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Schaeffer L, Ben-Anaya N, Sorbe C, Rustenbach SJ, Mrowietz U, Augustin M. Real-world outcomes and drug survival of brodalumab: results from the German Psoriasis Registry PsoBest. J DERMATOL TREAT 2024; 35:2340107. [PMID: 38636941 DOI: 10.1080/09546634.2024.2340107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
Brodalumab, a human monoclonal antibody that targets interleukin-17 receptor A (IL-17RA), is approved in the US and EU for treatment of adults with moderate-to-severe plaque psoriasis. Although brodalumab has demonstrated efficacy and safety vs placebo in clinical trials of patients with psoriasis and psoriatic arthritis (PsA), real-world evidence is needed to evaluate long-term effectiveness and safety of brodalumab in routine care. This interim analysis of the German Psoriasis Registry PsoBest examined patient profiles, treatment outcomes, and drug survival of first-time use of brodalumab for 12 months in adult patients with moderate-to-severe plaque-type psoriasis (with and without PsA) (data cutoff: June 30, 2021). Clinician and patient-reported outcomes of the total cohort (n = 227; PsA, n = 38) indicated a rapid response to brodalumab treatment within the first 3 months, which was maintained up to 12 months. The overall one-year drug survival rate was 76.2%, the mean time to discontinuation was 8.3 months. Reasons for discontinuation were mainly loss/lack of effectiveness, followed by adverse events, contraindication and skin clearance. In sum, brodalumab demonstrated rapid and sustained effectiveness and was well-tolerated over 12 months in German patients with moderate-to-severe psoriasis and PsA in a real-world setting.
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Affiliation(s)
- Lisa Schaeffer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nesrine Ben-Anaya
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stephan Jeff Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Psoriasis Centre, Clinic for Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Mrowietz U, Lauffer F, Sondermann W, Gerdes S, Sewerin P. Psoriasis as a Systemic Disease. Dtsch Arztebl Int 2024:arztebl.m2024.0064. [PMID: 38657176 DOI: 10.3238/arztebl.m2024.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Psoriasis was long regarded as an inflammatory disease limited to the skin. Data from dermatologic, rheumatologic and cardiologic research now show it to be a systemic disease, for which the term psoriatic disease is used. METHODS This paper is based on a selective literature search with special attention to the findings of clinical trials and other current publications, as well as the recommendations of international guidelines. RESULTS Immunologically mediated inflammation of the skin, arteries, bones, and joints is a central feature of psoriatic disease. Other diseases that are known to be associated with psoriatic disease include hypertension, metabolic syndrome, and depression. The main risk factor for the development of psoriatic disease is obesity, which also increases the likelihood of psoriatic arthritis. The main known trigger factors are stress, infection, and, less commonly, medication. Psoriatic disease is characterized by complex genetics and by a characteristic pattern of inflammation that involves elements of both innate and acquired immunity and, in particular, the cytokines interleukin 17 and 23. The inflammatory processes underlying psoriatic disease can now be targeted with modern biologic and other therapies. CONCLUSION In view of the complexity of psoriatic disease, structured management is now recommended so that physicians and patients can work together to determine the optimal treatment strategy.
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Warren RB, French LE, Blauvelt A, Langley RG, Egeberg A, Mrowietz U, Hunter HJA, Gooderham M, Soerensen P, Andres P, Sommer MOA, Carlsson A, Kjøller KD, Strober BE. Orismilast in moderate-to-severe psoriasis: Efficacy and safety from a 16-week, randomized, double-blinded, placebo-controlled, dose-finding, and phase 2b trial (IASOS). J Am Acad Dermatol 2024; 90:494-503. [PMID: 37951245 DOI: 10.1016/j.jaad.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Orismilast is a novel oral phosphodiesterase-4 (PDE4) B/D inhibitor being investigated as a potential treatment for moderate-to-severe psoriasis. OBJECTIVE To evaluate efficacy and safety of orismilast modified-release formulation in moderate-to-severe psoriasis. METHODS This multicenter, randomized (1:1:1:1 to 20, 30, 40 mg orismilast or placebo, twice daily), double-blinded, placebo-controlled, parallel-group, phase 2b, 16-week, dose-ranging study evaluated orismilast in adults with moderate-to-severe plaque psoriasis (NCT05190419). Efficacy end points were analyzed using multiple imputation. RESULTS Of 202 randomized patients, baseline characteristics were balanced across arms, except greater severe disease proportions for orismilast vs placebo. Orismilast showed significant improvements in the primary end point, percentage change in Psoriasis Area and Severity Index (PASI), from baseline to week 16 (orismilast -52.6% to -63.7% and placebo, -17.3%; all P <.001). Greater proportions receiving orismilast achieved PASI75 (39.5%-49.0%; P <.05) and PASI90 (22.0%-28.3%; P <.05 for 20 and 40 mg) vs placebo (PASI75, 16.5% and PASI90, 8.3%) at week 16. Safety findings were as expected with PDE4 inhibition; dose-dependent tolerability effects observed. LIMITATIONS Small sample size, disease severity imbalance between groups, limited duration and diversity in study population. CONCLUSION Orismilast demonstrated greater efficacy vs placebo and a safety profile in line with PDE4 inhibition.
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Affiliation(s)
- Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany; Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hamish J A Hunter
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Medicines Evaluation Unit, Manchester, United Kingdom
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, Canada; Department of Medicine, Queen's University, Kingston, Canada
| | | | | | - Morten O A Sommer
- UNION Therapeutics A/S, Hellerup, Denmark; Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | - Bruce E Strober
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut
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Augustin M, Mrowietz U, Willsmann-Theis D, Gerdes S, Fotiou K, Schuster C, Mert C, Holzkaemper T, Behrens F, Pinter A. Ixekizumab im Vergleich zu Fumarsäureestern und Methotrexat bei der Behandlung der Nagelpsoriasis bei Patienten mit mittelschwerer bis schwerer Psoriasis: Ixekizumab versus FAEs and methotrexate in treatment of nail psoriasis in patients with moderate-to-severe psoriasis. J Dtsch Dermatol Ges 2024; 22:278-282. [PMID: 38361190 DOI: 10.1111/ddg.15292_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/28/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Matthias Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - Ulrich Mrowietz
- Klinik für Dermatologie, Psoriasis-Zentrum, Universitätsklinikum Schleswig-Holstein Kiel, Campus Kiel, Deutschland
| | - Dagmar Willsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Sascha Gerdes
- Klinik für Dermatologie, Psoriasis-Zentrum, Universitätsklinikum Schleswig-Holstein Kiel, Campus Kiel, Deutschland
| | | | - Christopher Schuster
- Eli Lilly and Company, Indianapolis, Indiana, USA
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Can Mert
- HaaPACS GmbH, Schriesheim, Deutschland
| | | | - Frank Behrens
- Centrum für Innovative Diagnostik und Therapie Rheumatologie/Immunologie (CIRI) der Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Andreas Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
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Sommer R, Mrowietz U, Gaarn Du Jardin K, Kasujee I, Martini E, Daudén E, Fabbrocini G, Zink A, Griffiths CEM, Augustin M. Implementing well-being in the management of psoriasis: An expert recommendation. J Eur Acad Dermatol Venereol 2024; 38:302-310. [PMID: 37822008 DOI: 10.1111/jdv.19567] [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: 02/08/2023] [Accepted: 08/30/2023] [Indexed: 10/13/2023]
Abstract
Psoriasis causes detriment in a person's physical, mental and social health which impairs their quality of life (QoL). However, the current psoriasis management may not adequately address all relevant health domains. Since the goal of healthcare is to restore or maintain health, health outcomes should include all areas of the patient's overall health. Life satisfaction, QoL and patient well-being are essential to a comprehensive approach to the disease. With the inclusion of more people-centred policies, care of patients with psoriasis should evolve towards a holistic and integrated assessment of the disease impact, including subjective measures of well-being in order to encompass all aspects of health. The main objective of this expert review is to give the concept of well-being a place as an entity within the holistic therapeutic approach for patients with psoriasis. Identifying and defining common goals beyond the skin with the patient and testing them throughout the course of treatment will benefit and enhance treatment success. We propose a series of recommendations for application in clinical practice, providing tangible clinical guidance for implementing well-being in the management of psoriasis. Among the recommendations are the need to initially listen to the patient, to know their level of empowerment or what they want to achieve, their preferences in decision making, the evaluation of not only the physical but also the emotional impact of the disease (well-being), the definition of the aspects that can generate a cumulative deterioration of the disease throughout life, and a continuous assessment of the patient's preferences with the opinion of the expert clinician and the integration of the knowledge of external clinical evidence.
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Affiliation(s)
- Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | - Esteban Daudén
- La Princesa University Hospital, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Germany
| | - Christopher E M Griffiths
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Salford Royal Hospital, The University of Manchester, Manchester, UK
- Department of Dermatology, King's College Hospital, King's College London, London, UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Augustin M, Mrowietz U, Willsmann-Theis D, Gerdes S, Fotiou K, Schuster C, Mert C, Holzkaemper T, Behrens F, Pinter A. Ixekizumab versus FAEs and methotrexate in treatment of nail psoriasis in patients with moderate-to-severe psoriasis. J Dtsch Dermatol Ges 2024; 22:278-281. [PMID: 38185772 DOI: 10.1111/ddg.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Matthias Augustin
- German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Kiel, Campus Kiel, Germany
| | - Dagmar Willsmann-Theis
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Sascha Gerdes
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Kiel, Campus Kiel, Germany
| | | | - Christopher Schuster
- Eli Lilly and Company, Indianapolis, Indiana, USA
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Can Mert
- HaaPACS GmbH, Schriesheim, Germany
| | | | - Frank Behrens
- Center for Innovative Diagnostics and Therapy Rheumatology/Immunology (CIRI) of the University of Frankfurt, Frankfurt am Main, Germany
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Mrowietz U. [This is how I deal with corticosteroid-induced skin atrophy]. Z Rheumatol 2023; 82:784-786. [PMID: 37695545 DOI: 10.1007/s00393-023-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Ulrich Mrowietz
- Zentrum für entzündliche Hautkrankheiten, Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus U27, 24105, Kiel, Deutschland.
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Augustin M, Lindner L, Kühl L, Weiss A, Rustenbach SJ, Stephan B, Feuchtenberger M, Mrowietz U, Thaçi D, Staubach P, Baraliakos X, Strangfeld A, von Kiedrowski R, Behrens F, Regierer AC. Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries. J Dtsch Dermatol Ges 2023; 21:1170-1176. [PMID: 37653583 DOI: 10.1111/ddg.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care. PATIENTS AND METHODS Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed. RESULTS The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS. CONCLUSIONS Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lisa Lindner
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Laura Kühl
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Weiss
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Stephan Jeff Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, Venereology and Allergy, University Medical Center Schleswig-Holstein Kiel, Campus Kiel, Germany
| | - Diamant Thaçi
- Excellence Center for Inflammation Medicine, University Medical Center Schleswig-Holstein Lübeck, Campus Lübeck, Germany
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz, Mainz, Germany
| | | | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
- Medical Clinic with focus on rheumatology and clinical immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Frank Behrens
- Rheumatology, University Hospital, Fraunhofer Institute for Translational Medicine & Pharmacology ITMP, Goethe University and Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt am Main, Germany
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Augustin M, Lindner L, Kühl L, Weiss A, Rustenbach SJ, Stephan B, Feuchtenberger M, Mrowietz U, Thaçi D, Staubach P, Baraliakos X, Strangfeld A, von Kiedrowski R, Behrens F, Regierer AC. Charakterisierung von Patienten mit Psoriasisarthritis in der dermatologischen und rheumatologischen Versorgung: Analyse von zwei Registern: Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries. J Dtsch Dermatol Ges 2023; 21:1170-1178. [PMID: 37845069 DOI: 10.1111/ddg.15178_g] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrund und ZielsetzungDie Psoriasisarthritis (PsA) ist eine chronische systemische Entzündungskrankheit, die den Bewegungsapparat, die Haut und die Nägel betrifft. Ziel ist es, soziodemografische und klinische Patientenprofile zu charakterisieren, die in der dermatologischen und rheumatologischen Versorgung dokumentiert werden.Patienten und MethodikEs wurden die Daten von 704 PsA‐Patienten aus dem dermatologischen Psoriasis‐Register PsoBest (PB) und 1066 Patienten aus dem rheumatologischen Krankheitsregister RABBIT‐SpA (RS) analysiert. Vergleichbare anamnestische und klinische Variablen wurden identifiziert und deskriptiv ausgewertet.ErgebnisseDas Durchschnittsalter betrug 51,7 Jahre bei PB und 51,9 Jahre bei RS. Die Krankheitsdauer der Psoriasis war länger und der mittlere Schweregrad der Hauterkrankung war bei den Patienten in PB höher, jedoch hatten mehr Patienten in RS schmerzende und geschwollene Gelenke. Der mittlere Dermatology Life Quality Index war bei den Patienten in PB höher und der mittlere Health Assessment Questionnaire bei den Patienten in RS. Die von den Patienten angegebene globale Krankheitsaktivität und die Schmerzen waren in PB geringer. IL‐23‐Inhibitoren wurden in PB häufiger eingesetzt, TNF‐Inhibitoren bei RS.SchlussfolgerungenDie klinische Spezialisierung wurde mit unterschiedlichen Krankheitsbildern und Behandlungsmustern der PsA in Verbindung gebracht. Dies könnte auf eine Selektion nach der vorherrschenden Manifestation der Psoriasis‐Erkrankung und möglicherweise auf Auswirkungen des Zugangs zur Gesundheitsversorgung hinweisen. Die PsA sollte in einem multidisziplinären Ansatz behandelt werden, der alle Facetten dieser komplexen Erkrankung berücksichtigt.
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Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Lisa Lindner
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
| | - Laura Kühl
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Anja Weiss
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
| | - Stephan Jeff Rustenbach
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Brigitte Stephan
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | - Ulrich Mrowietz
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Diamant Thaçi
- Exzellenzzentrum Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | | | | | - Anja Strangfeld
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin
| | | | - Frank Behrens
- Rheumatologische Universitätsklinik, Fraunhofer-Institut für Translationale Medizin & Pharmakologie ITMP, Goethe-Universität und Fraunhofer-Exzellenzcluster Immunvermittelte Erkrankungen CIMD, Frankfurt am Main
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Mrowietz U, Sümbül M, Gerdes S. Depression, a major comorbidity of psoriatic disease, is caused by metabolic inflammation. J Eur Acad Dermatol Venereol 2023; 37:1731-1738. [PMID: 37184282 DOI: 10.1111/jdv.19192] [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] [Received: 01/31/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Psoriatic disease is a chronic, systemic immune-mediated inflammatory disorder comprising three major domains, skin, vascular and bone/joint inflammation. It is known for a long time that psoriatic disease is associated with a number of conditions such as hypertension, dyslipidemia, diabetes (metabolic syndrome) and depression. Up to one out of five people with psoriasis show concomitant depression. In the past, this was attributed to psychological stress of suffering from a chronic condition that is often visible and itchy, leading to stigmatization and adding to a significant burden of disease. Recent data provide evidence that depression associated with psoriatic disease is linked to the specific inflammatory pattern with IL-23, IL-17 family cytokines, TNF, IL-6 and IL-8 causing neuroinflammation and subsequently depression or depressive behaviour and/or anxiety. Psoriatic disease shows a distinct pattern of immune cells (e.g. dendritic cells, Th17 cells, neutrophils), mediators (e.g. IL-17A/F, IL-23, TNF) and tissue-related factors in all major domains that is different from other inflammatory dermatoses. There is a striking similarity between the inflammatory pattern in psoriatic disease and neuroinflammation that leads to depression. A number of risk factors have been identified in psoriatic disease, the most important of which are obesity and tobacco smoking. Obesity is known as a major risk factor for depression and anxiety due to its inflammatory signature. Apart from psychotherapy and anti-depressive medication, targeted treatments for psoriasis, including TNF, IL-17 and IL-23 inhibitors, can improve depression/depressive symptoms. The review summarizes the current knowledge about depression as a comorbidity in psoriatic disease.
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Affiliation(s)
- U Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - M Sümbül
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - S Gerdes
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Elewski BE, Lebwohl MG, Anadkat MJ, Barker J, Ghoreschi K, Imafuku S, Mrowietz U, Li L, Quaresma M, Thoma C, Bachelez H. Rapid and sustained improvements in Generalized Pustular Psoriasis Physician Global Assessment scores with spesolimab for treatment of generalized pustular psoriasis flares in the randomized, placebo-controlled Effisayil 1 study. J Am Acad Dermatol 2023; 89:36-44. [PMID: 36870370 DOI: 10.1016/j.jaad.2023.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Effisayil 1 was a randomized, placebo-controlled study of spesolimab, which is an anti-IL-36 receptor antibody, in patients presenting with a generalized pustular psoriasis flare. OBJECTIVE To assess the effects of spesolimab over the 12-week study. METHODS The primary endpoint of the study was Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 at week 1. Patients (N = 53) were randomized (2:1) to receive a single intravenous dose of 900 mg spesolimab or placebo on day 1. Patients could receive open-label spesolimab for persistent flare symptoms on day 8. RESULTS Most patients receiving spesolimab achieved a GPPGA pustulation subscore of 0 (60.0%) and GPPGA total score of 0 or 1 (60.0%) by week 12. In patients randomized to placebo who received open-label spesolimab on day 8, the proportion with GPPGA pustulation subscore of 0 increased from 5.6% at day 8 to 83.3% at week 2. No factors predictive of spesolimab response were identified in patient demographics or clinical characteristics. LIMITATIONS The effect of initial randomization was not determined conventionally beyond week 1 due to patients receiving open-label spesolimab. CONCLUSION Rapid control of generalized pustular psoriasis flare symptoms with spesolimab was sustained over 12 weeks, further supporting its potential use as a therapeutic option for patients.
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Affiliation(s)
- Boni E Elewski
- University of Alabama School of Medicine, Birmingham, Alabama.
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Milan J Anadkat
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ling Li
- Boehringer Ingelheim Investment Co, Ltd, Shanghai, China
| | | | | | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France; INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
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12
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Vaher H, Kingo K, Kolberg P, Pook M, Raam L, Laanesoo A, Remm A, Tenson T, Alasoo K, Mrowietz U, Weidinger S, Kingo K, Rebane A. Skin Colonization with S. aureus Can Lead to Increased NLRP1 Inflammasome Activation in Patients with Atopic Dermatitis. J Invest Dermatol 2023; 143:1268-1278.e8. [PMID: 36736455 DOI: 10.1016/j.jid.2023.01.013] [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] [Received: 09/26/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
The role of NLRP1 inflammasome activation and subsequent production of IL-1 family cytokines in the development of atopic dermatitis (AD) is not clearly understood. Staphylococcus aureus is known to be associated with increased mRNA levels of IL1 family cytokines in the skin and more severe AD. In this study, the altered expression of IL-1 family cytokines and inflammasome-related genes was confirmed, and a positive relationship between mRNA levels of inflammasome sensor NLRP1 and IL1B or IL18 was determined. Enhanced expression of the NLRP1 and PYCARD proteins and increased caspase-1 activity were detected in the skin of patients with AD. The genetic association of IL18R1 and IL18RAP with AD was confirmed, and the involvement of various immune cell types was predicted using published GWAS and expression quantitative trait loci datasets. In keratinocytes, the inoculation with S. aureus led to the increased secretion of IL-1β and IL-18, whereas small interfering RNA silencing of NLRP1 inhibited the production of these cytokines. Our results suggest that skin colonization with S. aureus may cause the activation of the NLRP1 inflammasome in keratinocytes, which leads to the secretion of IL-1β and IL-18 and thereby may contribute to the pathogenesis of AD, particularly in the presence of genetic variations in the IL-18 pathway.
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Affiliation(s)
- Helen Vaher
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kristiina Kingo
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Peep Kolberg
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Martin Pook
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Liisi Raam
- Dermatology Clinic, Tartu University Hospital, Tartu, Estonia; Department of Dermatology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Anet Laanesoo
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Anu Remm
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Tanel Tenson
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Kaur Alasoo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Ulrich Mrowietz
- Department of Dermatology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Stephan Weidinger
- Department of Dermatology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Külli Kingo
- Dermatology Clinic, Tartu University Hospital, Tartu, Estonia; Department of Dermatology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Ana Rebane
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.
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13
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Strober B, Tada Y, Mrowietz U, Lebwohl M, Foley P, Langley RG, Warren RB, Wang M, Vanvoorden V, Szilagyi B, Ciaravino V, Paul C. Bimekizumab maintenance of response through three years in patients with moderate to severe plaque psoriasis: Results from the BE BRIGHT open-label extension trial. Br J Dermatol 2023; 188:749-759. [PMID: 36967713 DOI: 10.1093/bjd/ljad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Given the chronic nature of psoriasis and the loss of response that can be observed with therapies over time, it is important to understand the long-;term efficacy of new treatments.
Objective
To evaluate maintenance of Week 16 responses with bimekizumab treatment through Year 3, in patients with moderate to severe plaque psoriasis.
Methods
Data were pooled from bimekizumab-treated patients in the 52-week (BE VIVID) and 56-week (BE READY and BE SURE) phase 3 studies, and their ongoing open-label extension (OLE), BE BRIGHT. Efficacy outcomes are reported through three years of bimekizumab treatment in patients with an efficacy response at Week 16. Missing data were imputed primarily using modified non-responder imputation (mNRI), with non-responder imputation and observed case data also reported.
Results
A total of 989 patients were randomized to bimekizumab at baseline in BE VIVID, BE READY, and BE SURE. At Week 16, 693 patients achieved ≥90% reduction from baseline in Psoriasis Area and Severity Index (PASI 90), 503 achieved 100% reduction from baseline in PASI (PASI 100), 694 achieved absolute PASI ≤2, and 597 achieved body surface area (BSA) ≤1%, and continued into the OLE. Of these, 93.0% maintained PASI 90, 80.8% maintained PASI 100, 94.0% maintained PASI ≤2, and 90.3% maintained BSA ≤1% responses through to three years of bimekizumab treatment (mNRI). Among Week 16 PASI 90 responders, 96.8% and 72.5% also achieved Investigator’s Global Assessment (IGA) 0/1 and PASI 100 at Week 16, respectively, and 92.2% and 73.4% achieved these responses at Year 3 (mNRI). Among Week 16 PASI 100 responders, 76.3% also achieved Dermatology Life Quality Index (DLQI) 0/1 at Week 16, and DLQI 0/1 response increased with continuous bimekizumab treatment to 89.0% at Year 3 (mNRI).
Conclusions
High levels of clinical response were maintained through to three years of bimekizumab treatment in the vast majority of Week 16 responders. Long-term treatment with bimekizumab was efficacious, with important benefits on health-related quality of life (HRQoL), in patients with moderate to severe plaque psoriasis.
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Affiliation(s)
- Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
- Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Probity Medical Research Inc., Skin Health Institute, Carlton, Victoria, Australia
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Maggie Wang
- UCB Pharma, Morrisville, North Carolina, USA
| | | | | | | | - Carle Paul
- Toulouse University and CHU, Toulouse, France
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14
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Valencia López M, Meineke A, Stephan B, Rustenbach S, Kis A, Thaci D, Mrowietz U, Reich K, Staubach-Renz P, von Kiedrowski R, Bogena H, Augustin M. SARS-CoV-2 vaccination status and adverse events among patients with psoriasis - data from the German Registries PsoBest and CoronaBest. J Eur Acad Dermatol Venereol 2023. [PMID: 36914370 DOI: 10.1111/jdv.19039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Affiliation(s)
- M Valencia López
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Meineke
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - S Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Kis
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - U Mrowietz
- Psoriasis Center Kiel, Department of Dermatology, Venereology and Allergology University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K Reich
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - P Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center Mainz, Mainz, Germany
| | | | - H Bogena
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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15
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Augustin M, Sommer R, Daudén E, Laws P, de Jong E, Fabbrocini G, Naldi L, Navarini A, Lambert J, Reguiai Z, Gerdes S, Massana E, Obis T, Kasujee I, Mrowietz U. Patient-reported well-being in value-based care using tildrakizumab in a real-world setting: protocol of a multinational, phase IV, 1-cohort prospective observational study (the POSITIVE study). BMJ Open 2023; 13:e060536. [PMID: 36792337 PMCID: PMC9933754 DOI: 10.1136/bmjopen-2021-060536] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory skin disease that negatively impacts the quality of life of patients and their families. However, the most commonly used decision-making tools in psoriasis, Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA) and Dermatology Life Quality Index (DLQI), do not fully capture the impact of psoriasis on patients' lives. In contrast, the well-established 5-item WHO Well-being Index (WHO-5) assesses the subjective psychological well-being of patients. Moreover, while drug innovations became available for psoriasis, data on the impact of these therapies on patients' lives and their closest environment (family, physicians) are limited. This study will assess the effect of tildrakizumab, an interleukin-23p19 inhibitor, on the overall well-being of patients with moderate-to-severe psoriasis. Moreover, the long-term benefit of tildrakizumab on physicians' satisfaction and partners' lives of patients with psoriasis will be evaluated. METHODS AND ANALYSIS This non-interventional, prospective, observational, real-world evidence study will involve multiple sites in Europe and approximately 500 adults with moderate-to-severe psoriasis treated with tildrakizumab. Each patient will be followed for 24 months. The primary endpoint is well-being measured by the WHO-5 questionnaire. Key secondary endpoints include Physician's Satisfaction and partner's quality of life (FamilyPso). Other endpoints will evaluate skin-generic quality of life (DLQI-R), Treatment Satisfaction Questionnaire for Medication (TSQM-9), Treatment-related Patient Benefit Index 'Standard', 10 items (PBI-S-10) and work productivity and activity impairment due to psoriasis (WPAI:PSO). Statistical analyses will be based on observed cases. Multiple imputations will be performed as a sensitivity analysis, and adverse events will be reported. ETHICS AND DISSEMINATION The study will be conducted according to the protocol, which received ethics committee approval and applicable regulatory requirements of each participating country. The results will be disseminated through scientific publications and congress presentations. TRAIL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04823247 (Pre-results).
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Esteban Daudén
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), La Princesa University Hospital, Madrid, Spain
| | - Philip Laws
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elke de Jong
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Ziad Reguiai
- Department of Dermatology, Polyclinic Courlancy, Reims, France
| | - Sascha Gerdes
- Center for Inflammatory Skin Diseases, Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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16
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Mrowietz U, Barker J, Conrad C, Jullien D, Gisondi P, Flower A, Reddy J, Paris M, Picard H, Jardon S, Augustin M. Efficacy and safety of apremilast in patients with limited skin involvement, plaque psoriasis in special areas and impaired quality of life: Results from the EMBRACE randomized trial. J Eur Acad Dermatol Venereol 2023; 37:348-355. [PMID: 36300769 DOI: 10.1111/jdv.18689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/14/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION/BACKGROUND Manifestations of psoriasis in special areas are difficult to treat and are associated with a high disease burden and significant quality of life (QoL) impairment. Topical therapies may be inadequate for these patients, necessitating systemic treatment. OBJECTIVE The objective of EMBRACE was to evaluate the impact on QoL, efficacy and safety of apremilast 30 mg BID in patients with limited skin involvement with plaque psoriasis manifestations in special areas and impaired QoL. METHODS EMBRACE (NCT03774875) was a phase 4, randomized, placebo-controlled, multinational study. Patients had plaque psoriasis not controlled by topical therapy; lack of response, contraindication or intolerance to conventional first-line systemic therapy; psoriasis in ≥1 special area (including visible locations, scalp, nails, genital areas or palmoplantar areas); Psoriasis Area and Severity Index (PASI) ≥3 to ≤10; and Dermatology Life Quality Index (DLQI) >10. The primary endpoint was DLQI response (≥4-point reduction) at Week 16. RESULTS Of 277 randomized patients (apremilast: n = 185; placebo: n = 92), 221 completed Week 16 (apremilast: n = 152; placebo: n = 69). The primary endpoint (≥4-point reduction in DLQI at Week 16) was met by significantly more patients receiving apremilast (73.3%) versus placebo (41.3%; p < 0.0001). Significantly greater improvement in affected body surface area (BSA) and PASI was observed with apremilast versus placebo at Week 16. There were also significantly greater improvements with apremilast versus placebo in itch numeric rating scale (-2.5 vs. -0.9, p < 0.0001) and skin discomfort/pain visual analog scale (-21.5 vs. -5.4, p = 0.0003) and greater achievement of Patient Benefit Index ≥1 (77% vs. 40%, p < 0.0001) at Week 16. No new safety signals were observed. CONCLUSIONS Apremilast significantly improved skin-related QoL in patients with limited skin involvement with plaque psoriasis in special areas and highly impaired QoL. The safety profile was consistent with prior apremilast studies.
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Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jonathan Barker
- St John's Institute of Dermatology of King's College, London, UK
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Denis Jullien
- Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | | | | | | | | | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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17
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Mrowietz U, Augustin M. Using the upgrade criteria of the European Psoriasis Consensus is best practice care according to the people-centred healthcare concept of the World Health Organization. Br J Dermatol 2022; 187:1007-1008. [PMID: 36464934 DOI: 10.1111/bjd.21827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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18
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Elewski B, Barker J, Mrowietz U, Imafuku S, Hu N, Quaresma M, Thoma C. 32924 Sustained treatment effect of spesolimab over 12 weeks for generalized pustular psoriasis flares; results from the Effisayil 1 study. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.858] [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: 10/14/2022]
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19
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Augustin M, Mrowietz U, Du Jardin KG, Kasujee I, Daudén E. 33130 Effect of tildrakizumab on work/study-related productivity: Pooled analysis from reSURFACE 1 and reSURFACE 2 phase 3 trials. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.674] [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: 10/14/2022]
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20
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Reich K, Mrowietz U, Sorbe C, von Kiedrowski R, Diemert S, Schaeffer L, Kirsten N, Ben-Anaya N, Augustin M. Response to fumaric acid esters for plaque type psoriasis in real-world practice is largely independent of patient characteristics at baseline - a multivariable regression analysis from the German psoriasis registry PsoBest. J DERMATOL TREAT 2022; 33:3170-3177. [PMID: 35981144 DOI: 10.1080/09546634.2022.2115285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Fumaric acid esters (FAEs) are a well-established treatment option for long-term therapy of moderate to severe plaque psoriasis. This study examines effectiveness of FAEs for the treatment of plaque psoriasis in real-world practice at 12 months and if patient characteristics affect the odds of clinical response. METHODS A descriptive, multivariable logistic regression analysis was conducted in a cohort drawn from the German registry PsoBest. Baseline patient characteristics were assessed as potential treatment effect modifiers. RESULTS 444 patients (mean age 47.0 years, 39.0% female) were eligible for response analysis using nonresponder imputation at month 12. Of these, 39.6% achieved clinical response, i.e., Psoriasis Area and Severity Index (PASI) ≤3 or skin clearance. In logistic regression analysis (R2 = 0.114), only baseline PASI was a significant factor: patients with PASI <10 had a 4 times higher odds (p ≤ 0.001, OR 4.088), patients with PASI of 10-20 a twofold higher odds of response (p ≤ 0.044, OR 1.961) compared to those with PASI >20. Neither sex, age, body weight, disease duration, comorbidity nor pre-treatment had an impact on the odds of response (p > 0.05). CONCLUSIONS FAEs showed a favorable response at 12 months, largely independent of patient characteristics.
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Affiliation(s)
- K Reich
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - U Mrowietz
- Psoriasis-Center Kiel, Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - S Diemert
- Almirall Hermal GmbH, Reinbek, Germany
| | - L Schaeffer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - N Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - N Ben-Anaya
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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21
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Sommer R, Westphal L, Mrowietz U, Gerdes S, Augustin M. Measuring well-being in psoriasis: Psychometric properties of the WHO-5 questionnaire. J Eur Acad Dermatol Venereol 2022; 36:e986-e987. [PMID: 35788987 DOI: 10.1111/jdv.18396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Westphal
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - U Mrowietz
- Psoriasis-Center Kiel, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - S Gerdes
- Psoriasis-Center Kiel, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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22
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Gerdes S, Lenz D, Seidl U, Weidinger S, Mrowietz U, von Spreckelsen R. Entwicklung eines Fragebogens zur Evaluation des Kratzverhaltens bei Patienten mit Psoriasis und atopischer Dermatitis. J Dtsch Dermatol Ges 2022; 20:1011-1015. [PMID: 35881095 DOI: 10.1111/ddg.14775_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sascha Gerdes
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Darya Lenz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Ulrich Seidl
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
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Gerdes S, Lenz D, Seidl U, Weidinger S, Mrowietz U, von Spreckelsen R. Development of a questionnaire to evaluate scratching behavior in patients with psoriasis and atopic dermatitis. J Dtsch Dermatol Ges 2022; 20:1011-1015. [PMID: 35701100 DOI: 10.1111/ddg.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sascha Gerdes
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Darya Lenz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Ulrich Seidl
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
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Lindner L, Augustin M, Kühl L, Weiß A, Rustenbach SJ, Behrens F, Feuchtenberger M, Schwarze I, Mrowietz U, Thaçi D, Reich K, Strangfeld A, Regierer A. AB0952 Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: an analysis of two disease registries. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system, skin and nails. Therapeutic management in Germany is usually provided by a dermatologist or rheumatologist.ObjectivesThe aim is to characterize the socioeconomic and clinical patient profiles in dermatologic and rheumatologic settings.MethodsBaseline data of patients with PsA from [1] the dermatological German Psoriasis Registry PsoBest (PB) and [2] the rheumatological German disease register RABBIT-SpA (RS) [2] were analyzed. For this purpose, comparable anamnestic and clinical variables collected in the period 10/2017 to 12/2020 were identified and descriptively analyzed. The analysis was carried out in each of the data-holding registers.Results1066 RS patients and 704 PB patients were included in the analysis (Table 1). The proportion of women was higher in the rheumatology setting (RS) (60% vs. 49%). Disease duration of psoriasis was longer in the dermatology setting (PB). Cutaneous severity was higher in PB, including affected body surface area and nail psoriasis. However, more patients in RS had tender joints and swollen joints. The physician-reported global disease activity was higher in RS. The mean DLQI (Dermatology Life Quality Index) was higher in PB and the mean HAQ (Health Assessment Questionnaire) was higher in RS. Patient reported global disease activity and pain were lower in PB.Table 1.Baseline data of patients with PsA from the registers PsoBest and RABBIT-SpA included 10/2017 to 12/2020.RABBIT-SpA(Rheumatology setting)PsoBest(Dermatology setting)N1066704Age, mean (SD)51.9 (12.2)51.7 (13.2)Female, n (%)637 (60)346 (49)Disease duration skin, mean (SD)14.3 (13.9)21.6 (16.0)Body surface area, mean (SD)8.5 (15.0)20.8 (19.8)Nail psoriasis, n (%)434 (41)407 (58)Tender joints, n (%)905 (85)498 (71)Swollen joints, n (%)708 (67)387 (55)Physician reported disease activity, mean (SD)5.2 (1.9)4.6 (2.7)DLQI, mean (SD)5.6 (6.2)12.2 (7.6)HAQ, mean (SD)0.9 (0.7)0.7 (0.6)Patient reported disease activity, mean (SD)5.7 (2.4)4.9 (2.9)Patient reported pain, mean (SD)5.5 (2.4)5.2 (2.8)bDMARD, n (%)751 (71)514 (73)TNF, n (%)346 (46)117 (23)IL17, n (%)351 (47)246 (48)IL23, n (%)54 (7)151 (29)tsDMARD, n (%)109 (10)47 (7)csDMARD, n (%)195 (18)142 (20)Most of the patients received biologics at inclusion (RS: 71% and PB: 73%). In the dermatology setting IL23 inhibitors were used more frequently, whereas TNF inhibitors were used more frequently in the rheumatology setting.ConclusionThe clinical specialization of the treating physician was associated with a different treatment and clinical status of patients with PsA. Our analysis showed that patients in the rheumatology setting more frequently had joint affections and lower functional status, whereas skin severity was worse in the dermatology setting, indicating selection effects of health care access. We hypothesize out that these differences may be biased due to different diagnostic and therapeutic routines in the specialized health care settings. Psoriatic arthritis should be treated in a multidisciplinary approach to take into account all facets of this complex disease.References[1]PMID: 24393314[2]PMID: 30874933Disclosure of InterestsLisa Lindner Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Matthias Augustin Grant/research support from: The PsoBest registry is/was supported by AbbVie, Almirall Hermal, Amgen, Biogen, BMS, Celgene, Hexal, Janssen-Cilag, LEO Pharma, Eli Lilly, Medac, Novartis, Pfizer, UCB and Viatris. These companies do not have influence on the design of the registry, data collection, analyses, the publication decisions or development., Laura Kühl Grant/research support from: The PsoBest registry is/was supported by AbbVie, Almirall Hermal, Amgen, Biogen, BMS, Celgene, Hexal, Janssen-Cilag, LEO Pharma, Eli Lilly, Medac, Novartis, Pfizer, UCB and Viatris. These companies do not have influence on the design of the registry, data collection, analyses, the publication decisions or development., Anja Weiß Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Stephan Jeff Rustenbach Grant/research support from: The PsoBest registry is/was supported by AbbVie, Almirall Hermal, Amgen, Biogen, BMS, Celgene, Hexal, Janssen-Cilag, LEO Pharma, Eli Lilly, Medac, Novartis, Pfizer, UCB and Viatris. These companies do not have influence on the design of the registry, data collection, analyses, the publication decisions or development., Frank Behrens: None declared, Martin Feuchtenberger: None declared, Ilka Schwarze: None declared, Ulrich Mrowietz: None declared, Diamant Thaçi: None declared, Kristian Reich Grant/research support from: The PsoBest registry is/was supported by AbbVie, Almirall Hermal, Amgen, Biogen, BMS, Celgene, Hexal, Janssen-Cilag, LEO Pharma, Eli Lilly, Medac, Novartis, Pfizer, UCB and Viatris. These companies do not have influence on the design of the registry, data collection, analyses, the publication decisions or development., Anja Strangfeld Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anne Regierer Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.
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Reich K, Augustin M, Gerdes S, Ghoreschi K, Kokolakis G, Mößner R, Mrowietz U, Navarini AA, Pinter A, Schäkel K, Staubach P, Sticherling M, Thaçi D, Wilsmann-Theis D. Generalisierte pustulöse Psoriasis: Überblick zum Status quo und Ergebnisse einer Diskussionsrunde. J Dtsch Dermatol Ges 2022; 20:753-772. [PMID: 35711041 DOI: 10.1111/ddg.14764_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kristian Reich
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf (UKE)
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf (UKE)
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt- Universität zu Berlin
| | - Georgios Kokolakis
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt- Universität zu Berlin
| | - Rotraut Mößner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Ulrich Mrowietz
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Andreas Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Goethe-Universität, Frankfurt am Main
| | - Knut Schäkel
- Abteilung für Dermatologie, Universitätsklinikum Heidelberg
| | | | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Klinik für Dermatologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Diamant Thaçi
- Institut für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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von Spreckelsen R, Gerdes S, Mrowietz U, Emmert H. Zugang und Inanspruchnahme psychosomatischer Versorgung aus ärztlicher Sicht: Eine qualitative Interviewstudie. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1754-4332] [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: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Chronisch entzündliche Hauterkrankungen sind häufig mit psychosozialen Beeinträchtigungen und einer reduzierten Lebensqualität vergesellschaftet. Ziel dieser Studie war es zu erfassen, wie spezialisiertes medizinisches Personal eines universitären Haut-Entzündungszentrums die Zugangswege und die Inanspruchnahme psychosomatischer Sondierungsgespräche oder Kurzzeitinterventionen bei PatientInnen mit chronisch entzündlichen Hauterkrankungen wahrnimmt.
Methoden Es wurden qualitative Erhebungen in Form von 10 Einzelinterviews mit medizinischem Personal durchgeführt, das zum Zeitpunkt der Befragung im Zentrum für entzündliche Hauterkrankungen der Uni-Hautklinik tätig war. Die Daten wurden inhaltsanalytisch mithilfe einer qualitativen Analysesoftware ausgewertet.
Ergebnisse Die Ergebnisse aus den geführten Einzelinterviews ergaben, dass die Einbindung einer psychosomatischen Versorgung innerhalb eines dermatologischen Entzündungszentrums vom ärztlichen Personal als durchweg positiv bewertet wurde. Die Option auf ein zeit- und zentrumsnahes Gesprächsangebot nimmt dabei eine besondere Rolle ein. Experten fühlen sich mit der ortsnahen Einbindung psychosomatischer Expertise sicherer im Umgang mit belasteten Patient*innen. Der holistische Ansatz scheint einen positiven Einfluss auf die individuelle Behandlung und die Beziehungsgestaltung mit den Patient*innen zu nehmen. Dabei zeigten sich keine wesentlichen Unterschiede im Geschlecht und über verschiedene Altersgruppen hinweg.
Diskussion Die Möglichkeit zur zentrumsnahen Anbindung von belasteten Patient*innen in Form von zusätzlichen psychosomatischen Sondierungsgesprächen wie auch dem Einsatz von adaptierten Kurzzeitinterventionen trägt zur holistischen Behandlung bei, scheint einen günstigen Einfluss auf den somatischen Behandlungsverlauf zu nehmen und unterstützt Ärzt*innen in ihrer Behandlung.
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Affiliation(s)
- Regina von Spreckelsen
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
- Klinik für Psychotherapie und Psychosomatik, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Sascha Gerdes
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Ulrich Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Hila Emmert
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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Reich K, Augustin M, Gerdes S, Ghoreschi K, Kokolakis G, Mößner R, Mrowietz U, Navarini AA, Pinter A, Schäkel K, Staubach P, Sticherling M, Thaçi D, Wilsmann-Theis D. Generalized pustular psoriasis: overview of the status quo and results of a panel discussion. J Dtsch Dermatol Ges 2022; 20:753-771. [PMID: 35674482 DOI: 10.1111/ddg.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare, severe, potentially life-threatening, autoinflammatory, neutrophilic skin disease that may be accompanied by fever and leukocytosis. This paper describes the current state of knowledge on GPP in terms of classification, (differential) diagnosis and prevalence. We present a comparison of the genetics and pathoimmunology of GPP and psoriasis vulgaris with the central mechanisms of autoimmunology and autoinflammation. The currently available therapeutic options, expert recommendations for therapy, and data from early clinical trials investigating targeted therapies will be summarized. We present the results of our discussion with 13 experts for psoriasis vulgaris and GPP and give an integrated overview of indication and therapy based on our personal experience and present an outlook on further research questions. Collectively, this article highlights the high unmet need in GPP, as there exists no satisfactory method of diagnosis or treatment to date and new treatment options will be of great therapeutic benefit to those affected.
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Affiliation(s)
- Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Clinic for Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein/Campus Kiel, Kiel, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Georgios Kokolakis
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Rotraut Mößner
- Department of Dermatology, Venerology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center, Clinic for Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein/Campus Kiel, Kiel, Germany
| | | | - Andreas Pinter
- Department of Dermatology, Venereology, and Allergology, Goethe University, Frankfurt am Main, Germany
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Department of Dermatology, Friedrich- Alexander University, Friedrich-Alexander University, Erlangen-Nuermberg, Erlangen, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Riedl E, Mrowietz U, Hill B. J, Sapin C, Warren R. Subgroup Analyses by European Country-Specific Reimbursement Requirements Confirm Efficacy for Ixekizumab in Psoriasis. J Drugs Dermatol 2022; 21:659-667. [DOI: 10.36849/jdd.6620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Burden AD, Mrowietz U, Skalicky AM, Rentz AM, Esser D, Gloede T, Thoma C, Menter A. Symptom Experience and Content Validity of the Psoriasis Symptom Scale (PSS) in Patients with Generalized Pustular Psoriasis (GPP). Dermatol Ther (Heidelb) 2022; 12:1367-1381. [PMID: 35590037 PMCID: PMC9209619 DOI: 10.1007/s13555-022-00736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We sought to understand key symptoms of generalized pustular psoriasis (GPP) and to confirm the relevance to patients and content validity of the Psoriasis Symptom Scale (PSS) in GPP. Methods A targeted literature review and clinical expert interviews were conducted as background research. Patients were interviewed individually (involving concept elicitation and cognitive interviews), and a separate patient workshop was conducted to determine disease-specific symptoms of importance. Results Seven participants with moderate (n = 4), severe (n = 2), and mild (n = 1) GPP and clinician diagnosis were interviewed. During concept elicitation, all participants indicated that pustules may underlie other symptoms. Symptoms reported by all patients were pain, redness, itch, burning, and discomfort. The PSS symptoms of pain, itching, burning, and redness were reported by ≥ 86% of patients as most frequently experienced. Upon debriefing, the PSS was well understood. Relevance and importance of these symptoms was confirmed in the GPP patient workshop. Conclusion Participant feedback found the PSS measure to be relevant and easy to understand. The symptoms included in the instrument, pain, redness, itch, and burning, were most frequently reported, important, and well understood by patients. Study results provided support for the content validity of the PSS for use as endpoints in GPP clinical trials. Generalized pustular psoriasis (GPP) is a severe rare disease, including redness and boils that sometimes come with fever and other general symptoms. This study asked patients with GPP about their key symptoms, and whether the Psoriasis Symptom Scale (PSS) is relevant to them as patients. The PSS is a questionnaire with the symptoms pain, itching, burning, and redness. We searched the literature and interviewed clinical experts to guide the patient interviews. Patients were recruited through clinical sites and the National Psoriasis Foundation (NPF). The interviews discussed GPP symptoms and the PSS questionnaire. Patients with GPP were also asked about commonly experienced symptoms in a workshop. Most patients had moderate to severe GPP. Patients in both the interviews and workshop described experiencing pain, redness, itch, burning, and discomfort with their boils. During interviews, the patients said the PSS questionnaire was easy to understand. Patients in the workshop also found the PSS to be relevant and easy to understand. Patients agreed the symptoms in the PSS, pain, redness, itch, and burning, were common and important. Study results support the PSS for use with patients in clinical trials.
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Affiliation(s)
- A David Burden
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Dirk Esser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Tristan Gloede
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Alan Menter
- Baylor Scott & White Health, Dallas, TX, USA
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Ruffer N, Haberstock H, Bohne AS, Kötter I, Mrowietz U. Papulonodular tattoo lesions as a clinical sign of systemic sarcoidosis. Clin Rheumatol 2022; 41:2589-2590. [PMID: 35377007 DOI: 10.1007/s10067-022-06136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Nikolas Ruffer
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, Oskar-Alexander-Straße 26, 24576, Bad Bramstedt, Germany.
| | - Heinrich Haberstock
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, Oskar-Alexander-Straße 26, 24576, Bad Bramstedt, Germany
| | - Ann-Sophie Bohne
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ina Kötter
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, Oskar-Alexander-Straße 26, 24576, Bad Bramstedt, Germany
| | - Ulrich Mrowietz
- Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Papp K, Paul C, Kleyn CE, Huang YH, Tsai TF, Schuster C, El Baou C, Toth A, Riedl E, Mrowietz U. Time to Loss of Response following Withdrawal of Ixekizumab in Patients with Moderate-to-Severe Psoriasis. Acta Derm Venereol 2022; 102:adv00672. [PMID: 35170742 PMCID: PMC9574691 DOI: 10.2340/actadv.v102.1984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In clinical practice, interruption of treatment may not result in immediate cessation of disease control, and some patients even experience sustained treatment response following treatment interruption. This post hoc analysis of UNCOVER-1 and -2 Phase 3 clinical trials characterized the time to loss of treatment response in patients with psoriasis who responded to ixekizumab through a 12-week treatment period, and who were then re-randomized to placebo for the following 48 weeks. For those with static Physician Global Assessment [sPGA]0/1 and Psoriasis Area and Severity Index [PASI]90 at Week 12, the median time to loss of PASI90 was 16.1 weeks (95% confidence interval 12.7–16.4). For those with PASI100 at Week 12, the median time to loss of PASI100 was 12.1 weeks (95% confidence interval 9.0–13.0). A small subset of patients maintained high levels of disease control through Week 60. This study adds to the growing body of evidence on sustained treatment response following treatment interruption.
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Affiliation(s)
- Kim Papp
- Probity Medical Research, Inc., Waterloo, Ontario, Canada.
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Reich K, Iversen L, Puig L, Lambert J, Mrowietz U, Kaplan Saday K, Warren RB. Long‐term efficacy and safety of brodalumab in moderate‐to‐severe plaque psoriasis: a post hoc pooled analysis of AMAGINE‐2 and ‐3. J Eur Acad Dermatol Venereol 2022; 36:1275-1283. [DOI: 10.1111/jdv.18068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - L. Iversen
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - L. Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona Barcelona Spain
| | - J. Lambert
- Department of Dermatology Ghent University Ghent Belgium
| | - U. Mrowietz
- Department of Dermatology University Medical Center Schleswig‐Holstein Kiel Germany
| | | | - R. B. Warren
- Dermatology Centre Salford Royal NHS Foundation Trust Manchester NIHR Biomedical Research Centre University of Manchester United Kingdom
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Armstrong AW, Blauvelt A, Mrowietz U, Strober B, Gisondi P, Merola JF, Langley RG, Ståhle M, Lebwohl M, Netea MG, Nunez Gomez N, Warren RB. A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17. Dermatol Ther (Heidelb) 2022; 12:787-800. [PMID: 35167107 PMCID: PMC8941045 DOI: 10.1007/s13555-022-00687-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/16/2021] [Accepted: 01/22/2022] [Indexed: 12/21/2022] Open
Abstract
Plaque psoriasis is an immune-mediated inflammatory skin disease associated with the dysregulation of cytokines, especially those involved in the interleukin (IL)-23/IL-17 pathways. In recent years, there has been growing interest in developing biologic therapies that target these pathways. However, inhibition of the cytokines of the IL-23/IL-17 pathways may increase patients' risk of developing fungal infections, particularly oral candidiasis. Therefore, it is important that dermatology practitioners can effectively diagnose and treat oral candidiasis. In this review, we examine the role of the IL-23/IL-17 pathways in antifungal host defense, and provide a practical guide to the diagnosis and treatment of oral candidiasis in patients with psoriasis. Overall, while treatment with anti-IL-17 medications leads to an increased incidence of oral candidiasis in patients with psoriasis, these cases are typically mild or moderate in severity and can be managed with standard antifungal therapy without discontinuing treatment for psoriasis. If applicable, patients with psoriasis should also be advised to practice good oral hygiene and manage or control co-existing diabetes, and should be provided with information on smoking cessation to prevent oral candidiasis.
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine of USC, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | | | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bruce Strober
- Yale University, New Haven, CT, USA
- Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | - Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard G Langley
- Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mona Ståhle
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, Solna, Sweden
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
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Suhrkamp I, Morrison PJ, Assmann JC, Schwaninger M, Wettschureck N, Mrowietz U. ORAL DIMETHYL FUMARATE TARGETS HCA 2-EXPRESSING SKIN CELLS IN THE IMIQUIMOD MOUSE MODEL. J Invest Dermatol 2022; 142:2547-2550.e5. [PMID: 35189149 DOI: 10.1016/j.jid.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ina Suhrkamp
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Peter J Morrison
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Julian C Assmann
- Institute for Experimental and Clinical Pharmacology and Toxicology, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Nina Wettschureck
- Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
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Dykukha I, Schoenenberger A, Kasujee I, Mrowietz U, Vonthein R. Application of the Statistical Method to Convert Published PASI 50/75/90/100 into Absolute PASI Response Rate in Patients with Moderate-to-Severe Plaque Psoriasis Treated with Tildrakizumab Based on Data from the Two Pivotal Phase 3 Studies reSURFACE 1 and reSURFACE 2. Dermatology 2022; 238:910-918. [PMID: 35168231 DOI: 10.1159/000522009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Absolute Psoriasis Area and Severity Index (PASI) is a key endpoint in psoriasis management. Petto et al. [Pharm Stat. 2019;18(1):4-21] developed a statistical method to estimate the proportion of patients reaching absolute PASI response given baseline PASI score and proportion of patients achieving relative improvements at predefined time points. OBJECTIVES To test this method on clinical data from two phase 3 tildrakizumab trials (reSURFACE 1/2) comparing estimated absolute PASI ≤1/≤2/≤3/≤5 responses with reference responses from clinical databases. METHODS Reference PASI responses of ≤1/≤2/≤3/≤5 were extracted from clinical databases. Estimation of absolute PASI ≤1/≤2/≤3/≤5 response rates at week (W) 12 and W28 by treatment and trial were performed. Differences between estimated and reference responses were analysed. Bland-Atman limits of agreement and Passing-Bablok regression to assess variations between estimated and reference responses were performed. RESULTS Differences between estimated and reference absolute PASI ≤1/≤2/≤3/≤5 responses at W12 and W28 by treatment and trial were of little clinical relevance with an overall mean difference in PASI response proportion of -2.2% (e.g., for the tildrakizumab 100-mg arm, original proportions of patients achieving PASI of ≤1/≤2/≤3/≤5 at W28 were 38.5%/52.2%/63.5%/73.9% and 39.8%/54.8%/63.6%/76.9% [reSURFACE 1 and 2, respectively] vs. estimated proportions of 33.2%/49.8%/62.5%/78.3% and 34.3%/51.6%/64.5%/79.9%). Limits of agreement were -7.1% to 1.4% at W12 and -6.8% to 4.3% at W28. Scatterplots revealed linearity that stood the cusum test in Passing-Bablok regression with slope 1.14 (95% confidence intervals: 1.06 to 1.20). CONCLUSION Good estimates of absolute PASI response rates were achieved with the application of the statistical method to tildrakizumab data reported in the phase 3 studies, in particular in the verum study arms. Our data support the method provided by Petto et al. [2019] to estimate proportions of psoriasis patients reaching absolute PASI value thresholds using relative PASI improvements.
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Affiliation(s)
| | | | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Reinhard Vonthein
- Universität zu Lübeck, Institut für Medizinische Biometrie und Statistik, Lübeck, Germany
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Mrowietz U, Kircik L, Reich K, Munjal S, Shenoy S, Lebwohl M. Tepilamide Fumarate (PPC-06) Extended Release Tablets in Patients with Moderate-to-Severe Plaque Psoriasis: Safety and Efficacy Results from the Randomized, Double-blind, Placebo-controlled AFFIRM Study. J Clin Aesthet Dermatol 2022; 15:53-58. [PMID: 35309277 PMCID: PMC8903235] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Safe, effective, long-term oral therapies are needed for plaque psoriasis. This study aimed to assess the safety and effectiveness of tepilamide fumarate (a fumaric acid ester) extended-release tablets. METHODS This Phase IIb, randomized, double-blind, placebo-controlled, 24-week, multicenter study treated adults with moderate-to-severe plaque psoriasis with tepilamide fumarate 400 mg once (QD) or twice daily (BID), 600 mg BID, or placebo. Coprimary endpoints were the proportion of patients achieving ≥75% reduction in the Psoriasis Area and Severity Index (PASI-75) and Investigator's Global Assessment (IGA) of clear or almost clear (≥2 points' reduction). RESULTS A total of 426 patients were randomized (mean age 49.6 [±13.0] years). There was a ≥75% PASI reduction in 39.7%, 47.2%, 44.3%, and 20.0% in the 400 mg QD, 400 mg BID, 600 mg BID, and placebo groups, respectively; IGA treatment success was 35.7%, 41.4%, 44.4%, and 22.0%, respectively. Between 50%-66% of tepilamide fumarate and 48% of placebo patients experienced ≥1 treatment-emergent adverse event. Gastrointestinal intolerance (20%-42%), infection (6%-18%), and decreased lymphocyte count (4%-9%) were more common with tepilamide fumarate. LIMITATIONS High placebo response somewhat limits the utility of these findings. CONCLUSION Patients with moderate-to-severe plaque psoriasis treated with oral tepilamide fumarate demonstrated positive response.
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Affiliation(s)
- Ulrich Mrowietz
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Leon Kircik
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Kristian Reich
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Sagar Munjal
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Srinivas Shenoy
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Mark Lebwohl
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
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Sommer R, Weinberger NA, Von Spreckelsen R, Mrowietz U, Schielein MC, Luck-Sikorski C, Augustin M. A Structured Intervention for Medical Students Significantly Improves Awareness for Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial. Acta Derm Venereol 2021; 102:adv00641. [PMID: 34904689 PMCID: PMC9631292 DOI: 10.2340/actadv.v101.894] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome “social distance”, a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome “agreement with disease-related misconceptions”, a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome “stigmatising behaviour” (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.
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Affiliation(s)
- Rachel Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, DE-20246 Hamburg, Germany.
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Mrowietz U. Gefäßentzündung – Innovative Diagnostik der zentralen Domäne der Psoriasis‐Krankheit. J Dtsch Dermatol Ges 2021; 19:1709-1710. [PMID: 34894178 DOI: 10.1111/ddg.14684_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Drerup KA, Seemann C, Gerdes S, Mrowietz U. Effective and Safe Treatment of Psoriatic Disease with the Anti-IL-23p19 Biologic Tildrakizumab: Results of a Real-World Prospective Cohort Study in Nonselected Patients. Dermatology 2021; 238:615-619. [PMID: 34775387 PMCID: PMC9393809 DOI: 10.1159/000519924] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background After registration of drugs, evidence about efficacy and safety is solely based on data of phase 2/3 clinical trial programs. A major drawback is the selection of patients following inclusion/exclusion criteria. There is a considerable time and knowledge gap between study and registry data that evaluate real-world evidence (RWE). To close this gap, prospective cohort data are helpful. Objectives Soon after tildrakizumab, an interleukin 23p19-inhibitor, was registered for moderate-to-severe plaque psoriasis, a prospective single-center cohort study was established to evaluate efficacy and safety of tildrakizumab in daily practice. Methods Following approval of tildrakizumab, patients with moderate-to-severe plaque psoriasis eligible for systemic treatment were included into the Kiel Tildra Cohort (KTC) and followed using routine assessments of efficacy, psoriasis area and severity index (PASI), body surface area (BSA), dermatology life quality index (DLQI), itch (visual analog scale), and safety. Data of the KTC were compared to the respective phase 3 clinical trials. Results The KTC included 150 patients differing substantially from those in the trial program. There was a high rate of previous systemic (87.3%) and biologic (31.8%) therapy and of comorbidity in the KTC as compared to the phase 3 studies. Due to the best practice approach, baseline PASI was lower in the KTC, but DLQI was similar in both groups. At the time of this analysis, 126 patients completed week 28, 92 patients week 52, and 58 patients week 76, respectively. There was a constant improvement in PASI, BSA, DLQI, and itch from baseline until week 76. There was no clinically meaningful laboratory abnormality. Conclusions Patients treated in routine practice with tildrakizumab differed substantially from the phase 3 studies. Despite systemic pre-treatment and increased comorbidity, tildrakizumab showed comparable efficacy and safety in the KTC. Prospective cohort studies are a suitable tool to generate RWE before registry data become available.
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Affiliation(s)
- Katharina A Drerup
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Seemann
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sascha Gerdes
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Seidl U, Pinter A, Wilsmann-Theis D, Poortinga S, Morrison K, Mrowietz U, Gerdes S. Absolute Psoriasis Area and Severity Index as a valuable marker to determine initial treatment response in psoriasis patients treated with guselkumab in routine clinical care. Dermatol Ther 2021; 35:e15193. [PMID: 34741783 DOI: 10.1111/dth.15193] [Citation(s) in RCA: 1] [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] [Received: 04/27/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
Guselkumab is an anti-interleukin-23p19 monoclonal antibody approved as a first-line medication in patients with moderate-to-severe plaque-type psoriasis and second-line in active psoriatic arthritis. In the clinic, patients who have shown a lack of previous treatment efficacy and/or tolerability are often prescribed guselkumab. These patients generally have less severe psoriasis compared to clinical trial cohorts, reflected in lower Psoriasis Area and Severity Index (PASI). To evaluate treatment response in a real-world setting, we conducted a multicenter-retrospective chart review in three specialized dermatological centers. Seventy-four patients who received guselkumab treatment were included in the study and baseline characteristics were described. The mean PASI at baseline was 13.0 (± 6.7). After 12 weeks of treatment 40 patients could be followed up at the participating centers and efficacy was assessed: 72.5% of these patients achieved an absolute PASI ≤5 (55.0% ≤3; 42.5% ≤2) whereas only 57.5% of patients were able to gain a delta PASI reduction of at least 75%. Using the absolute PASI as a treatment goal rather than response rate revealed that guselkumab was highly effective in this real-world setting. In conclusion, the absolute PASI proved to be a more valuable tool to measure treatment outcome.
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Affiliation(s)
- Ulrich Seidl
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Sietske Poortinga
- Department of Dermatology and Allergy, University Bonn, Bonn, Germany
| | - Kirsten Morrison
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Sascha Gerdes
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
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Boehncke WH, Ehrchen J, Mrowietz U. [Learning from each other, treating together]. Hautarzt 2021; 72:933-934. [PMID: 34686885 PMCID: PMC8536559 DOI: 10.1007/s00105-021-04896-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Wolf-Henning Boehncke
- Service de Dermatologie et Vénéréologie, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211, Genf, Schweiz.
| | - Jan Ehrchen
- Klinik für Hautkrankheiten, Universitätsklinikum Münster (UKM), Von-Esmarch Str. 58, 48149, Münster, Deutschland.
| | - Ulrich Mrowietz
- Psoriasis-Zentrum Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus U27, 24105, Kiel, Deutschland.
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Otten M, Mrowietz U, von Kiedrowski RM, Otto R, Altenburg A, Aschoff R, Beissert S, Beiteke U, Bonnekoh B, Hoffmann M, Körber A, Maaßen D, Mössner R, Navarini A, Petering H, Ramaker-Brunke J, Rosenbach T, Schwichtenberg U, Sticherling M, Sondermann W, Thaci D, Timmel A, Tsianakas A, Werfel T, Wilsmann-Theis D, Augustin M. Dokumentation der Psoriasis in der Routineversorgung – Expertenkonsens zu einem deutschen Datensatz. J Dtsch Dermatol Ges 2021; 19:1463-1477. [PMID: 34661349 DOI: 10.1111/ddg.14547_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Otten
- Competenzzentrum für Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Ulrich Mrowietz
- Psoriasis-Zentrum Kiel, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Ramona Otto
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Andreas Altenburg
- Fachbereich für Haut- und Geschlechtskrankheiten, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
| | - Roland Aschoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Stefan Beissert
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | | | | | | | - Rotraut Mössner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | | | | | | | | | | | | | - Wiebke Sondermann
- Klinik für Dermatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
| | - Diamant Thaci
- Exzellenzzentrum für Entzündungsmedizin, Universitätsklinikum Schleswig- Holstein, Campus Lübeck
| | | | | | - Thomas Werfel
- Forschungsabteilung Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover (MHH)
| | | | - Matthias Augustin
- Competenzzentrum für Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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Otten M, Mrowietz U, von Kiedrowski RM, Otto R, Altenburg A, Aschoff R, Beissert S, Beiteke U, Bonnekoh B, Hoffmann M, Körber A, Maaßen D, Mössner R, Navarini A, Petering H, Ramaker-Brunke J, Rosenbach T, Schwichtenberg U, Sticherling M, Sondermann W, Thaci D, Timmel A, Tsianakas A, Werfel T, Wilsmann-Theis D, Augustin M. Documentation of psoriasis in routine care - expert consensus on a German data set. J Dtsch Dermatol Ges 2021; 19:1463-1475. [PMID: 34622544 DOI: 10.1111/ddg.14547] [Citation(s) in RCA: 4] [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: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Documenting patient data in psoriasis clinical practice can improve care, but standardized and transparent documentation is rare. The current project aimed to develop a data set for the documentation of psoriasis in daily practice. MATERIAL AND METHODS In four online Delphi rounds and one in-person meeting, 27 psoriasis experts allocated variables to a standard, an optimal and an optional data set. Most of the questions were standardized. Open questions were included to allow for the provision of reasons and to enlarge the data sets. Furthermore, in the in-person meeting we considered a) patients' attitudes and b) dermatologists' information on the current usage and acceptability in Germany. RESULTS The consensus approach resulted in a data set with 69 variables. The standard data set includes 20, the optimal data set 31 and the optional data set 18 variables. In summary, the data set can mainly be grouped into master data, general status and medical history data, medical history of psoriasis, status of psoriasis, diagnostics and comorbidity, therapies and patient-reported outcomes. CONCLUSIONS The consensus recommendation of a standard, an optimal and an optional data set for routine care of psoriasis intends to be a decision-making aid and an orientation for both daily practice and further development of documentation systems.
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Affiliation(s)
- Marina Otten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center Kiel, Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Ramona Otto
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Roland Aschoff
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ulrike Beiteke
- Department of Dermatology, Hospital of Dortmund, Dortmund, Germany
| | - Bernd Bonnekoh
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | | | | | | | - Rotraut Mössner
- Department of Dermatology, Venerology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Navarini
- Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | | | | | | | | | - Michael Sticherling
- Department of Dermatology, University Medical Center Erlangen, Erlangen, Germany
| | - Wiebke Sondermann
- Clinic for Dermatology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Diamant Thaci
- Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | | | - Thomas Werfel
- Division of Immunodermatology and Allergy Reasearch, Department of Dermatology and Allergy, Hannover Medical School (MHH), Hannover, Germany
| | | | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Shourick J, Taieb C, Seneschal J, Merhand S, Ezzedine K, Halioua B, Richard MA, Mrowietz U. EczemaPartner - adapting a questionnaire to assess the impact of atopic dermatitis on partners of patients. J Eur Acad Dermatol Venereol 2021; 36:e192-e193. [PMID: 34626005 DOI: 10.1111/jdv.17726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- J Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - C Taieb
- EMMA, Fontenay sous Bois, France
| | | | - S Merhand
- Association Française de l'Eczema, Redon, France
| | | | | | | | - U Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Ghashghaeinia M, Mrowietz U. Human erythrocytes, nuclear factor kappaB (NFκB) and hydrogen sulfide (H 2S) - from non-genomic to genomic research. Cell Cycle 2021; 20:2091-2101. [PMID: 34559024 PMCID: PMC8565816 DOI: 10.1080/15384101.2021.1972557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/13/2022] Open
Abstract
Enucleated mature human erythrocytes possess NFĸBs and their upstream kinases. There is a negative correlation between eryptosis (cell death of erythrocytes) and the amount of NFĸB subunits p50 and Rel A (p65). This finding is based on the fact that young erythrocytes have the highest levels of NFĸBs and the lowest eryptosis rate, while in old erythrocytes the opposite ratio prevails. Human erythrocytes (hRBCs) effectively control the homeostasis of the cell membrane permeable anti-inflammatory signal molecule hydrogen sulfide (H2S). They endogenously produce H2S via both non-enzymic (glutathione-dependent) and enzymic processes (mercaptopyruvate sulfur transferase-dependent). They uptake H2S from diverse tissues and very effectively degrade H2S via methemoglobin (Hb-Fe3+)-catalyzed oxidation. Interestingly, a reciprocal correlation exists between the intensity of inflammatory diseases and endogenous levels of H2S. H2S deficiency has been observed in patients with diabetes, psoriasis, obesity, and chronic kidney disease (CKD). Furthermore, endogenous H2S deficiency results in impaired renal erythropoietin (EPO) production and EPO-dependent erythropoiesis. In general we can say: dynamic reciprocal interaction between tumor suppressor and oncoproteins, orchestrated and sequential activation of pro-inflammatory NFĸB heterodimers (RelA-p50) and the anti-inflammatory NFĸB-p50 homodimers for optimal inflammation response, appropriate generation, subsequent degradation of H2S etc., are prerequisites for a functioning cell and organism. Diseases arise when the fragile balance between different signaling pathways that keep each other in check is permanently disturbed. This work deals with the intact anti-inflammatory hRBCs and their role as guarantors to maintain the redox status in the physiological range, a basis for general health and well-being.
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Affiliation(s)
- Mehrdad Ghashghaeinia
- Physiological Institute I, Department of Vegetative and Clinical Physiology, University of Tübingen, Tübingen, Germany
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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46
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Nast A, Altenburg A, Augustin M, Boehncke WH, Härle P, Klaus J, Koza J, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Schlaeger M, Schmid-Ott G, Sebastian M, von Kiedrowski R, Weberschock T, Dressler C. German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monitoring and specific clinical or comorbid situations. J Dtsch Dermatol Ges 2021; 19:1092-1115. [PMID: 34288477 DOI: 10.1111/ddg.14507] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Altenburg
- Dermatology, Venereology and Allergology, Immunology Center, Dessau Municipal Hospital, Dessau, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Wolf-Henning Boehncke
- Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Tobias Weberschock
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt/Main, Germany and Working group Evidence-based Medicine Frankfurt, Institute for General Practice, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Corinna Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Nast A, Altenburg A, Augustin M, Boehncke WH, Härle P, Klaus J, Koza J, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Schlaeger M, Schmid-Ott G, Sebastian M, von Kiedrowski R, Weberschock T, Dressler C. German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 1: Treatment goals and treatment recommendations. J Dtsch Dermatol Ges 2021; 19:934-150. [PMID: 34139083 DOI: 10.1111/ddg.14508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Altenburg
- Dermatology, Venereology and Allergology, Immunology Center, Dessau Municipal Hospital, Dessau, Germany
| | - Matthias Augustin
- Department of Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolf-Henning Boehncke
- Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | | | | | | | | | - Tobias Weberschock
- Center of Dermatology and Venereology, Hospital of the Johann Wolfgang Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Corinna Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Weinberger NA, Mrowietz S, Luck-Sikorski C, von Spreckelsen R, John SM, Sommer R, Augustin M, Mrowietz U. Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: Results of a controlled trial in future educators. Health Expect 2021; 24:1790-1800. [PMID: 34318568 PMCID: PMC8483191 DOI: 10.1111/hex.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/06/2021] [Accepted: 07/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Chronic visible skin diseases are highly prevalent, and patients affected frequently report feeling stigmatised. Interventions to reduce stigmatisation are rare. Objectives This study aimed to evaluate the effectiveness of a structured short intervention in reducing stigmatising attitudes towards psoriasis in future educators. Methods The intervention consisted of four components: (1) self‐reflection, (2) education on skin diseases, (3) contact between participants and a person with psoriasis and (4) practising of knowledge via case studies. A quasi‐experimental, pre–post study design was chosen with a nonrandomized contemporaneous control group that attended regular lessons. The main outcomes were participants' desire for social distance, stereotype endorsement, illness‐related misconceptions and intended behaviour. Intervention effects were analysed using mixed repeated‐measures analysis of variance, with Bonferroni post‐hoc tests for pairwise comparisons. Results The sample consisted of 221 students attending vocational training as educators (n = 118 intervention group, n = 103 control group). While no effect of the intervention was found in social distance, small to large effect sizes were observed for intended behaviour (r = .14), illness‐related misconceptions (r = .28) and stereotype endorsement (r = .42). The intervention group reported significantly higher satisfaction with the seminar compared to the control group. Conclusions Overall, the short intervention was effective at reducing stigmatising attitudes in future educators. In perspective, revised versions could help in reducing stigmatisation in various demographics and promote patient empowerment by acknowledging and including them as experts on their own behalf. Patient or Public Contribution Patient advocate groups were consulted and involved in the superordinate destigmatization research programme and intervention.
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Affiliation(s)
- Natascha-Alexandra Weinberger
- Research Group: Chronic Diseases and Psychological Health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - Sonja Mrowietz
- Vocational College for Social Pedagogy, RBZ Koenigsweg, Kiel, Germany
| | - Claudia Luck-Sikorski
- Research Group: Chronic Diseases and Psychological Health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - Regina von Spreckelsen
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sven M John
- Department of Dermatology, Environmental Medicine, Health Theory, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Osnabrueck, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Nast A, Altenburg A, Augustin M, Boehncke WH, Härle P, Klaus J, Koza J, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Schlaeger M, Schmid-Ott G, Sebastian M, von Kiedrowski R, Weberschock T, Dressler C. Deutsche S3-Leitlinie zur Therapie der Psoriasis vulgaris, adaptiert von EuroGuiDerm - Teil 2: Therapiemonitoring, besondere klinische Situationen und Komorbidität. J Dtsch Dermatol Ges 2021; 19:1092-1117. [PMID: 34288473 DOI: 10.1111/ddg.14507_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Andreas Altenburg
- Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau
| | - Matthias Augustin
- Kompetenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg
| | | | | | | | | | - Ulrich Mrowietz
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | | | - Kristian Reich
- Zentrum für Translationale Forschung bei entzündlichen Hauterkrankungen, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsmedizin Hamburg-Eppendorf
| | | | | | | | | | | | - Tobias Weberschock
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt/Main und Arbeitsgruppe EbM Frankfurt, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt
| | - Corinna Dressler
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
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50
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Reich K, Mrowietz U, Menter A, Griffiths CEM, Bagel J, Strober B, Nunez Gomez N, Shi R, Guerette B, Lebwohl M. Effect of baseline disease severity on achievement of treatment target with apremilast: results from a pooled analysis. J Eur Acad Dermatol Venereol 2021; 35:2409-2414. [PMID: 34255891 DOI: 10.1111/jdv.17520] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treating to absolute treatment targets rather than relative measures such as Psoriasis Area and Severity Index (PASI)-75 is emerging as an important clinical concept included in psoriasis guidelines and clinical practice. Achieving treatment targets is associated with achievement of long-term outcomes. OBJECTIVE To evaluate the relationship between psoriasis severity, disease characteristics and achievement of PASI ≤2 with apremilast in a pooled analysis of the phase 3 ESTEEM 1 and 2 (NCT01194219 and NCT01232283), phase 3b LIBERATE (NCT01690299) and phase 4 UNVEIL (NCT02425826) clinical trials. METHODS Pooled data from patients with moderate-to-severe plaque psoriasis randomized to apremilast 30 mg BID were analysed by baseline PASI quartiles (Q1: 2.4-13.1; Q2: 13.2-15.9; Q3: 16.0-20.0; Q4: 20.1-57.8). Assessments included PASI, Dermatology Life Quality Index (DLQI), Scalp Physician's Global Assessment (ScPGA; ScPGA ≥1) and target (worst) Nail Psoriasis Severity Index (NAPSI; NAPSI ≥1). RESULTS Of 1062 patients, 963 had ScPGA ≥1 and 643 had NAPSI ≥1; 771 patients with baseline and Week 32 PASI assessments were included in analyses of Week 32 PASI target achievement. Rates of PASI ≤2 at Week 32 were greater in lower PASI quartiles (Q1: 43.5%; Q2: 31.2%; Q3: 26.8%; Q4: 18.4%). Most patients achieving PASI ≤2 target (83.6%) achieved DLQI ≤5 at Week 32; 59.3% of patients who did not achieve PASI ≤2 target achieved DLQI ≤5. At Week 32, mean improvements in ScPGA and NAPSI were similar with more moderate vs. more severe disease (ScPGA, range: 1.1-1.4; NAPSI, range: 1.6-2.5). In a subgroup analysis, achievement of PASI ≤2 target was higher in the lowest PASI quartile and with disease duration <5 years. CONCLUSIONS Greater achievement of PASI ≤2 was observed in patients with more moderate vs. more severe skin disease. Apremilast may be particularly beneficial in more moderate disease early in the treatment paradigm.
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Affiliation(s)
- K Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Mrowietz
- University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - A Menter
- Baylor University Medical Center, Dallas, TX, USA
| | - C E M Griffiths
- The Dermatology Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - J Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, NJ, USA
| | - B Strober
- Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | - R Shi
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - M Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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