDA at ≥3 and ≥4 consecutive visits was associated with significantly less radiographic progression and more improvement in MDA components allowing specific assessment of physical function (HAQ DI) and overall disease activity (patient global assessment of disease activity) at week 256 versus patients not achieving MDA. Logistic regression analyses indicated that a 1‐unit higher baseline HAQ DI score yielded a significantly lower likelihood of achieving MDA at ≥3 (odds ratio 0.514 [95% confidence interval 0.321–0.824]; P = 0.006) and ≥4 (odds ratio 0.480 [95% confidence interval 0.290–0.795]; P = 0.004) consecutive visits. Conclusion Among golimumab‐treated PsA patients, better long‐term functional improvement, patient global assessment, and radiographic outcomes were observed when patients achieved persistent MDA.
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Affiliation(s)
| | | | - Anna Beutler
- Janssen Research & Development, Spring House, Pennsylvania
| | | | - Philip Mease
- Swedish Medical Center, Seattle, Washington, and University of Washington, Seattle
| | | | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Stephen Xu
- Janssen Research & Development, Spring House, Pennsylvania
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19
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Menter A, Papp KA, Gooderham M, Pariser DM, Augustin M, Kerdel FA, Fakharzadeh S, Goyal K, Calabro S, Langholff W, Chavers S, Naessens D, Sermon J, Krueger GG. Drug survival of biologic therapy in a large, disease-based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Eur Acad Dermatol Venereol 2016; 30:1148-58. [PMID: 27027388 PMCID: PMC5071685 DOI: 10.1111/jdv.13611] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [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] [Revised: 07/14/2015] [Accepted: 01/06/2016] [Indexed: 12/18/2022]
Abstract
Background Drug survival is a marker for treatment sustainability in chronic diseases such as psoriasis. Objective The aim of these analyses was to assess survival of biologic treatments in the PSOriasis Longitudinal Assessment and Registry (PSOLAR). Methods PSOLAR is a large, prospective, international, disease‐based registry of patients with psoriasis receiving (or eligible for) systemic therapy in a real‐world setting. Drug survival is defined as the time from initiation to discontinuation (stop/switch) of biologic therapy on registry. The number of patients who discontinued each treatment and the duration of therapy were recorded. Using Kaplan–Meier survival curves and Cox‐regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)], time to discontinuation was compared across cohorts undergoing first‐, second‐ or third‐line treatment with ustekinumab, infliximab, adalimumab or etanercept. Results As of the 2013 data cut, 12 095 patients with psoriasis were enrolled in PSOLAR. Of the 4000 patients initiating any new biologic therapy, approximately 3500 started a first‐line, second‐line or third‐line biologic therapy during the registry. Lack of effectiveness was the most common reason for discontinuation across biologic therapies. Based on the multivariate analysis, significantly shorter times to discontinuation were observed for infliximab [HR (95%CI) = 2.73 (1.48–5.04), P = 0.0014]; adalimumab [4.16 (2.80–6.20), P < 0.0001]; and etanercept [4.91 (3.28–7.35) P < 0.0001] compared with ustekinumab [reference treatment]) for first‐line biologic use; results were similar for treatment effects for second/third‐line therapies. Although limited in power, analyses in patients with concurrent psoriatic arthritis confirmed by a rheumatologist reflect observations in the overall psoriasis population. Conclusion Drug survival was superior for ustekinumab compared with infliximab, adalimumab and etanercept in patients with psoriasis.
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Affiliation(s)
- A Menter
- Baylor University Medical Center, Dallas, TX, USA
| | - K A Papp
- K Papp Clinical Research and Probity Medical Research, Inc., Waterloo, Ontario, Canada
| | - M Gooderham
- SKIN Centre for Dermatology and Probity Medical Research, Peterborough, Ontario, Canada
| | - D M Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Norfolk, VA, USA
| | - M Augustin
- University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - F A Kerdel
- Florida Academic Dermatology Centers, Miami, FL, USA
| | | | - K Goyal
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - S Calabro
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - W Langholff
- Janssen Research & Development, LLC, Horsham, PA, USA
| | - S Chavers
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - J Sermon
- Janssen-Cilag NV, Beerse, Belgium
| | - G G Krueger
- University of Utah School of Medicine, Salt Lake City, UT, USA
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20
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Zaghi D, Weir C, Ying J, Carlin C, Greene T, DeShazo R, Callis Duffin K, Krueger GG. Desired Improvement Tool (DIT): A tool to assess desire for improvement in psoriasis patients. J DERMATOL TREAT 2015; 27:27-30. [PMID: 26247843 DOI: 10.3109/09546634.2015.1050351] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
No validated instrument exists to measure desire for improvement in psoriasis patients. To address this void, we conducted a single-center longitudinal study of 268 moderate-to-severe psoriasis patients to psychometrically validate the Desired Improvement Tool (DIT). The DIT is a single-item instrument scored 0-5 by the patient. A 0 indicates the patient is satisfied with disease level and does not desire further treatment. A 5 indicates a large amount of improvement is desired. The DIT demonstrated high test-retest reliability (Spearman, r = 0.97). Predictive and construct validity were moderate-to-high: r = 0.70 for BSA, 0.67 for PASI, and 0.56 for PGA and r = 0.67 for Life Quality Assessment (LQA), respectively. A sensitivity analysis revealed the DIT responded to changes in BSA. As a psychometrically valid tool, the DIT may guide clinical management of psoriasis patients by capturing an important clinical construct in an expedient and quantifiable manner.
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Affiliation(s)
- Daniel Zaghi
- a Department of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Charlene Weir
- b Department of Biomedical Informatics , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Jian Ying
- c Department of Internal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Christopher Carlin
- d West Dermatology, 1300 Avenida Vista Hermosa , San Clemente , CA , USA , and
| | - Tom Greene
- c Department of Internal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Rosemary DeShazo
- e Department of Dermatology , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Kristina Callis Duffin
- e Department of Dermatology , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Gerald G Krueger
- e Department of Dermatology , University of Utah School of Medicine , Salt Lake City , UT , USA
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21
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Blauvelt A, Armstrong AW, Krueger GG. Essential Truths for the Care and Management of Moderate-to-Severe Psoriasis. J Drugs Dermatol 2015; 14:805-812. [PMID: 26267724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Psoriasis is a systemic inflammatory disease. Effective management requires treatment with agents targeting inflammation in skin, joints, and other tissues. Biologics for psoriasis are directed at more specific targets, have a better safety profile, are better tolerated, and are more effective than conventional systemic agents. Despite these advances, many patients with psoriasis remain undertreated, and overall patient satisfaction remains low. The dichotomy between ideal therapeutic outcomes and suboptimal outcomes (which are currently commonplace) is likely largely due to misperceptions about psoriasis and biologic treatments. This article discusses these misperceptions, including the notions that psoriasis is a benign disorder, and that conventional systemic therapies are safer than biologics and adequate for most patients with moderate-to-severe disease. We present practical and evidence-based discussions to refute these misconceptions and provide useful resources for providers and patients that support access to advanced therapies. We believe that biologics represent optimal treatment for most patients with moderate-to-severe psoriasis, and until more effective approaches are generated, these efficacious and target-specific approaches should become the standard of care.
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22
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Beresniak A, Auray JP, Duru G, Aractingi S, Krueger GG, Talarico S, Tsutani K, Dupont D, de Linares Y. Quality of life assessment in cosmetics: specificity and interest of the international BeautyQol instrument. J Cosmet Dermatol 2015; 14:260-5. [PMID: 26133392 DOI: 10.1111/jocd.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
Abstract
The wide use of cosmetics and their perceived benefits upon well-being imply objective descriptions of their effects upon the different dimensions contributing to the quality of life (QoL). Such a goal pleas for using relevant and validated scientific instruments with robust measurement methods. This paper discusses the interest of the new validated questionnaire BeautyQoL specifically designed to assess the effect of cosmetic products on physical appearance and QoL. After conducting a review of skin appearance and QoL, three phases of the international codevelopment have been carried out in the following sequence: semi-directed interviews (Phase 1), acceptability study (Phase 2), and validation study (Phase 3). Data collection and validation process have been carried out in 16 languages. This review confirms that QoL instruments developed in dermatology are not suitable to assess cosmetic products, mainly because of their lack of sensitivity. General acceptability of BeautyQol was very good. Forty-two questions have been structured in five dimensions that explained 76.7% of the total variance: Social Life, Self-confidence, Mood, Vitality, and Attractiveness. Cronbach's alpha coefficients are between 0.932 and 0.978, confirming the good internal consistency of the results. The BeautyQol questionnaire is the first international instrument specific to cosmetic products and physical appearance that has been validated in 16 languages and could be used in a number of clinical trials and descriptive studies to demonstrate the added value of these products on the QoL.
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Affiliation(s)
- Ariel Beresniak
- Data Mining International, Geneva, Switzerland.,Paris-Descartes University, Paris, France
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23
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Boehncke WH, Qureshi A, Merola JF, Thaçi D, Krueger GG, Walsh J, Kim N, Gottlieb AB. Diagnosing and treating psoriatic arthritis: an update. Br J Dermatol 2015; 170:772-86. [PMID: 24266754 DOI: 10.1111/bjd.12748] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis of uncertain pathogenesis, affecting approximately one in four patients with psoriasis. Onset of psoriasis typically precedes the development of PsA. Therefore, the dermatologist is ideally positioned to recognize the early signs and symptoms of PsA for diagnosis and subsequent treatment. The role of the dermatologist in early diagnosis and treatment is essential for preventing pain and functional disabilities, as well as the joint deterioration that accompanies progressive forms of PsA. Diagnosis of PsA is a key aspect of the clinical decision process for the dermatologist, as psoriasis plus PsA requires a different therapeutic approach from that required for psoriasis alone. Furthermore, PsA is associated with an increased risk of cardiovascular comorbidities that present significant health concerns. In this review, the pathogenesis and comorbidities of PsA are discussed. In addition, screening and imaging tools that aid in the diagnosis of PsA, as well as tools used for efficacy assessment, are reviewed. Available therapies are presented, with a focus on targeted biologics and emerging treatments.
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Affiliation(s)
- W H Boehncke
- Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
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24
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Beresniak A, Auray JP, Duru G, Aractingi S, Krueger GG, Talarico S, Adam AS, Piot B, Dupont D, de Linares Y. Impact of pigmentary disorders on quality of life in Japan: Interest of the BeautyQoL instrument. J COSMET LASER THER 2015; 17:313-7. [PMID: 25968164 DOI: 10.3109/14764172.2015.1039034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Skin pigmentary disorders and uneven skin tone represent common cosmetic concerns in Japan where fairer skin is culturally desirable. As the demographics of Asian countries continue to evolve, there is a need to understand the impact of cosmetic skin concerns on quality of life (QoL). 199 Japanese women self-claiming facial skin pigmentation disorders were asked to complete the BeautyQoL questionnaire, and the results were compared with those of a control group of 200 women. Of the five dimensions of the BeautyQoL questionnaire, the dimension "mood" appeared to be significantly lower in the group presenting facial dark spots, as compared with the control group (p < 0.05). In the group presenting facial dark spots, the five dimensions and the global score showed that subjects concerned had lower scores than subjects less concerned, even if statistical significance was not reached. This study confirms that common pigmentary disorders such as facial black spots may negatively impact QoL. Further comparative studies with a controlled randomized design would be necessary to confirm these findings.
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Affiliation(s)
- Ariel Beresniak
- a Data Mining International , Geneva , Switzerland.,b Paris-Descartes University , Paris , France
| | | | | | | | - Gerald G Krueger
- d Department of Dermatology , University of Utah , Salt Lake City , USA
| | - Sergio Talarico
- e Department of Dermatology , Federal University of Sao Paulo , Sao Paulo , Brazil
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Tsoi LC, Spain SL, Ellinghaus E, Stuart PE, Capon F, Knight J, Tejasvi T, Kang HM, Allen MH, Lambert S, Stoll SW, Weidinger S, Gudjonsson JE, Koks S, Kingo K, Esko T, Das S, Metspalu A, Weichenthal M, Enerback C, Krueger GG, Voorhees JJ, Chandran V, Rosen CF, Rahman P, Gladman DD, Reis A, Nair RP, Franke A, Barker JNWN, Abecasis GR, Trembath RC, Elder JT. Enhanced meta-analysis and replication studies identify five new psoriasis susceptibility loci. Nat Commun 2015; 6:7001. [PMID: 25939698 PMCID: PMC4422106 DOI: 10.1038/ncomms8001] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/24/2015] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic autoimmune disease with complex genetic architecture. Previous genome-wide association studies (GWAS) and a recent meta-analysis using Immunochip data have uncovered 36 susceptibility loci. Here, we extend our previous meta-analysis of European ancestry by refined genotype calling and imputation and by the addition of 5,033 cases and 5,707 controls. The combined analysis, consisting of over 15,000 cases and 27,000 controls, identifies five new psoriasis susceptibility loci at genome-wide significance (P<5 × 10(-8)). The newly identified signals include two that reside in intergenic regions (1q31.1 and 5p13.1) and three residing near PLCL2 (3p24.3), NFKBIZ (3q12.3) and CAMK2G (10q22.2). We further demonstrate that NFKBIZ is a TRAF3IP2-dependent target of IL-17 signalling in human skin keratinocytes, thereby functionally linking two strong candidate genes. These results further integrate the genetics and immunology of psoriasis, suggesting new avenues for functional analysis and improved therapies.
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Affiliation(s)
- Lam C Tsoi
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Sarah L Spain
- Division of Genetics and Molecular Medicine, King's College London, London WC2R 2LS, UK.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24105 Kiel, Germany
| | - Philip E Stuart
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Francesca Capon
- Division of Genetics and Molecular Medicine, King's College London, London WC2R 2LS, UK
| | - Jo Knight
- Neuroscience Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada M5T 1R8.,National Institute for Health Research (NIHR), Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Hyun M Kang
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Michael H Allen
- Division of Genetics and Molecular Medicine, King's College London, London WC2R 2LS, UK
| | - Sylviane Lambert
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Stefan W Stoll
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Stephan Weidinger
- Department of Dermatology, University Hospital, Schleswig-Holstein, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Sulev Koks
- Department of Pathophysiology, Centre of Translational Medicine and Centre for Translational Genomics, University of Tartu, 50409 Tartu, Estonia
| | - Külli Kingo
- Department of Dermatology and Venereology, University of Tartu, 50409 Tartu, Estonia
| | - Tonu Esko
- Estonian Genome Center, University of Tartu, 51010 Tartu, Estonia
| | - Sayantan Das
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, 51010 Tartu, Estonia
| | - Michael Weichenthal
- Department of Dermatology, University Hospital, Schleswig-Holstein, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Charlotta Enerback
- Department of Dermatology, Linköping University, SE-581 83 Linköping, Sweden
| | - Gerald G Krueger
- Department of Dermatology, University of Utah, Salt Lake City, Utah 84132, USA
| | - John J Voorhees
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada M5T 2S8
| | - Cheryl F Rosen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada M5T 2S8
| | - Proton Rahman
- Department of Medicine, Memorial University, St John's, Newfoundland, Canada A1C 5B8
| | - Dafna D Gladman
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada M5T 2S8
| | - Andre Reis
- Institute of Human Genetics, University of Erlangen-Nuremberg, Erlangen 91054, Germany
| | - Rajan P Nair
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24105 Kiel, Germany
| | - Jonathan N W N Barker
- Division of Genetics and Molecular Medicine, King's College London, London WC2R 2LS, UK
| | - Goncalo R Abecasis
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Richard C Trembath
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - James T Elder
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan 48105, USA
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26
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Gottlieb AB, Kalb RE, Langley RG, Krueger GG, de Jong EMGJ, Guenther L, Goyal K, Fakharzadeh S, Chevrier M, Calabro S, Langholff W, Menter A. Safety observations in 12095 patients with psoriasis enrolled in an international registry (PSOLAR): experience with infliximab and other systemic and biologic therapies. J Drugs Dermatol 2014; 13:1441-1448. [PMID: 25607786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Long-term data are essential to assess the safety of biologic agents for the treatment of psoriasis. OBJECTIVE To evaluate the incidence of adverse events of interest (AEIs), including all-cause mortality, major adverse cardiovascular events (MACE), malignancy (excluding nonmelanoma skin cancer), and serious infections (SI), in patients treated for psoriasis in clinical practice settings. METHODS PSOLAR is a large, ongoing, observational study of patients receiving, or eligible to receive, biologic or systemic therapy for psoriasis. Cumulative incidence rates of AEIs per 100 patient-years (PY) are reported across treatment cohorts: (1) infliximab, (2) ustekinumab, (3) other biologics (eg, adalimumab and etanercept), and (4) non-biologic agents. Significant predictors of each AEI were identified using Cox proportional hazards regression methodology. RESULTS PSOLAR is now fully enrolled at 12095 patients followed for 31818PY. The cumulative rate was 0.46/100PY for death, 0.36/100PY for MACE, 0.68/100PY for malignancy, and 1.50/100PY for SI. Increasing age was a significant predictor of all AEIs. A history of cardiovascular disease, malignancy, and significant infection was associated with a higher risk of developing MACE, malignancy, and SI, respectively. Exposure to infliximab (Hazard Ratio [HR]=3.101, P<0.001) and exposure to other biologics (HR=1.736, P<0.001) were significant predictors of SI. Use of immunomodulators (HR=1.954, P=0.005) was a significant predictor of MACE. Compared with non-biologic therapy, the use of biologic agents was not a significant predictor of death, MACE, or malignancy. CONCLUSIONS Based on PSOLAR data through 2013, no new safety concerns were observed with infliximab for all-cause mortality, MACE, or malignancy; the data suggest that infliximab was associated with serious infections.
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Takeshita J, Wang S, Shin DB, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Stierstorfer MB, Brod BA, Schleicher SM, Robertson AD, Linn KA, Shinohara RT, Troxel AB, Van Voorhees AS, Gelfand JM. Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting. J Am Acad Dermatol 2014; 71:1167-75. [PMID: 25260564 DOI: 10.1016/j.jaad.2014.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/31/2014] [Accepted: 08/05/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effectiveness of psoriasis therapies in real-world settings remains relatively unknown. OBJECTIVE We sought to compare the effectiveness of less commonly used systemic therapies and commonly used combination therapies for psoriasis. METHODS This was a multicenter cross-sectional study of 203 patients with plaque psoriasis receiving less common systemic monotherapy (acitretin, cyclosporine, or infliximab) or common combination therapies (adalimumab, etanercept, or infliximab and methotrexate) compared with 168 patients receiving methotrexate evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network. RESULTS In adjusted analyses, patients on acitretin (relative response rate 2.01; 95% confidence interval [CI] 1.18-3.41), infliximab (relative response rate 1.93; 95% CI 1.26-2.98), adalimumab and methotrexate (relative response rate 3.04; 95% CI 2.12-4.36), etanercept and methotrexate (relative response rate 2.22; 95% CI 1.25-3.94), and infliximab and methotrexate (relative response rate 1.72; 95% CI 1.10-2.70) were more likely to have clear or almost clear skin compared with patients on methotrexate. There were no differences among treatments when response rate was defined by health-related quality of life. LIMITATIONS Single time point assessment may result in overestimation of effectiveness. CONCLUSIONS The efficacy of therapies in clinical trials may overestimate their effectiveness as used in clinical practice. Although physician-reported relative response rates were different among therapies, absolute differences were small and did not correspond to differences in patient-reported outcomes.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Shuwei Wang
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Robert E Kalb
- Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | | | - Brian R Sperber
- Colorado Springs Dermatology Clinic, Colorado Springs, Colorado
| | | | - Bruce A Brod
- Dermatology Associates of Lancaster, Lancaster, Pennsylvania
| | | | | | - Kristin A Linn
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Russell T Shinohara
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Andrea B Troxel
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE To explore the relationship between fatigue and work productivity loss (WPL) in people with psoriatic arthritis (PsA). METHODS Data were collected from participants in the Utah Psoriasis Initiative Arthritis registry between January 2010 and May 2013. WPL was measured with the 8-item Work Limitations Questionnaire. Fatigue was assessed with question 1 from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI#1), "How would you describe the overall level of fatigue/tiredness you have experienced?" and with question 1 from the Psoriatic Arthritis Quality of Life Questionnaire (PsAQOL#1) "I feel tired whatever I do." Psoriatic activity was evaluated with tender joint count (TJC), swollen joint count (SJC), dactylitis count, enthesitis count, inflammatory back pain (IBP), physician global assessment, body surface area, and psoriasis pain and itch. RESULTS Among 107 participants, work productivity was reduced by 6.7%, compared to benchmark employees without limitations. Fatigue was reported by 54 patients (50.5%) on PsAQOL#1, and 64 (60.0%) were classified as high fatigue by BASDAI#1. TJC, SJC, enthesitis count, IBP, and depressed mood were highest or most frequent in participants reporting fatigue. After adjustments for psoriatic activity and depressed mood, WPL was associated with fatigue, as measured by PsAQOL#1 (p = 0.01) and BASDAI#1 (p = 0.002). CONCLUSION WPL was associated with fatigue, and the association was not entirely explained by the evaluated musculoskeletal, cutaneous, or psychiatric manifestations of PsA.
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Affiliation(s)
- Jessica A Walsh
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center.
| | - Molly L McFadden
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
| | - Michael D Morgan
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
| | - Allen D Sawitzke
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
| | - Kristina Callis Duffin
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
| | - Gerald G Krueger
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
| | - Daniel O Clegg
- From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center
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Chung J, Callis Duffin K, Takeshita J, Shin DB, Krueger GG, Robertson AD, Troxel AB, Van Voorhees AS, Edson-Heredia E, Gelfand JM. Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared with moderate to severe plaque psoriasis. J Am Acad Dermatol 2014; 71:623-32. [PMID: 24894455 DOI: 10.1016/j.jaad.2014.04.063] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 02/10/2014] [Revised: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of palmoplantar psoriasis on health-related quality of life (QoL) is largely unknown. OBJECTIVE We sought to compare clinical characteristics and patient-reported outcomes between patients with palmoplantar psoriasis and moderate to severe plaque psoriasis. METHODS We conducted a cross-sectional study of patients with plaque psoriasis (N=1153) and palmoplantar psoriasis (N=66) currently receiving systemic or light treatment for psoriasis. RESULTS Patients with palmoplantar psoriasis were more likely to report Dermatology Life Quality Index scores that correspond to at least a moderate impact on QoL (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.20-3.61); problems with mobility (OR 1.98; 95% CI 1.10-3.58), self-care (OR 3.12; 95% CI 1.24-7.86), and usual activities (OR 2.47; 95% CI 1.44-4.22) on the European Quality of Life-5 Dimensions questionnaire; and heavy topical prescription use of at least twice daily in the preceding week (OR 2.81; 95% CI 1.63-4.85) than those with plaque psoriasis. LIMITATIONS Our assessment tools may not account for all dimensions of health-related QoL affected by palmoplantar disease, and these results may not be generalizable to patients with milder forms of psoriasis. CONCLUSION Patients with palmoplantar psoriasis experience greater health-related QoL impairment and are more likely to report heavy use of topical prescriptions than those with moderate to severe plaque psoriasis.
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Affiliation(s)
- Jina Chung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Beresniak A, de Linares Y, Krueger GG, Talarico S, Tsutani K, Duru G, Berger G. Validation of a new international quality-of-life instrument specific to cosmetics and physical appearance: BeautyQoL questionnaire. ACTA ACUST UNITED AC 2014; 148:1275-82. [PMID: 23165832 DOI: 10.1001/archdermatol.2012.2696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To develop a new quality-of-life (QoL) instrument with international validity that specifically assesses cosmetic products and physical appearance. DESIGN In the first phase, semidirected interviews involved 309 subjects. In the second stage, an acceptability study was performed on 874 subjects. Thereafter, we recruited a total of 3231 subjects, each of whom completed the BeautyQoL questionnaire, a clinical checklist for the skin, the generic QoL 36-Item Short Form Health Survey, and a sociodemographic questionnaire. A retest was performed 8 days later on a subgroup of 652 subjects. SETTING Populations in France, the United Kingdom, Germany, Spain, Sweden, Italy, Russia, the United States, Brazil, Japan, India, China, and South Africa, representing 16 languages. PARTICIPANTS The general adult healthy population, including women and men. MAIN OUTCOME MEASURES Psychometric properties, construct validity, reproducibility, and internal and external consistency. RESULTS General acceptability was very good in the 16 languages, with a very low rate of no answers. The validation phase reduced the questionnaire to 42 questions structured in the following 5 dimensions that explained 76.7% of the total variance: social life, self-confidence, mood, energy, and attractiveness. Internal consistency was high (Cronbach α coefficients, 0.93-0.98). Reproducibility at 8 days was satisfactory in all dimensions. Results of external validity testing revealed that BeautyQoL scores correlated significantly with all 36-Item Short Form Health Survey scores except for physical function. CONCLUSION These results demonstrate the validity and reliability of the BeautyQoL questionnaire as the very first international instrument specific to cosmetic products and physical appearance.
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Kavanaugh A, McInnes IB, Mease P, Krueger GG, Gladman D, van der Heijde D, Zhou Y, Lu J, Leu JH, Goldstein N, Beutler A. Clinical efficacy, radiographic and safety findings through 5 years of subcutaneous golimumab treatment in patients with active psoriatic arthritis: results from a long-term extension of a randomised, placebo-controlled trial (the GO-REVEAL study). Ann Rheum Dis 2014; 73:1689-94. [PMID: 24748630 PMCID: PMC4145441 DOI: 10.1136/annrheumdis-2013-204902] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives Assess golimumab's long-term efficacy/safety in psoriatic arthritis (PsA). Methods Adults with active PsA (≥3 swollen and tender joints, active psoriasis) were randomly assigned to subcutaneous placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks (q4wks) through wk20. All patients received golimumab 50 mg or 100 mg q4wks from wk24 forward. Methotrexate was allowed and taken by approximately half the patients. Findings through 5 years are reported herein. Efficacy assessments included ≥20% improvement in American College of Rheumatology (ACR20) response, C-reactive-protein-based, 28-joint-count Disease Activity Score (DAS28-CRP) response, ≥75% improvement in Psoriasis Area and Severity Index (PASI75) scores, and PsA-modified Sharp/van der Heijde scores (SHSs). Results 126/405 (31%) randomised patients discontinued treatment through wk252. Golimumab was effective in maintaining clinical improvement through year-5 (ACR20: 62.8–69.9%, DAS28-CRP: 75.2-84.9% for randomised patients; PASI75: 60.8–72.2% among randomised patients with ≥3% body surface area involvement) and inhibiting radiographic progression (mean changes in PsA-modified SHS: 0.1–0.3) among patients with radiographic data. While concomitant methotrexate did not affect ACR20/PASI75, it appeared to reduce radiographic progression. No new safety signals were identified. Antibodies-to-golimumab occurred in 1.8%/10.0% of patients with/without methotrexate). Conclusions Long-term golimumab safety/efficacy in PsA was demonstrated through 5 years. Trial registration number NCT00265096.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California, San Diego, La Jolla, California, USA
| | - Iain B McInnes
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Philip Mease
- Department of Rheumatology, Swedish Medical Center, University of Washington, Seattle, Washington, USA
| | - Gerald G Krueger
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Dafna Gladman
- Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Désirée van der Heijde
- Director of Imaging Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yiying Zhou
- Department of Biostatistics, Janssen Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Jiandong Lu
- Department of Biostatistics, Janssen Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Jocelyn H Leu
- Biologics Clinical Pharmacology, Janssen Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Neil Goldstein
- Department of Immunology, Janssen Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Anna Beutler
- Department of Immunology, Janssen Research & Development, LLC., Spring House, Pennsylvania, USA
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Duffin KC, Yeung H, Takeshita J, Krueger GG, Robertson AD, Troxel AB, Shin DB, Van Voorhees AS, Gelfand JM. Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. Br J Dermatol 2014; 170:672-680. [PMID: 24266717 PMCID: PMC4302409 DOI: 10.1111/bjd.12745] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment satisfaction among patients with moderate-to-severe psoriasis has not been studied and compared across treatments using a validated instrument. OBJECTIVES To assess patient-reported satisfaction with systemic and phototherapy treatments for moderate-to-severe psoriasis in clinical practice and to correlate satisfaction with disease severity and quality-of-life measures. METHODS This was a cross-sectional study of 1182 patients with moderate-to-severe psoriasis in the Dermatology Clinical Effectiveness Research Network in the U.S.A. Patients receiving either topical therapies only; monotherapy with oral systemic therapies, biologics or narrowband ultraviolet B phototherapy; or combination therapy with biologics and methotrexate completed the Treatment Satisfaction Questionnaire for Medication version II. RESULTS Median unadjusted overall satisfaction scores were highest for patients receiving biologic monotherapies, biologic-methotrexate combinations, or phototherapy (83.3); scores were lowest for those receiving topical therapies only or acitretin (66.7). In fully adjusted models, compared with patients receiving methotrexate monotherapy, those receiving adalimumab, etanercept, ustekinumab, phototherapy or adalimumab with methotrexate had significantly higher median overall satisfaction scores by 7.2-8.3 points, while those receiving topical therapies only had significantly lower overall satisfaction by 8.9 points. Adjusted convenience scores were lowest for patients receiving topical therapies only or infliximab. Modest but significant correlations were found between the overall satisfaction subscale and both the Psoriasis Area and Severity Index (ρ = -0.36, P < 0.001) and the Dermatology Life Quality Index (ρ = -0.47, P < 0.001). CONCLUSIONS Discernible differences were found in treatment satisfaction among therapies, particularly regarding treatment effectiveness and convenience. Further application of treatment satisfaction measures may inform treatment decisions and guideline development.
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Affiliation(s)
- K Callis Duffin
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - H Yeung
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - G G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - A B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A S Van Voorhees
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Papp KA, Krueger GG, Jemec GBE, van de Kerkhof P, Robertson D, Estojak J, Pedersen R, Foehl J, Wajdula J, Boggs R, Molta C. Long-term, continuous dosing of etanercept in patients with plaque psoriasis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.11.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Walsh JA, McFadden M, Woodcock J, Clegg DO, Helliwell P, Dommasch E, Gelfand JM, Krueger GG, Duffin KC. Product of the Physician Global Assessment and body surface area: A simple static measure of psoriasis severity in a longitudinal cohort. J Am Acad Dermatol 2013; 69:931-7. [DOI: 10.1016/j.jaad.2013.07.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/15/2022]
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Kavanaugh A, McInnes IB, Krueger GG, Gladman D, Beutler A, Gathany T, Mack M, Tandon N, Han C, Mease P. Patient-reported outcomes and the association with clinical response in patients with active psoriatic arthritis treated with golimumab: findings through 2 years of a phase III, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken) 2013; 65:1666-73. [PMID: 23666608 PMCID: PMC4282022 DOI: 10.1002/acr.22044] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 01/02/2013] [Accepted: 04/24/2013] [Indexed: 01/17/2023]
Abstract
Objective To evaluate the effect of golimumab on physical function, health-related quality of life (HRQOL), and productivity in psoriatic arthritis (PsA). Methods GO-REVEAL was a multicenter, randomized, placebo-controlled study. Adult patients with active PsA (n = 405) received golimumab (50 or 100 mg) or placebo every 4 weeks, with early escape at week 16 (placebo → 50 mg, 50 → 100 mg) or placebo crossover to golimumab 50 mg at week 24. Patient-reported outcomes included physical function (Health Assessment Questionnaire [HAQ] disability index [DI] score), HRQOL (36-item Short Form health survey [SF-36] mental component summary [MCS] and physical component summary [PCS] scores), and productivity (home/school/work). Clinical response was assessed using the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP) and the Psoriasis Area and Severity Index (PASI) score for arthritis and skin symptoms, respectively. Results At week 24, golimumab-treated patients had significant mean improvements in HAQ DI (0.36), SF-36 (PCS 7.83, MCS 3.84), and productivity (2.24) scores compared with placebo (−0.01, 0.67, −0.60, and 0.08, respectively; P <0.001 for all). Also, greater proportions of golimumab- than placebo-treated patients had clinically meaningful improvements in HAQ DI (≥0.30) and SF-36 PCS and MCS (≥5) scores at week 24 (P <0.05). Also at week 24, improvements in DAS28-CRP scores were significantly but moderately correlated with improvements in HAQ DI, SF-36 PCS, and productivity scores. Correlations between these patient-reported outcomes and improvements in PASI, enthesitis, and dactylitis scores were very weak. Improvements in HAQ DI, SF-36, and productivity scores were similar among all groups by week 52 and week 104 when including placebo → golimumab crossover patients. Conclusion Golimumab-treated patients had significant improvements in physical function, HRQOL, and productivity through week 24; these improvements correlated with clinical improvement in signs and symptoms of peripheral arthritis and were sustained through 2 years.
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Gelfand JM, Wang S, Takeshita J, Robertson AD, Krueger GG, Callis Duffin K, Van Voorhees AS. Using Hawthorne effects to improve adherence in clinical practice: lessons from clinical trials--reply. JAMA Dermatol 2013; 149:491. [PMID: 23715064 DOI: 10.1001/jamadermatol.2013.2846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kavanaugh A, van der Heijde D, McInnes IB, Mease P, Krueger GG, Gladman DD, Gómez-Reino J, Papp K, Baratelle A, Xu W, Mudivarthy S, Mack M, Rahman MU, Xu Z, Zrubek J, Beutler A. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. ACTA ACUST UNITED AC 2012; 64:2504-17. [PMID: 22378566 DOI: 10.1002/art.34436] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Golimumab, administered subcutaneously every 4 weeks, has been shown to be effective in reducing the signs and symptoms of active psoriatic arthritis (PsA) through week 24 of the GO-REVEAL study. Herein we report 1-year clinical, radiographic, and safety findings. METHODS Adult patients with active PsA (≥3 swollen and ≥3 tender joints) were randomly assigned to receive subcutaneous placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks through week 20. At week 16, patients with <10% improvement from baseline in swollen and tender joint counts entered a blinded early escape phase, with placebo crossover to golimumab 50 mg, golimumab 50 mg increased to 100 mg, and golimumab 100 mg continued at 100 mg. Patients receiving placebo who did not enter the early escape phase crossed over to golimumab 50 mg at week 24. Findings through 1 year are reported, including the second of 2 coprimary end points (i.e., change from baseline to week 24 in PsA-modified Sharp/van der Heijde score [SHS]). RESULTS A total of 405 patients were randomized: 113 to placebo and 146 each to the golimumab 50 mg and 100 mg groups. Mean changes in PsA-modified SHS from baseline to week 24 for the combined golimumab 50 mg and 100 mg group (-0.09) and the golimumab 50 mg group (-0.16) were significantly different versus placebo (0.27) (P = 0.015 and P = 0.011, respectively). Radiographic benefit was maintained through week 52 with golimumab. Clinical efficacy, including improvement in joint and skin responses and physical function, was maintained through 1 year. The frequency/types of adverse events were similar to those reported through week 24. CONCLUSION Treatment of PsA with golimumab inhibited structural damage progression and demonstrated continued clinical efficacy and safety through 1 year.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, 9500 Gilman Drive, Room A-112, La Jolla, CA 92093-0943, USA.
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Strober BE, Clay Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb AB, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Schwartzman S, Sobell JM, Solomon GE, Young M. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 1. Dermatol Ther (Heidelb) 2012; 2:1. [PMID: 23205324 PMCID: PMC3510391 DOI: 10.1007/s13555-012-0001-y] [Citation(s) in RCA: 15] [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: 09/24/2011] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Traditional clinical trials in psoriasis exclude a significant proportion of patients with complex disease and comorbidities. A consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise to identify difficult-to-treat psoriasis clinical scenarios and to rank treatment approaches. METHODS The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting. RESULTS Six of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy. CONCLUSION The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with challenging patients with psoriasis.
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Affiliation(s)
- Bruce E. Strober
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT 06032 USA
| | - Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, and Modern Dermatology, Dallas, TX USA
| | - David Cohen
- Department of Dermatology, NYU Langone Medical Center, New York, USA
| | - Jeffrey J. Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA USA
| | - Kenneth B. Gordon
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alice B. Gottlieb
- Department of Dermatology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA USA
| | - Arthur F. Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, CA USA
| | - Neil J. Korman
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Gerald G. Krueger
- Department of Dermatology, University of Utah, Salt Lake City, UT USA
| | - Craig L. Leonardi
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO USA
| | - Sergio Schwartzman
- Weill Medical College of Cornell University, Hospital for Special Surgery, New York Presbyterian Hospital, New York, NY USA
| | - Jeffrey M. Sobell
- Department of Dermatology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA USA
| | - Gary E. Solomon
- Department of Rheumatology, NYU Langone School of Medicine, New York, NY USA
| | - Melodie Young
- University of Texas at Arlington, Graduate School of Nursing, and Modern Dermatology, Dallas, TX USA
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Strober BE, Clay Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb AB, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Schwartzman S, Sobell JM, Solomon GE, Young M. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2. Dermatol Ther (Heidelb) 2012; 2:2. [PMID: 23205325 PMCID: PMC3510406 DOI: 10.1007/s13555-012-0002-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 09/24/2011] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Clinicians may be confronted with difficult-to-treat psoriasis cases for which there are scant data to rely upon for guidance. To assist in managing such patients, who are typically excluded from clinical trials, a consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise. METHODS The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting. RESULTS Five of the 24 discussed case scenarios are presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to combine with low-dose methotrexate. A previous article (part 1) presented six other scenarios. CONCLUSION The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with patients with challenging cases of psoriasis.
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Affiliation(s)
- Bruce E. Strober
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT 06032 USA
| | - Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Modern Dermatology, Dallas, TX USA
| | - David Cohen
- Department of Dermatology, NYU Langone Medical Center, New York, USA
| | - Jeffrey J. Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA USA
| | - Kenneth B. Gordon
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alice B. Gottlieb
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA USA
| | - Arthur F. Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, CA USA
| | - Neil J. Korman
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Gerald G. Krueger
- Department of Dermatology, University of Utah, Salt Lake City, UT USA
| | - Craig L. Leonardi
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO USA
| | - Sergio Schwartzman
- Weill Medical College of Cornell University, Hospital for Special Surgery, New York Presbyterian Hospital, New York, NY USA
| | - Jeffrey M. Sobell
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA USA
| | - Gary E. Solomon
- Department of Rheumatology, NYU Langone School of Medicine, New York, NY USA
| | - Melodie Young
- Graduate School of Nursing, and Modern Dermatology, University of Texas at Arlington, Dallas, TX USA
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Tsoi LC, Spain SL, Knight J, Ellinghaus E, Stuart PE, Capon F, Ding J, Li Y, Tejasvi T, Gudjonsson JE, Kang HM, Allen MH, McManus R, Novelli G, Samuelsson L, Schalkwijk J, Ståhle M, Burden AD, Smith CH, Cork MJ, Estivill X, Bowcock AM, Krueger GG, Weger W, Worthington J, Tazi-Ahnini R, Nestle FO, Hayday A, Hoffmann P, Winkelmann J, Wijmenga C, Langford C, Edkins S, Andrews R, Blackburn H, Strange A, Band G, Pearson RD, Vukcevic D, Spencer CCA, Deloukas P, Mrowietz U, Schreiber S, Weidinger S, Koks S, Kingo K, Esko T, Metspalu A, Lim HW, Voorhees JJ, Weichenthal M, Wichmann HE, Chandran V, Rosen CF, Rahman P, Gladman DD, Griffiths CEM, Reis A, Kere J, Nair RP, Franke A, Barker JNWN, Abecasis GR, Elder JT, Trembath RC. Identification of 15 new psoriasis susceptibility loci highlights the role of innate immunity. Nat Genet 2012; 44:1341-8. [PMID: 23143594 PMCID: PMC3510312 DOI: 10.1038/ng.2467] [Citation(s) in RCA: 706] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/17/2012] [Indexed: 02/08/2023]
Abstract
To gain further insight into the genetic architecture of psoriasis, we conducted a meta-analysis of 3 genome-wide association studies (GWAS) and 2 independent data sets genotyped on the Immunochip, including 10,588 cases and 22,806 controls. We identified 15 new susceptibility loci, increasing to 36 the number associated with psoriasis in European individuals. We also identified, using conditional analyses, five independent signals within previously known loci. The newly identified loci shared with other autoimmune diseases include candidate genes with roles in regulating T-cell function (such as RUNX3, TAGAP and STAT3). Notably, they included candidate genes whose products are involved in innate host defense, including interferon-mediated antiviral responses (DDX58), macrophage activation (ZC3H12C) and nuclear factor (NF)-κB signaling (CARD14 and CARM1). These results portend a better understanding of shared and distinctive genetic determinants of immune-mediated inflammatory disorders and emphasize the importance of the skin in innate and acquired host defense.
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Affiliation(s)
- Lam C Tsoi
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan Ann Arbor, MI 48109, USA
| | - Sarah L Spain
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
| | - Jo Knight
- Neuroscience Research, Centre for Addiction and Mental Health, Toronto, ON, Canada M5T 1R8
- National Institute for Health Research (NIHR), Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Philip E Stuart
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Francesca Capon
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
| | - Jun Ding
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan Ann Arbor, MI 48109, USA
| | - Yanming Li
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan Ann Arbor, MI 48109, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Hyun M Kang
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan Ann Arbor, MI 48109, USA
| | - Michael H Allen
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
| | - Ross McManus
- Department of Clinical Medicine Trinity College Dublin, Ireland
- Institute of Molecular Medicine, Trinity College Dublin, Ireland
| | - Giuseppe Novelli
- National Agency for Evaluation of Universities and Research Institutes (ANVUR)
- Research Center San Pietro Hospital, Rome, Italy
| | - Lena Samuelsson
- Department of Medical and Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joost Schalkwijk
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mona Ståhle
- Dermatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Catherine H Smith
- St John’s Institute of Dermatology, King’s College London, London, UK
| | - Michael J Cork
- Academic Unit of Dermatology Research, Department of Infection and Immunity, The University of Sheffield, Sheffield, UK
| | - Xavier Estivill
- Genes and Disease Programme, Centre for Genomic Regulation (CRG) and UPF, Hospital del Mar Research Institute (CRG) and Public Health and Epidemiology Network Biomedical Research Centre (CIBERESP), Barcelona, Spain
| | - Anne M Bowcock
- Division of Human Genetics, Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | | | - Wolfgang Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Jane Worthington
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachid Tazi-Ahnini
- Academic Unit of Dermatology Research, Department of Infection and Immunity, The University of Sheffield, Sheffield, UK
| | - Frank O Nestle
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
| | - Adrian Hayday
- Division of Immunology, Infection and Inflammatory Disease; King’s College London, London, UK
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, 54127 Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, 54127 Bonn, Germany
| | - Juliane Winkelmann
- Department of Neurology, Technische Universität München, Munich, Germany
- Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Munich, Germany
| | - Cisca Wijmenga
- Genetics Department, University Medical Center and University of Groningen, Groningen, The Netherlands
| | | | - Sarah Edkins
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | | | | | - Amy Strange
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7LJ, UK
| | - Gavin Band
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7LJ, UK
| | - Richard D Pearson
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7LJ, UK
| | - Damjan Vukcevic
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7LJ, UK
| | - Chris CA Spencer
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7LJ, UK
| | | | - Ulrich Mrowietz
- Department of Dermatology, University Hospital, Schleswig-Holstein, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, 24105 Kiel, Germany
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, 24105 Kiel, Germany
- PopGen biobank, University Hospital S.-H., Kiel, Germany
| | - Stephan Weidinger
- Department of Dermatology, University Hospital, Schleswig-Holstein, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Sulev Koks
- Department of Physiology, Centre of Translational Medicine and Centre for Translational Genomics, University of Tartu, 50409 Tartu, Estonia
| | - Külli Kingo
- Department of Dermatology and Venerology, University of Tartu, 50409 Tartu, Estonia
| | - Tonu Esko
- Estonian Genome Center, University of Tartu, 51010 Tartu, Estonia
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, 51010 Tartu, Estonia
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - John J Voorhees
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael Weichenthal
- Department of Dermatology, University Hospital, Schleswig-Holstein, Christian-Albrechts-University, 24105 Kiel, Germany
| | - H. Erich Wichmann
- Institute of Epidemiology I, Helmholtz Centre Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, 81377 Munich, Germany
- Klinikum Grosshadern, 81377 Munich, Germany
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Cheryl F Rosen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario M5T 2S8
| | - Proton Rahman
- Department of Medicine, Memorial University, St. John’s, Newfoundland A1C 5B8, Canada
| | - Dafna D Gladman
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Christopher EM Griffiths
- Dermatological Sciences, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Andre Reis
- Institute of Human Genetics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Medical Genetics, University of Helsinki, Finland
| | | | | | | | | | - Rajan P Nair
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - Jonathan NWN Barker
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
- St John’s Institute of Dermatology, King’s College London, London, UK
| | - Goncalo R Abecasis
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan Ann Arbor, MI 48109, USA
| | - James T Elder
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
- Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, 48105, USA
| | - Richard C Trembath
- Division of Genetics and Molecular Medicine, King’s College London, London, UK
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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Kavanaugh A, McInnes IB, Mease PJ, Krueger GG, Gladman DD, van der Heijde D, Mudivarthy S, Xu W, Mack M, Xu Z, Beutler A. Clinical efficacy, radiographic and safety findings through 2 years of golimumab treatment in patients with active psoriatic arthritis: results from a long-term extension of the randomised, placebo-controlled GO-REVEAL study. Ann Rheum Dis 2012; 72:1777-85. [PMID: 23161902 PMCID: PMC3812864 DOI: 10.1136/annrheumdis-2012-202035] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives To assess long-term golimumab efficacy/safety in patients with active psoriatic arthritis (PsA). Methods Adult PsA patients (≥3 swollen, ≥3 tender joints, active psoriasis) were randomly assigned to subcutaneous injections of placebo, golimumab 50 mg or 100 mg every 4 weeks (q4wks) through week 20. All patients received golimumab 50 or 100 mg beginning week 24. Findings through 2 years are reported. Efficacy evaluations included ≥20% improvement in American College of Rheumatology (ACR20) response, good/moderate response in Disease Activity Scores incorporating 28 joints and C-reactive protein (DAS28-CRP), ≥75% improvement in Psoriasis Area and Severity Index (PASI75) and changes in PsA-modified Sharp/van der Heijde scores (SHS). Results Golimumab treatment through 2 years was effective in maintaining clinical response (response rates: ACR20 63%–70%, DAS28-CRP 77%–86%, PASI75 56%–72%) and inhibiting radiographic progression (mean change in PsA-modified SHS in golimumab-treated patients: −0.36), with no clear difference between doses. No new safety signals were identified through 2 years. With the study's tuberculosis screening and prophylactic measures, no patient developed active tuberculosis through 2 years. Conclusions Golimumab 50 and 100 mg for up to 2 years yielded sustained clinical and radiographic efficacy when administered to patients with active PsA. Increasing the golimumab dose from 50 to 100 mg q4wks added limited benefit. Golimumab safety through up to 2 years was consistent with other antitumour necrosis factor α agents used to treat PsA. Treatment of patients with latent tuberculosis identified at baseline appeared to be effective in inhibiting the development of active tuberculosis.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California, , San Diego, La Jolla, California, USA
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Langley RG, Papp K, Gottlieb AB, Krueger GG, Gordon KB, Williams D, Valdes J, Setze C, Strober B. Safety results from a pooled analysis of randomized, controlled phase II and III clinical trials and interim data from an open-label extension trial of the interleukin-12/23 monoclonal antibody, briakinumab, in moderate to severe psoriasis. J Eur Acad Dermatol Venereol 2012; 27:1252-61. [PMID: 23157612 DOI: 10.1111/j.1468-3083.2012.04705.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Anti-interleukin-12/23 treatment (anti-IL-12/23) has recently demonstrated significant efficacy for moderate to severe psoriasis, yet potential safety signals warrant further investigation. OBJECTIVES Expand safety findings for the anti-IL-12/23, briakinumab, beyond individual phase II and III clinical trials. METHODS Safety data pooled from five phase II and III clinical trials (parent studies) and an open-label extension study (OLE), through 22 October 2010; patients with ≥ 1 dose of briakinumab in a parent study or the OLE are included. All parent study briakinumab treatment groups were combined with the OLE population, which received 100-mg briakinumab every 4 weeks. Adverse events (AEs) were collected from the first dose of briakinumab, whether in a parent study or the OLE, through 45 days post-last dose. RESULTS Two thousand five hundred and twenty patients (4704 patient-years drug exposure) received ≥ 1 dose of briakinumab during the interim period: 5.6% withdrew due to AEs. Serious infections occurred in 1.3% and malignancies in 2.6% (including 1.0% basal cell carcinoma, 0.8% squamous cell carcinoma). Twenty-seven major adverse cardiovascular events (MACE) occurred, seven in one parent study and 20 in the OLE (incidence = 0.57 events/100 PY). Four cardiovascular risk factors were retrospectively found to be significant predictors for MACE during briakinumab exposure: history of cardiovascular disease, diabetes, body mass index (≥ 30) and baseline blood pressure (systolic ≥ 140 or diastolic ≥ 90). CONCLUSIONS Pooled briakinumab safety results from five parent studies and an OLE suggest increased rates of infections, malignancies and MACE, and that patients receiving anti-IL-12/23 treatment for moderate to severe psoriasis should be monitored for these potential safety signals.
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Affiliation(s)
- R G Langley
- Dalhousie University, Halifax, NS, Canada Probity Medical Research, Waterloo, ON, Canada Tufts Medical Centre, Boston, MA, USA University of Utah Health Sciences Centre, Salt Lake City, UT, USA Northwestern University, Evanston, IL, USA Abbott Laboratories, Abbott Park, IL, USA University of Connecticut School of Medicine, Farmington, CT, USA
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Armstrong AW, Callis Duffin K, Garg A, Gelfand JM, Gottlieb AB, Krueger GG, Qureshi AA, Rosen CF. Exploring priority research areas in psoriasis and psoriatic arthritis from dermatologists' perspective: a report from the GRAPPA 2011 annual meeting. J Rheumatol 2012; 39:2204-10. [PMID: 23118289 DOI: 10.3899/jrheum.120825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At the 2011 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Naples, Italy, the GRAPPA dermatology members led discussions on priority research areas in psoriasis and psoriatic arthritis (PsA). These discussions centered on 3 primary areas: evaluation of PsA screening tools, updates on psoriasis comorbidities, and new developments in genetics and comparative effectiveness research. Introductory presentations were followed by engaging panel discussions and audience interaction. The members agreed that screening tools are highly valuable in early detection of PsA among dermatology patients and that efforts are necessary to develop tools suitable for adoption in clinical practice. Members also agreed that a collaborative investigation to evaluate the effect of psoriasis treatments on cardiovascular comorbidities would be highly informative. Finally, the members supported continued efforts to explore the genetic basis of psoriasis and more studies focused on comparative effectiveness of existing treatments.
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, University of California Davis, Sacramento, California 95816, USA.
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Wagner CL, Visvanathan S, Elashoff M, McInnes IB, Mease PJ, Krueger GG, Murphy FT, Papp K, Gomez-Reino JJ, Mack M, Beutler A, Gladman D, Kavanaugh A. Markers of inflammation and bone remodelling associated with improvement in clinical response measures in psoriatic arthritis patients treated with golimumab. Ann Rheum Dis 2012; 72:83-8. [PMID: 22975755 PMCID: PMC3551220 DOI: 10.1136/annrheumdis-2012-201697] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To determine serum biomarker associations with clinical response to golimumab treatment in patients with psoriatic arthritis (PsA). Methods GO–REVEAL was a randomised, placebo-controlled study of golimumab in patients with active PsA. Samples were collected from 100 patients at baseline, week 4 and week 14, and analysed for serum-based biomarkers and protein profiling (total 92 markers); data were correlated with clinical measures at week 14. Results Serum levels of a subset of proteins (apolipoprotein C III, ENRAGE, IL-16, myeloperoxidase, vascular endothelial growth factor, pyridinoline, matrix metalloproteinase 3, C-reactive protein (CRP), carcinoembryonic antigen, intercellular adhesion molecule 1 and macrophage inflammatory protein 1α) at baseline or week 4 were strongly associated with American College of Rheumatology 20% improvement (ACR20) response and/or disease activity score in 28 joints (DAS28) at week 14. A smaller subset of proteins was significantly associated with a 75% improvement in the psoriasis area and severity index score (PASI75) at week 14, (adiponectin, apolipoprotein CIII, serum glutamic oxaloacetic transaminase, and tumour necrosis factor α). Subsets of proteins were identified as potentially predictive of clinical response for each of the clinical measures, and the power of these biomarker panels to predict clinical response to golimumab treatment was stronger than for CRP alone. Conclusions This analysis provides insight into several panels of markers that may have utility in identifying PsA patients likely to have ACR20, DAS28, or PASI75 responses following golimumab treatment.
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Affiliation(s)
- Carrie L Wagner
- Department of Immunology, Janssen Research & Development, LLC, Spring House, PA, USA.
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Abuabara K, Wan J, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Variation in dermatologist beliefs about the safety and effectiveness of treatments for moderate to severe psoriasis. J Am Acad Dermatol 2012; 68:262-9. [PMID: 22910105 DOI: 10.1016/j.jaad.2012.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple systemic treatments are available for moderate to severe psoriasis, but dermatologists' perceptions of these treatments are unknown. Physician perceptions can influence prescribing patterns and patient outcomes, and may help to explain variations in clinical practice. OBJECTIVE We sought to describe the variation in dermatologist's beliefs about the safety and effectiveness of psoriasis treatments and evaluate how these relate to dermatologist characteristics and treatment preferences. METHODS We conducted a cross-sectional mail survey of a random sample of 500 National Psoriasis Foundation (NPF) members and 500 American Academy of Dermatology (AAD) members who treat psoriasis. RESULTS Of 989 clinicians who could be contacted, 246 NPF members and 141 AAD members returned the survey (39% response rate). Respondents perceived infliximab, ustekinumab, cyclosporine, and adalimumab to have the highest likelihood of skin clearance in 3 months (67%-75%). Etanercept, adalimumab, ultraviolet B, and ustekinumab had the lowest perceived likelihood of side effects requiring treatment discontinuation (9%-11%). Up to 49% of respondents "didn't know" the effectiveness or likelihood of side effects; calculated coefficients of variation were higher for perceived likelihood of side effects than perceived effectiveness. There were few significant associations between safety and effectiveness perceptions and respondent characteristics, and treatment preferences were not consistently predictive of perceptions. LIMITATIONS Only dermatologists with interest in treating psoriasis were surveyed and general perceptions were elicited via survey format. Perceptions may differ between survey respondents and nonrespondents. CONCLUSIONS Psoriasis providers demonstrate wide variation in their perception of the effectiveness and especially safety of systemic treatments.
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Affiliation(s)
- Katrina Abuabara
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Yeung H, Wan J, Van Voorhees AS, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Brod BA, Schleicher SM, Bebo BF, Shin DB, Troxel AB, Gelfand JM. Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis. J Am Acad Dermatol 2012; 68:64-72. [PMID: 22846688 DOI: 10.1016/j.jaad.2012.06.035] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/20/2012] [Accepted: 06/26/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood. OBJECTIVES We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice. METHODS A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments. RESULTS A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95% confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72). LIMITATIONS The study is limited by its reliance on patient recall. CONCLUSIONS Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Gelfand JM, Wan J, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Stierstorfer MB, Brod BA, Schleicher SM, Bebo BF, Troxel AB, Shin DB, Steinemann JM, Goldfarb J, Yeung H, Van Voorhees AS. Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting. ACTA ACUST UNITED AC 2012; 148:487-94. [PMID: 22508874 DOI: 10.1001/archdermatol.2012.370] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis. DESIGN A cross-sectional design was used. SETTING Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study. PARTICIPANTS A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy. MAIN OUTCOME MEASURES The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index. RESULTS The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency. CONCLUSIONS The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.
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Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Jordan CT, Cao L, Roberson EDO, Duan S, Helms CA, Nair RP, Duffin KC, Stuart PE, Goldgar D, Hayashi G, Olfson EH, Feng BJ, Pullinger CR, Kane JP, Wise CA, Goldbach-Mansky R, Lowes MA, Peddle L, Chandran V, Liao W, Rahman P, Krueger GG, Gladman D, Elder JT, Menter A, Bowcock AM. Rare and common variants in CARD14, encoding an epidermal regulator of NF-kappaB, in psoriasis. Am J Hum Genet 2012; 90:796-808. [PMID: 22521419 PMCID: PMC3376540 DOI: 10.1016/j.ajhg.2012.03.013] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/29/2012] [Accepted: 03/13/2012] [Indexed: 11/26/2022] Open
Abstract
Psoriasis is a common inflammatory disorder of the skin and other organs. We have determined that mutations in CARD14, encoding a nuclear factor of kappa light chain enhancer in B cells (NF-kB) activator within skin epidermis, account for PSORS2. Here, we describe fifteen additional rare missense variants in CARD14, their distribution in seven psoriasis cohorts (>6,000 cases and >4,000 controls), and their effects on NF-kB activation and the transcriptome of keratinocytes. There were more CARD14 rare variants in cases than in controls (burden test p value = 0.0015). Some variants were only seen in a single case, and these included putative pathogenic mutations (c.424G>A [p.Glu142Lys] and c.425A>G [p.Glu142Gly]) and the generalized-pustular-psoriasis mutation, c.413A>C (p.Glu138Ala); these three mutations lie within the coiled-coil domain of CARD14. The c.349G>A (p.Gly117Ser) familial-psoriasis mutation was present at a frequency of 0.0005 in cases of European ancestry. CARD14 variants led to a range of NF-kB activities; in particular, putative pathogenic variants led to levels >2.5× higher than did wild-type CARD14. Two variants (c.511C>A [p.His171Asn] and c.536G>A [p.Arg179His]) required stimulation with tumor necrosis factor alpha (TNF-α) to achieve significant increases in NF-kB levels. Transcriptome profiling of wild-type and variant CARD14 transfectants in keratinocytes differentiated probably pathogenic mutations from neutral variants such as polymorphisms. Over 20 CARD14 polymorphisms were also genotyped, and meta-analysis revealed an association between psoriasis and rs11652075 (c.2458C>T [p.Arg820Trp]; p value = 2.1 × 10(-6)). In the two largest psoriasis cohorts, evidence for association increased when rs11652075 was conditioned on HLA-Cw*0602 (PSORS1). These studies contribute to our understanding of the genetic basis of psoriasis and illustrate the challenges faced in identifying pathogenic variants in common disease.
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Affiliation(s)
- Catherine T Jordan
- Division of Human Genetics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
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Wan J, Abuabara K, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Dermatologist preferences for treatments to compare in future randomized controlled comparative effectiveness trials for moderate to severe psoriasis. ACTA ACUST UNITED AC 2012; 148:539-41. [PMID: 22508884 DOI: 10.1001/archdermatol.2011.1399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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