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Silverberg JI, Eichenfield LF, Hebert AA, Simpson EL, Stein Gold L, Bissonnette R, Papp KA, Browning J, Kwong P, Korman NJ, Brown PM, Rubenstein DS, Piscitelli SC, Somerville MC, Tallman AM, Kircik L. Tapinarof Cream 1% Once Daily: Significant Efficacy in the Treatment of Moderate to Severe Atopic Dermatitis in Adults and Children Down to 2 Years of Age in the Pivotal Phase 3 ADORING Trials. J Am Acad Dermatol 2024:S0190-9622(24)00755-2. [PMID: 38777187 DOI: 10.1016/j.jaad.2024.05.023] [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: 02/08/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Tapinarof cream 1% once daily (QD), a topical aryl hydrocarbon receptor agonist, downregulates pro-inflammatory Th2 cytokines, upregulates skin-barrier components, and reduces oxidative stress. OBJECTIVE To assess tapinarof efficacy and safety in adults and children down to 2 years of age with atopic dermatitis (AD). METHODS 813 patients were randomized to tapinarof or vehicle QD in two 8-week phase 3 trials. RESULTS The primary efficacy endpoint, Validated Investigator Global Assessment for Atopic DermatitisTM score of 0 or 1 and ≥2-grade improvement from baseline at Week 8, was met with statistical significance in both trials: 45.4% vs 13.9% and 46.4% vs 18.0% (tapinarof versus vehicle; both P<0.0001). Significantly superior EASI75 responses were also observed with tapinarof versus vehicle at Week 8: 55.8% vs 22.9% and 59.1% vs 21.2% (both P<0.0001). Rapid improvements in patient-reported pruritus were also significant with tapinarof versus vehicle. Common adverse events (≥5%) of folliculitis, headache, and nasopharyngitis were mostly mild or moderate, with lower discontinuations due to adverse events in the tapinarof groups than with vehicle. LIMITATIONS Long-term efficacy was not assessed. CONCLUSION Tapinarof demonstrated highly significant efficacy and favorable safety and tolerability in a diverse population of patients with AD down to 2 years of age.
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Affiliation(s)
- Jonathan I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Adelaide A Hebert
- UTHealth McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | | | | | | | - Kim A Papp
- Probity Medical Research Inc. and Alliance Clinical Trials, Waterloo, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Pearl Kwong
- Solutions through Advanced Research, Jacksonville FL, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | - Leon Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; Indiana University School of Medicine, Indianapolis, IN, USA
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Larson EL, DeMeo DP, Young AB, Margevicius S, Rutter J, Davies AL, Rohan CA, Korman NJ, Travers JB, McCormick TS, Cooper KD. Circulating Monocytes Are Predictive and Responsive in Moderate-to-Severe Plaque Psoriasis Subjects Treated with Apremilast. J Invest Dermatol 2024:S0022-202X(24)00166-0. [PMID: 38431222 DOI: 10.1016/j.jid.2024.01.034] [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: 03/17/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024]
Abstract
Monocytes play a critical role in the inflammation associated with psoriasis, and their abnormalities have been reported as biomarkers of cardiovascular event risk, a psoriasis comorbidity. Monocytic cells in chronic inflammatory disorders express elevated levels of cAMP phosphodiesterase. Restoring cAMP levels using the oral cAMP phosphodiesterase-4 inhibitor, apremilast, improves clinical outcomes for a subset of patients with psoriasis. We asked whether aberrant monocyte subsets or transcriptomic pathways can function as biomarkers of psoriasis endotypes that can predict enhanced clinical responses to cAMP phosphodiesterase inhibition. A 16-week open-label study of 22 patients with monocyte flow cytometric and transcriptomic analysis was performed. Subjects with elevated hyperadhesive monocyte doublets at baseline were more likely to be responders to apremilast (P < .0001); 82% of subjects with elevated hyperadhesive monocyte doublets achieved 50% reduction in PASI compared with 46% in those without elevated doublets. We observed a significant reduction in hyperadhesive monocyte-containing doublets and monocyte-platelet aggregates, suggesting an effect of apremilast on the adhesiveness of blood monocytes during chronic inflammation. Monocyte differentially expressed gene transcripts predictive of clinical response uncovered pharmacoendotypes with distinct patterns of nucleotide metabolism, energetics, and differentiation. Further study to understand the basis of drug responsiveness and to develop an apremilast psoriasis treatment algorithm using monocyte-refined gene expression is required to validate and become practical in clinical use, offering patients a test that personalizes their likelihood of clinical response.
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Affiliation(s)
- Emma L Larson
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Dustin P DeMeo
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Andrew B Young
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Joseph Rutter
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amanda L Davies
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Craig A Rohan
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton Ohio, Ohio, USA
| | - Neil J Korman
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffrey B Travers
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton Ohio, Ohio, USA
| | - Thomas S McCormick
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kevin D Cooper
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Burshtein J, Shah M, Zakria D, Lockshin B, Crowley J, Merola JF, Gordon K, Shahriari M, Korman NJ, Chovatiya R, Kalb R, Lebwohl M. The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel. Dermatol Ther (Heidelb) 2024; 14:323-339. [PMID: 38340237 PMCID: PMC10891030 DOI: 10.1007/s13555-024-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. RESULTS The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of "A", one of which was given a strength of "B", and one of which was given a strength of "C". CONCLUSION Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Milaan Shah
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danny Zakria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Lockshin
- US Dermatology Partners, Rockville, MD, USA
- Department of Dermatology, Georgetown University Medical Center, Washington, DC, USA
| | - Jeff Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Joseph F Merola
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ken Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Robert Kalb
- SUNY at Buffalo School of Medicine and Biomedical Sciences, Department of Dermatology, Buffalo Medical Group, Buffalo, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Taylor S, Korman NJ, Tsai TF, Shimomura Y, Feely M, Dutronc Y, Wu WS, Somani N, Tosti A. Efficacy of Baricitinib in Patients with Various Degrees of Alopecia Areata Severity: Post-Hoc Analysis from BRAVE AA1 and BRAVE AA2. Dermatol Ther (Heidelb) 2023; 13:3181-3191. [PMID: 37740856 PMCID: PMC10689675 DOI: 10.1007/s13555-023-01033-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Baricitinib, an oral selective JAK1/JAK2 inhibitor, is approved for the treatment of adults with severe alopecia areata (AA). OBJECTIVE To evaluate differences in response up to week 52 among subgroups based on the baseline severity of AA assessed with the Severity of Alopecia Tool (SALT) score. METHODS Data were pooled from BRAVE-AA1 and BRAVE-AA2, two randomized, placebo-controlled, phase 3 trials, which enrolled adults with a SALT score ≥ 50. Patients were subdivided by the degree of AA severity at baseline. RESULTS Among the 855 patients treated with baricitinib 2 mg and 4 mg, improvements in scalp hair growth continued through to week 52. A superior response was observed in patients with a SALT score of 50-94 versus a score of 95-100. Patients on baricitinib 4 mg had a faster and higher response rate compared to baricitinib 2 mg. CONCLUSION Across all degrees of severity for baricitinib 2 mg and 4 mg doses, the proportion of patients responding was yet to plateau up to week 52. Response to treatment was longer for patients with a baseline SALT score 95-100. Further studies are needed to analyze other parameters that may impact observed response rates.
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Affiliation(s)
- Susan Taylor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Meghan Feely
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Dermatology, Mount Sinai, New York, NY, USA
| | | | - Wen-Shuo Wu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.
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Daniels P, Liou YL, Scarberry KB, Sharma TR, Korman NJ. Paraneoplastic pemphigus in a patient with a locally invasive, unresectable type B2 thymoma complicated by an intestinal perforation. JAAD Case Rep 2023; 35:103-107. [PMID: 37131866 PMCID: PMC10149147 DOI: 10.1016/j.jdcr.2023.03.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Phuong Daniels
- Department of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
- Correspondence to: Phuong Daniels, DPT.
| | - Yujie Linda Liou
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Kelly B. Scarberry
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Timmie R. Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Neil J. Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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Eley SJ, DeMeo DP, Korman NJ, Carroll BT. Equity in the usage of biologics for psoriasis in the working poor. Arch Dermatol Res 2022; 315:1029-1031. [PMID: 36307556 DOI: 10.1007/s00403-022-02410-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Biologic therapy often produces excellent outcomes for psoriasis; however, their high cost may create a barrier to appropriate usage, especially in the working poor population. This study defines working poor as income below 150% of the federal poverty level and holding or seeking work at least half a year. Our study aims to identify gaps in access to biologic therapy for psoriasis based on working poor status. This retrospective cross-sectional study was conducted utilizing data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2018. Patients were stratified into working poor (57,091), non-working poor (43,421), and non-poor (693,841) groups for analysis. In univariate analysis, WP (4.0%, ph p = 0.003) and NWP (2.8%, ph p = 0.006) were less likely to use biologics than NP (15.8%) (X2 p < 0.001). A binary logistic regression showed that WP vs. NP status (OR 0.27, p = 0.05), female vs. male sex (OR 0.55, p = 0.05), Black vs. White race (OR 0.14, p = 0.02), and Medicare vs. private insurance (OR 0.09, p = 0.03) had lower odds of using biologics. After correcting for age, sex, race, and insurance, WP confers an independent risk factor to lower biologic prescriptions. The high cost of biologics in the setting of financial barriers for some patients should be considered by physicians prescribing biologic therapy for psoriasis.
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7
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Kim EJ, Mangold AR, DeSimone JA, Wong HK, Seminario-Vidal L, Guitart J, Appel J, Geskin L, Lain E, Korman NJ, Zeitouni N, Nikbakht N, Dawes K, Akilov O, Carter J, Shinohara M, Kuzel TM, Piette W, Bhatia N, Musiek A, Pariser D, Kim YH, Elston D, Boh E, Duvic M, Huen A, Pacheco T, Zwerner JP, Lee ST, Girardi M, Querfeld C, Bohjanen K, Olsen E, Wood GS, Rumage A, Donini O, Haulenbeek A, Schaber CJ, Straube R, Pullion C, Rook AH, Poligone B. Efficacy and Safety of Topical Hypericin Photodynamic Therapy for Early-Stage Cutaneous T-Cell Lymphoma (Mycosis Fungoides): The FLASH Phase 3 Randomized Clinical Trial. JAMA Dermatol 2022; 158:1031-1039. [PMID: 35857290 PMCID: PMC9301595 DOI: 10.1001/jamadermatol.2022.2749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Indexed: 11/14/2022]
Abstract
Importance Given that mycosis fungoides-cutaneous T-cell lymphoma (MF/CTCL) is chronic, there is a need for additional therapies with minimal short- and long-term adverse effects. Topical synthetic hypericin ointment, 0.25%, activated with visible light is a novel, nonmutagenic photodynamic therapy (PDT). Objectives To determine the efficacy and safety of topical synthetic hypericin ointment, 0.25%, activated with visible light as a nonmutagenic PDT in early-stage MF/CTCL. Design, Settings, and Participants This was a multicenter, placebo-controlled, double-blinded, phase 3 randomized clinical trial (FLASH study) conducted from December 2015 to November 2020 at 39 academic and community-based US medical centers. Participants were adults (≥18 years) with early-stage (IA-IIA) MF/CTCL. Interventions In cycle 1, patients were randomized 2:1 to receive hypericin or placebo to 3 index lesions twice weekly for 6 weeks. In cycle 2, all patients received the active drug for 6 weeks to index lesions. In cycle 3 (optional), both index and additional lesions received active drug for 6 weeks. Main Outcomes and Measures The primary end point was index lesion response rate (ILRR), defined as 50% or greater improvement in modified Composite Assessment of Index Lesion Severity (mCAILS) score from baseline after 6 weeks of therapy for cycle 1. For cycles 2 and 3, open label response rates were secondary end points. Adverse events (AEs) were assessed at each treatment visit, after each cycle, and then monthly for 6 months. Data analyses were performed on December 21, 2020. Results The study population comprised 169 patients (mean [SD] age, 58.4 [16.0] years; 96 [57.8%] men; 120 [72.3%] White individuals) with early-stage MF/CTCL. After 6 weeks of treatment, hypericin PDT was more effective than placebo (cycle 1 ILRR, 16% vs 4%; P = .04). The ILRR increased to 40% in patients who received 2 cycles of hypericin PDT (P < .001 vs cycle 1 hypericin) and to 49% after 3 cycles (P < .001 vs cycle 1 hypericin). Significant clinical responses were observed in both patch and plaque type lesions and were similar regardless of age, sex, race, stage IA vs IB, time since diagnosis, and number of prior therapies. The most common treatment-related AEs were mild local skin (13.5%-17.3% across cycles 1-3 vs 10.5% for placebo in cycle 1) and application-site reactions (3.2%-6.9% across cycles 1-3 vs 4% for placebo in cycle 1). No drug-related serious AEs occurred. Conclusion and Relevance The findings of this randomized clinical trial indicate that synthetic hypericin PDT is effective in early-stage patch and plaque MF/CTCL and has a favorable safety profile. Trial Registration ClinicalTrials.gov Identifier: NCT02448381.
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Affiliation(s)
- Ellen J. Kim
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | | | - Henry K. Wong
- University of Arkansas for Medical Sciences, Little Rock
| | | | - Joan Guitart
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - James Appel
- PMG Research of Wilmington, Wilmington, North Carolina
- Campbell University−Sampson Regional Medical Center, Buies Creek, North Carolina
| | - Larisa Geskin
- Columbia University Medical Center, New York, New York
| | - Edward Lain
- Austin Institute for Clinical Research, Pflugerville, Texas
| | - Neil J. Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kenneth Dawes
- Dawes Fretzin Dermatology Group, Indianapolis, Indiana
| | - Oleg Akilov
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joi Carter
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Michi Shinohara
- University of Washington−Seattle Cancer Care Alliance, Seattle
| | | | | | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, California
| | - Amy Musiek
- Washington University School of Medicine, St Louis, Missouri
| | | | - Youn H. Kim
- Stanford University School of Medicine, Stanford, California
| | - Dirk Elston
- Medical University of South Carolina, Charleston
| | - Erin Boh
- Tulane University, New Orleans, Louisiana
| | | | - Auris Huen
- University of Texas−MD Anderson Cancer Center, Houston
| | | | | | - Seung Tae Lee
- University of Maryland Comprehensive Cancer Center, Baltimore
| | | | | | | | - Elise Olsen
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | | | | | - Alain H. Rook
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Brian Poligone
- Rochester Skin Lymphoma Medical Group, Fairport, New York
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Guignant M, Tedbirt B, Murrell DF, Amagai M, Aoki V, Bauer J, Ciancinni G, Culton D, Daneshpazhooh M, De D, Fairley J, Hall R, Kim SC, Korman NJ, Kowalewski C, Mimouni D, Patsatsi A, Hebert V, Saleh MAM, Schmidt E, Sprecher E, Uzun S, Venning V, Werth VP, Zillikens D, Joly P. How Do Experts Treat Patients with Bullous Pemphigoid around the World? An International Survey. JID Innov 2022; 2:100129. [PMID: 35860447 PMCID: PMC9289845 DOI: 10.1016/j.xjidi.2022.100129] [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: 11/01/2021] [Revised: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022] Open
Abstract
Many treatments are currently proposed for treating patients with bullous pemphigoid (BP). We assessed treatment modalities of BP depending on the different countries, BP extent, and patients' comorbidities. We surveyed worldwide experts about how they treat patients with BP. A total of 61 experts from 27 countries completed the survey. Severe and moderate BP were treated with oral prednisone (61.4 and 53.7%, respectively) or superpotent topical corticosteroids (CSs) (38.6 and 46.3%, respectively). Conventional immunosuppressants were more frequently combined with oral prednisone (74.5%) than with superpotent topical CS (37.5%) in severe BP. Topical CSs were mainly used in Europe in mild (81.1%), moderate (55.3%), and severe (54.3%) BP. In the United States of America and Asia, systemic CSs were mainly proposed for treating severe (77.8 and 100%, respectively), moderate (70 and 77.8%, respectively), and also mild (47.1 and 33.3%, respectively) BP. Most experts reduced the initial dose of oral CS in patients with diabetes mellitus (48.1%) or cardiac insufficiency (40.2%) but rarely changed BP treatment in patients with neurological disorders or neoplasia. This survey showed major differences in the way patients with BP are treated between AmeriPac countries (United State of America, Latin America, and Australia) and Asia on the one hand and Europe and the Middle East on the other hand.
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Affiliation(s)
- Marine Guignant
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandie University, Rouen, France
| | - Billal Tedbirt
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandie University, Rouen, France
| | - Dedee F. Murrell
- Department of Dermatology, St George Hospital, University of New South Wales Sydney, Kensington, Australia
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Valeria Aoki
- Department of Dermatology and Allergology, University of Sao Paulo, Sao Paulo, Brazil
| | - Johannes Bauer
- Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Donna Culton
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maryam Daneshpazhooh
- Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Janet Fairley
- Department of Dermatology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Iowa City, Iowa, USA
| | - Russell Hall
- Duke Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Seoul, South Korea
| | - Neil J. Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Daniel Mimouni
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aikaterini Patsatsi
- Department of Dermatology, "Papageorgiou" General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vivien Hebert
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandie University, Rouen, France
| | | | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- The Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Soner Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Vanessa Venning
- Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
| | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandie University, Rouen, France
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9
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Harris KM, Smilek DE, Byron M, Lim N, Barry WT, McNamara J, Garcet S, Konrad RJ, Stengelin M, Bathala P, Korman NJ, Feldman SR, Boh EE, Barber K, Laumann AE, Helfrich YR, Krueger GG, Sofen H, Bissonnette R, Krueger JG. Effect of Costimulatory Blockade With Abatacept After Ustekinumab Withdrawal in Patients With Moderate to Severe Plaque Psoriasis: The PAUSE Randomized Clinical Trial. JAMA Dermatol 2021; 157:1306-1315. [PMID: 34643650 PMCID: PMC8515260 DOI: 10.1001/jamadermatol.2021.3492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Question Does blockade of CD28/B7 costimulatory signaling with abatacept suppress the psoriasis molecular signature and prevent psoriasis relapse after ustekinumab withdrawal? Findings In this parallel-design, double-blind randomized clinical trial of 91 adults with moderate to severe plaque psoriasis, costimulatory blockade with abatacept did not prevent psoriasis relapse and did not maintain suppression of the pathogenic psoriasis molecular signature following ustekinumab withdrawal. Meaning In this study, abatacept did not prevent psoriasis relapse, which may rely on alternative, compensatory mechanisms of residual T-cell activation in skin. Importance Psoriasis relapse may involve compensatory T-cell activation pathways in the presence of CD28-CD80/CD86 blockade with abatacept. Objective To determine whether costimulatory signaling blockade with abatacept prevents psoriasis relapse after ustekinumab withdrawal. Design, Setting, and Participants Psoriasis Treatment with Abatacept and Ustekinumab: a Study of Efficacy (PAUSE), a parallel-design, double-blind, placebo-controlled randomized clinical trial, was conducted at 10 sites in the US and Canada. Participant enrollment opened on March 19, 2014, and concluded on April 11, 2016. Participants were adults with moderate to severe plaque psoriasis and received ustekinumab in a lead-in phase. Those who responded to ustekinumab at week 12 were randomized 1:1 to either the continued with ustekinumab group (ustekinumab group) or the switched to abatacept group (abatacept group). Treatment was discontinued at week 39, and participants were followed up for psoriasis relapse until week 88. Statistical analyses were performed in the intention-to-treat (ITT) and safety samples from May 3, 2018, to July 6, 2021. Interventions Participants received subcutaneous ustekinumab at weeks 0 and 4 (45 mg per dose for those ≤100 kg; 90 mg per dose for those >100 kg). Participants randomized to the abatacept group at week 12 received subcutaneous abatacept, 125 mg weekly, from weeks 12 to 39 and ustekinumab placebo at weeks 16 and 28. Participants randomized to the ustekinumab group received ustekinumab at weeks 16 and 28 and abatacept placebo weekly from weeks 12 to 39. Main Outcomes and Measures The primary end point was the proportion of participants with psoriasis relapse (loss of ≥50% of the initial Psoriasis Area and Severity Index improvement) between weeks 12 and 88. Secondary end points included time to psoriasis relapse, proportion of participants with psoriasis relapse between weeks 12 and 40, and adverse events. The psoriasis transcriptome and serum cytokines were evaluated. Results A total of 108 participants (mean [SD] age, 46.1 [12.1] years; 73 [67.6%] men) were treated with open-label ustekinumab; 91 were randomized to blinded treatment. Similar proportions of participants in the abatacept group and the ustekinumab group relapsed between weeks 12 and 88 (41 of 45 [91.1%] vs 40 of 46 [87.0%]; P = .41). Median time to relapse from the last dose of ustekinumab was similar between groups as well: 36 weeks (95% CI, 36-48 weeks) in the abatacept group vs 32 weeks (95% CI, 28-40 weeks) in the ustekinumab group. Similar numbers and rates of adverse events occurred. Abatacept did not maintain suppression of the pathogenic IL-23-mediated psoriasis molecular signature in lesions after ustekinumab withdrawal, and serum IL-19 levels increased. Conclusions and Relevance This parallel-design, double-blind randomized clinical trial found that abatacept did not prevent psoriasis relapse that occurred after ustekinumab withdrawal because it did not completely block the pathogenic psoriasis molecular pathways that led to relapse. Trial Registration ClinicalTrials.gov Identifier: NCT01999868
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Affiliation(s)
- Kristina M Harris
- Biomarker and Discovery Research, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | - Dawn E Smilek
- Clinical Trials Group, Clinical and Translational Medicine, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | | | - Noha Lim
- Biomarker and Discovery Research, Immune Tolerance Network, University of California, San Francisco, San Francisco
| | | | - James McNamara
- Autoimmunity and Mucosal Immunology Branch, Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | | | - Robert J Konrad
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Neil J Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin E Boh
- Health Sciences Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kirk Barber
- Department of Medicine (Dermatology), University of Calgary, Calgary, Alberta, Canada
| | - Anne E Laumann
- Department of Dermatology, Northwestern University, Colorado Springs, Colorado
| | | | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Howard Sofen
- Dermatology, David Geffen UCLA (University of California, Los Angeles) School of Medicine, Los Angeles
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10
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Tedbirt B, Gillibert A, Andrieu E, Hébert V, Bastos S, Korman NJ, Tang MBY, Li J, Borradori L, Cortés B, Kim SC, Gual A, Xiao T, Wieland CN, Fairley JA, Ezzedine K, Joly P. Mixed Individual-Aggregate Data on All-Cause Mortality in Bullous Pemphigoid: A Meta-analysis. JAMA Dermatol 2021; 157:421-430. [PMID: 33729430 DOI: 10.1001/jamadermatol.2020.5598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The 1-year standardized mortality ratio (SMR) of bullous pemphigoid (BP) has been reported as 2.15 to 7.56 and lower in the US than in Europe. Objective To estimate the worldwide 1-year SMR of BP. Data Sources PubMed, Embase, Cochrane Library, Google Scholar, Lissa, and gray literature (eg, medRxiv) were screened for studies of BP published from inception to June 10, 2020, with review of reference lists. Study Selection Retrospective and prospective studies reporting 1-year all-cause mortality rate in patients with BP and providing age statistics (eg, mean [SD]). Data Extraction and Synthesis Two reviewers independently extracted the data. The 1-year SMR was computed in studies reporting 1-year mortality by combining information on age obtained from studies with aggregate data and individual data. Risk of representativity, misclassification, and attrition bias were assessed by a custom tool. Main Outcomes and Measures The primary end point was the worldwide 1-year SMR. Secondary analysis included comparison of 1-year SMRs between continents in a meta-regression. Results Three studies were performed in the US (n = 260), 1 in South America (n = 45), 16 in Asia (n = 1903), and 36 in Europe (n = 10 132) for a total of 56 unique studies and 12 340 unique patients included in the meta-analysis (mean [SD] age, 77.3 [12.7] years; 55.9% women). The mean (SD) patient age in the United States was 75.6 (13.7) years; in Asia, 73.8 (13.6) years; and in Europe, 78.1 (12.3) years. The worldwide 1-year SMR was estimated at 2.93 (95% CI, 2.59-3.28; I2 = 85.6%) for all 56 studies. The 1-year SMR in the US was 2.40 (95% CI, 0.89-3.90; I2 = 86.3%) for 3 studies; in Asia, 3.53 (95% CI, 2.85-4.20; I2 = 86.3%) for 16 studies; and in Europe, 2.77 (95% CI, 2.35-3.19; I2 = 86.3%) for 36 studies. After adjustment on the expected 1-year mortality rate, the European 1-year SMR did not differ significantly from the 1-year SMR in the United States (-0.48 vs Europe; 95% CI, -2.09 to 1.14; P = .56) and Asia (0.51 vs Europe; 95% CI, -0.56 to 1.58; P = .35). Risk of attrition bias was high (>10% censorship) in 16 studies (28.6%), low in 16 (28.6%), and unclear in 24 (42.9%). Only 4 studies (7.1%) had a sampling method guaranteeing the representativity of BP cases in a population. Conclusions and Relevance Although heterogeneity was high and overall quality of follow-up was poor, this meta-analysis confirms the high mortality rate among patients with BP.
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Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, Centre Hospitalier Universitaire Rouen, Rouen, France.,Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Auto-immunes, Normandie University, Rouen, France
| | - André Gillibert
- Department of Biostatistics, Centre Hospitalier Universitaire Rouen, Normandie University, Rouen, France
| | - Emilie Andrieu
- Department of Dermatology, Centre Hospitalier Universitaire Rouen, Rouen, France.,Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Auto-immunes, Normandie University, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, Centre Hospitalier Universitaire Rouen, Rouen, France.,Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Auto-immunes, Normandie University, Rouen, France
| | - Sarah Bastos
- Department of Dermatology, Centre Hospitalier Universitaire Rouen, Rouen, France.,Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Auto-immunes, Normandie University, Rouen, France
| | - Neil J Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark B Y Tang
- Department of Dermatology, National Skin Centre, Singapore
| | - Jun Li
- Department of Dermatology, Pekin Union Medical College Hospital, Beijing, China
| | - Luca Borradori
- Department of Dermatology, Bern University Hospital, Geneva, Switzerland
| | - Begonia Cortés
- Department of Dermatology, Geneva University Hospital, Geneva, Switzerland
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Seoul, South Korea
| | - Adrià Gual
- Department of Dermatology, University of Barcelona, Barcelona, Spain
| | - Ting Xiao
- Department of Dermatology, Hospital of China Medical University, Shenyang, China.,Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | | | | | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor, University Hospital, Créteil, Rouen, France
| | - Pascal Joly
- Department of Dermatology, Centre Hospitalier Universitaire Rouen, Rouen, France.,Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Auto-immunes, Normandie University, Rouen, France
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11
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Tripathi R, Korman NJ, Ezaldein HH. Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa. J Am Acad Dermatol 2021; 86:1362-1365. [PMID: 34051317 DOI: 10.1016/j.jaad.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Neil J Korman
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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12
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Ständer S, Weisshaar E, Berger TG, Korman NJ, Yosipovitch G. 16257 Prevalence of prurigo nodularis in the United States. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.784] [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: 11/27/2022]
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13
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Crowley J, Korman NJ, Spelman L, Igarashi A, Gupta AK, Mendelsohn AM, Rozzo SJ, Eads KM, Guenthner ST. 15904 Efficacy and safety of long-term tildrakizumab for plaque psoriasis: 4-year results from reSURFACE 1. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Ständer S, Augustin M, Berger T, Elmariah S, Korman NJ, Weisshaar E, Yosipovitch G. Prevalence of prurigo nodularis in the United States of America: A retrospective database analysis. JAAD Int 2020; 2:28-30. [PMID: 34409350 PMCID: PMC8362303 DOI: 10.1016/j.jdin.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Berger
- Dermatology Clinic, University of California San Francisco Medical Center, San Francisco, California
| | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Gil Yosipovitch
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, Florida
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15
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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16
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Korman NJ, Malatestinic W, Goldblum OM, Murage MJ, Renda L, Lin CY, Lucas J, Middleton C, Lobosco S. Assessment of the benefit of achieving complete versus almost complete skin clearance in psoriasis: a patient's perspective. J DERMATOL TREAT 2020; 33:733-739. [PMID: 32432957 DOI: 10.1080/09546634.2020.1772454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/28/2023]
Abstract
Background: Psoriasis is characterized by thick and scaly plaques. The Dermatology Life Quality Index (DLQI) and Physician Global Assessment (PGA) can be used to define its severity.Objective: To assess the impact of complete clearance of skin versus almost clear skin across various disease measures.Methods: Data were collected in a survey of US dermatologists and patients with psoriasis from November 2016-January 2017. Dermatologists completed a 6-point PGA (0 = clear skin, 1 = almost clear skin). Patients completed the DLQI and Work Productivity and Activity Impairment questionnaire (WPAI). Patients with clear and almost clear skin were compared using analysis of covariance for continuous variables, and multivariate logistic regression analysis for categorical variables.Results: Data for 99 and 160 patients with clear and almost clear skin, respectively, were included in the analyses. Patients with clear skin reported less frequent and lower intensity itching, lower total DLQI score (indicating better health-related quality of life), and less impairment of overall work productivity than patients with almost clear skin (all: p < 0.05).Limitations: Limitations relating to general survey methodology.Conclusion: Patients perceived a meaningful difference between clear and almost clear skin. Clear skin is now a realistic treatment target with newer biologics approved in psoriasis.
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Affiliation(s)
- Neil J Korman
- University Hospitals Case Medical Center, Cleveland, OH, USA
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17
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Gordon KB, Reich K, Crowley JJ, Korman NJ, Murphy FT, Poulin Y, Spelman L, Yamauchi PS, Mendelsohn AM, Parno J, Rozzo SJ, Ellis CN. Disease activity and treatment efficacy using patient-level Psoriasis Area and Severity Index scores from tildrakizumab phase 3 clinical trials. J DERMATOL TREAT 2020; 33:219-228. [PMID: 32349565 DOI: 10.1080/09546634.2020.1747590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is unclear whether primary efficacy outcomes in plaque psoriasis clinical trials represent residual disease during treatment. OBJECTIVES To evaluate supplementing dichotomous efficacy with residual disease activity. METHODS This post hoc analysis used pooled, patient-level data after tildrakizumab 100 mg (N = 616) or placebo (N = 309) treatment from reSURFACE 1/2 (NCT01722331/NCT01729754) phase 3 clinical trials of patients with moderate to severe plaque psoriasis. RESULTS Median baseline Psoriasis Area and Severity Index (PASI) was 17.9 for patients receiving tildrakizumab 100 mg. At Week 12, median PASI was 2.9, whereas dichotomous PASI 90 response rate was 36.9%, and absolute PASI <5.0, <3.0, and <1.0 were 64.0%, 50.8%, and 23.3%, respectively. At Week 28, median PASI was 1.7, whereas PASI 90 response rate was 51.9%, and absolute PASI <5.0, <3.0, and <1.0 were 75.3%, 62.8%, and 38.0%, respectively. Dermatology Life Quality Index and PASI scores were correlated through Week 28 (r = 0.51, p ≤ .0001). CONCLUSIONS Disease activity was more reliably estimated by PASI scores than percentage PASI improvement; this may partially explain efficacy disparities between clinical trials and practice. These results suggest supplementing dichotomous PASI improvement with PASI scores and consideration of patient treatment goals could facilitate clinical decisions.
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Affiliation(s)
- K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf and Skinflammation®, Hamburg, Germany
| | - J J Crowley
- Bakersfield Dermatology, Bakersfield, CA, USA
| | - N J Korman
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - F T Murphy
- Altoona Arthritis and Osteoporosis Center, Duncansville, PA, USA.,Villanova University, Villanova, PA, USA
| | - Y Poulin
- Centre Hospitalier de l'Université Laval, Hôpital Hôtel-Dieu de Québec, Québec City, QC, Canada.,Centre de Recherche Dermatologique du Québec Métropolitain, Québec City, QC, Canada
| | - L Spelman
- Veracity Clinical Research, Brisbane, QLD, Australia.,Probity Medical Research, Waterloo, ON, Canada
| | - P S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - J Parno
- Sun Pharmaceutical Industries, Inc, Princeton, NJ, USA
| | - S J Rozzo
- Sun Pharmaceutical Industries, Inc, Princeton, NJ, USA
| | - C N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
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18
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Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Prater EF, Rahimi RS, Rupani RN, Siegel M, Stoff B, Strober BE, Tapper EB, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol 2020; 82:1445-1486. [PMID: 32119894 DOI: 10.1016/j.jaad.2020.02.044] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).
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Affiliation(s)
| | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Diego, California
| | | | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- Central Connecticut Dermatology, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Elliot B Tapper
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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19
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Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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20
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Abstract
Background Psoriasis is a chronic, systemic immune‐mediated disease characterized by development of erythematous, indurated, scaly, pruritic and often painful skin plaques. Psoriasis pathogenesis is driven by proinflammatory cytokines and psoriasis is associated with increased risk for comorbidities, including, but not limited to, psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease and nonalcoholic fatty liver disease compared with the general population. Objectives To explore the pathophysiological relationship between psoriasis and its common comorbidities and discuss the need for new treatment paradigms that include strategies to reduce systemic inflammation in patients with moderate‐to‐severe psoriasis. Methods This narrative review summarizes the published evidence related to the ability of biological therapies to ameliorate the consequences of systemic inflammation in patients with psoriasis. Results Current evidence suggests that preventing damage associated with inflammation, and preventing development of future inflammatory damage and comorbidities, may be a potentially achievable treatment goal for many patients with moderate‐to‐severe plaque psoriasis when biological therapies are utilized early in the disease. Encouraging data from recent studies suggest that the loftier goal of reversing existing inflammatory damage and improving signs and symptoms of inflammatory comorbidities could also possibly be attainable. Conclusions Results from ongoing prospective studies regarding the effects of biologics on markers of systemic inflammation in patients with psoriasis will strengthen the clinical evidence base that can be used to inform treatment decisions for patients with moderate‐to‐severe psoriasis. What's already known about this topic? Psoriasis is a systemic inflammatory disease and treatments are needed to optimize patient outcomes.
What does this study add? This review discusses new psoriasis treatment paradigms that may potentially reduce effects of systemic inflammation. Evidence demonstrating that biological treatment may prevent or reverse inflammatory damage associated with psoriasis comorbidities is reviewed.
Linked Comment:https://doi.org/10.1111/bjd.18456
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Affiliation(s)
- N J Korman
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, U.S.A.,University Hospitals Cleveland Medical Center, Cleveland, OH, U.S.A
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21
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Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M, Armstrong AW, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Leonardi CL, Lichten J, Mehta NN, Paller AS, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol 2019; 81:775-804. [PMID: 31351884 DOI: 10.1016/j.jaad.2019.04.042] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/12/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
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Affiliation(s)
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probidity Medical Research, Waterloo, Ontario, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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22
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 438] [Impact Index Per Article: 87.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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23
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [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: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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24
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Lee J, Werth VP, Hall RP, Eming R, Fairley JA, Fajgenbaum DC, Harman KE, Jonkman MF, Korman NJ, Ludwig RJ, Murrell DF, Musette P, Naik HB, Sadik CD, Yamagami J, Yale ML, Payne AS. Perspective From the 5th International Pemphigus and Pemphigoid Foundation Scientific Conference. Front Med (Lausanne) 2018; 5:306. [PMID: 30467542 PMCID: PMC6236000 DOI: 10.3389/fmed.2018.00306] [Citation(s) in RCA: 18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022] Open
Abstract
The 5th Scientific Conference of the International Pemphigus and Pemphigoid Foundation (IPPF), “Pemphigus and Pemphigoid: A New Era of Clinical and Translational Science” was held in Orlando, Florida, on May 15–16, 2018. Scientific sessions covered recent, ongoing, and future clinical trials in pemphigus and bullous pemphigoid, disease activity and quality of life instruments, and the IPPF Natural History Study. Furthermore, the meeting provided an opportunity to hear firsthand from patients, investigators, and industry about their experience enrolling for clinical trials.
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Affiliation(s)
- Jinmin Lee
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
| | - Russell P Hall
- Department of Dermatology, Duke University, Durham, NC, United States
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Janet A Fairley
- Department of Dermatology, University of Iowa, Iowa City, IA, United States
| | - David C Fajgenbaum
- Orphan Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen E Harman
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Marcel F Jonkman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Neil J Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Ralf J Ludwig
- Department of Dermatology, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Dedee F Murrell
- Department of Dermatology, University of New South Wales, Sydney, NSW, Australia
| | - Philippe Musette
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Haley B Naik
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Jun Yamagami
- Department of Dermatology, Keio University, Tokyo, Japan
| | - Marc L Yale
- International Pemphigus and Pemphigoid Foundation, Sacramento, CA, United States
| | - Aimee S Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
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25
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Oki Y, Haverkos B, Zain JM, Lechowicz MJ, Devata S, Korman NJ, Ramchandren R, Pinter-Brown LC, Barde PJ, Nair A, Huen A. Tenalisib, a dual PI3K δ/γ inhibitor: Safety and efficacy results from an on-going phase I/Ib study in relapsed/refractory T-cell lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yasuhiro Oki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Ajit Nair
- Rhizen Pharmceuticals SA, La Chaux-De-Fonds,, SC, Switzerland
| | - Auris Huen
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center,, Houston, TX
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26
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Abstract
Biologics are offering new hope for patients with moderate to severe chronic plaque psoriasis and psoriatic arthritis, and every day more dermatologists are prescribing these medications for their patients. Prior to prescribing a biologic it is important to conduct the proper screening to determine if your patient is an appropriate candidate. While patients are being treated with biologics they need to be monitored carefully to maximize the benefit of the agent and minimize harmful side effects. Apart from the recommendations and requirements of the U.S. Food and Drug Administration (FDA), there are as yet no consensus statements or guidelines addressing the appropriate approach to initiating and monitoring patients being treated with biologics. In this article we will discuss our own approach to initiating and monitoring that we believe is appropriate for patients being treated with biologics. Our recommendations, which in many ways go beyond the recommendations and requirements of the FDA, should not be interpreted as the standard of care.
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Affiliation(s)
- Shannon B. Routhouska
- Clinical Research Fellow Department of Dermatology Case Western Reserve University University Hospitals of Cleveland
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27
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Papp KA, Leonardi CL, Blauvelt A, Reich K, Korman NJ, Ohtsuki M, Paul C, Ball S, Cameron GS, Erickson J, Zhang L, Mallbris L, Griffiths CEM. Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3). Br J Dermatol 2018; 178:674-681. [PMID: 28991370 DOI: 10.1111/bjd.16050] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, is approved for the treatment of moderate-to-severe psoriasis. OBJECTIVES This analysis represents an overview of the efficacy outcomes from three phase III psoriasis studies. METHODS Data were integrated from the 12-week induction period of three studies in which patients received ixekizumab 80 mg every 2 weeks (IXE Q2W; n = 1169) or every 4 weeks (IXE Q4W; n = 1165) after an initial 160-mg dose for both; etanercept (50 mg biweekly; n = 740; two studies) or placebo (n = 792). The coprimary end points were the percentages of patients with response of static Physician's Global Assessment (sPGA; score 0 or 1) and ≥ 75% improvement in baseline Psoriasis Area and Severity Index (PASI 75) at week 12. Response rates were compared between treatments using the Cochran-Mantel-Haenszel test stratified by study. Treatment comparisons with placebo included data from three studies, whereas etanercept comparisons were based on two studies. RESULTS Ixekizumab treatment was superior to placebo (P < 0·001) and etanercept (P < 0·001) on sPGA (0, 1) and PASI 75, with significant differences in PASI improvement at week 1. With IXE Q2W, at week 12, the frequencies of patients achieving PASI 75, 90 and 100 were nearly 90%, 70% and 40%, respectively. Ixekizumab-treated patients showed significantly greater improvement vs. placebo and etanercept in percentage body surface area involvement and fingernail psoriasis. IXE Q2W was superior to IXE Q4W on all treatment outcomes. CONCLUSIONS Ixekizumab therapy at both dosing regimens demonstrated rapid onset and superior efficacy to placebo and etanercept, with IXE Q2W providing better outcomes than IXE Q4W during the first 12 weeks of treatment.
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Affiliation(s)
- K A Papp
- K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
| | | | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - K Reich
- Dermatologikum Hamburg and SCIderm GmbH, Hamburg, Germany
| | - N J Korman
- Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A
| | - M Ohtsuki
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - C Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - S Ball
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - G S Cameron
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - J Erickson
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Zhang
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Mallbris
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
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28
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Murrell DF, Peña S, Joly P, Marinovic B, Hashimoto T, Diaz LA, Sinha AA, Payne AS, Daneshpazhooh M, Eming R, Jonkman MF, Mimouni D, Borradori L, Kim SC, Yamagami J, Lehman JS, Saleh MA, Culton DA, Czernik A, Zone JJ, Fivenson D, Ujiie H, Wozniak K, Akman-Karakaş A, Bernard P, Korman NJ, Caux F, Drenovska K, Prost-Squarcioni C, Vassileva S, Feldman RJ, Cardones AR, Bauer J, Ioannides D, Jedlickova H, Palisson F, Patsatsi A, Uzun S, Yayli S, Zillikens D, Amagai M, Hertl M, Schmidt E, Aoki V, Grando SA, Shimizu H, Baum S, Cianchini G, Feliciani C, Iranzo P, Mascaró JM, Kowalewski C, Hall R, Groves R, Harman KE, Marinkovich MP, Maverakis E, Werth VP. Diagnosis and management of pemphigus: Recommendations of an international panel of experts. J Am Acad Dermatol 2018; 82:575-585.e1. [PMID: 29438767 DOI: 10.1016/j.jaad.2018.02.021] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 01/18/2018] [Accepted: 02/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management. OBJECTIVE We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations. METHODS A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus. RESULTS The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion. LIMITATIONS Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.
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Affiliation(s)
- Dedee F Murrell
- Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, Australia.
| | - Sandra Peña
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Branka Marinovic
- Department of Dermatology and Venereology, Zagreb University Hospital Center and School of Medicine, Zagreb, Croatia
| | - Takashi Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Luis A Diaz
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Animesh A Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Aimee S Payne
- Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maryam Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rüdiger Eming
- Department of Dermatology and Allergology, University Hospital, Philipps-Universität Marburg, Marburg, Germany
| | - Marcel F Jonkman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniel Mimouni
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luca Borradori
- Department of Dermatology, University Hospital of Bern, Bern, Switzerland
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Donna A Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Annette Czernik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John J Zone
- Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David Fivenson
- St. Joseph Mercy Health System, Department of Dermatology, Ann Arbor, Michigan
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Katarzyna Wozniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ayşe Akman-Karakaş
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Philippe Bernard
- Department of Dermatology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| | - Neil J Korman
- Department of Dermatology and the Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Frédéric Caux
- Department of Dermatology, Avicenne Hospital, University Paris 13, Bobigny, France
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical Faculty, University of Medicine, Sofia, Bulgaria
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Department of Histology, Reference Center for Autoimmune Bullous Diseases, Avicenne Hospital, University Paris 13, Bobigny, France
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical Faculty, University of Medicine, Sofia, Bulgaria
| | - Ron J Feldman
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Johann Bauer
- Division of Molecular Dermatology, Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Hana Jedlickova
- Department of Dermatovenereology, St. Anna University Hospital, Masaryk University, Brno, Czech Republic
| | | | - Aikaterini Patsatsi
- Second Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Soner Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Savas Yayli
- Dermatology Department, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Detlef Zillikens
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Michael Hertl
- Department of Dermatology, University Hospital, Marburg, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - Valeria Aoki
- Departamento de Dermatologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergei A Grando
- Department of Dermatology, University of California, Irvine, California; Department of Biological Chemistry Cancer Center, University of California, Irvine, California; Research Institute, Institute for Immunology, University of California, Irvine, California
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sharon Baum
- Sheba Medical Center, Dermatology Department, Tel-Hashomer, Ramat-Gan, Israel
| | - Guiseppe Cianchini
- Department of Immunodermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy; Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | | | - Pilar Iranzo
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jose M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Russell Hall
- Dermatology, Duke University Medical Center, Durham
| | - Richard Groves
- St. John's Institute of Dermatology, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - Karen E Harman
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - M Peter Marinkovich
- Department of Dermatology, Stanford University School of Medicine, Stanford, California; Center for Clinical Sciences Research, Palo Alto, California; Division of Dermatology, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California, Davis, California
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Puig L, Augustin M, Blauvelt A, Gottlieb AB, Vender R, Korman NJ, Thaçi D, Zhao Y, Gilloteau I, Sherif B, Williams N, Guana A, Lebwohl MG. Effect of secukinumab on quality of life and psoriasis-related symptoms: A comparative analysis versus ustekinumab from the CLEAR 52-week study. J Am Acad Dermatol 2017; 78:741-748. [PMID: 29066271 DOI: 10.1016/j.jaad.2017.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 03/06/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Secukinumab has demonstrated greater sustained skin clearance than ustekinumab through week 52, greater improvement in symptoms and health-related quality of life, and comparable safety profile. OBJECTIVE To assess the impact of secukinumab versus that of ustekinumab on complete relief from psoriasis-related symptoms, time to response in terms of health-related quality of life, and cumulative benefit among patients with moderate-to-severe plaque psoriasis. METHODS Psoriasis-related pain, itching, and scaling and the Dermatology Life Quality Index (DLQI) score were compared between treatments on the basis of time to complete relief of symptoms and time to DLQI response in the CLEAR trial. Cumulative benefit over 52 weeks based on Psoriasis Area and Severity Index score, symptom relief, and DLQI response were evaluated by area under the curve analysis. RESULTS Significantly more patients treated with secukinumab achieved complete relief of pain at weeks 16 and 52 (all P < .05). Complete relief of itching and scaling occurred significantly faster with secukinumab (median, 4 weeks faster for itching and 8 weeks faster for scaling [P < .001]). Response as measured by the DLQI was 4 weeks faster with secukinumab (P < .0001). Cumulative benefits were greater with secukinumab (all P < .05). LIMITATIONS Analyses were post hoc. CONCLUSION This patient-reported outcome analysis confirms greater and sustained benefits of secukinumab versus those of ustekinumab treatment on patients' lives.
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Affiliation(s)
- Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Alice B Gottlieb
- New York Medical College at Metropolitan Hospital, New York, New York
| | - Ron Vender
- Dermatrials Research Inc., Hamilton, Ontario, Canada
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Yang Zhao
- formerly with Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Bintu Sherif
- RTI Health Solutions, Research Triangle Park, North Carolina.
| | - Nicole Williams
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Adriana Guana
- formerly with Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
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Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD, Callis Duffin K, Eichenfield LF, Garg A, Gelfand JM, Gottlieb AB, Koo JY, Korman NJ, Krueger GG, Lebwohl MG, Leonardi CL, Mandelin AM, Menter MA, Merola JF, Pariser DM, Prussick RB, Ryan C, Shah KN, Weinberg JM, Williams MO, Wu JJ, Yamauchi PS, Van Voorhees AS. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol 2017; 76:290-298. [DOI: 10.1016/j.jaad.2016.10.017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 02/03/2023]
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Korman NJ, Sofen H, Fretzin S, Rich P, Zhao Y, Herrera V, Nyirady J, Williams N, Mordin M, Tyring S. Secukinumab provides better relief from the impact of psoriasis on daily activities and personal relationships than etanercept: results of two phase 3 placebo-controlled randomized clinical trials in moderate-to-severe psoriasis. J DERMATOL TREAT 2016; 28:384-389. [PMID: 27832717 DOI: 10.1080/09546634.2016.1255306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/14/2022]
Abstract
BACKGROUND Psoriasis can greatly impact patients' lives, influencing what clothing they wear and impairing their sexual functioning. OBJECTIVE To provide a detailed comparison of the impact of secukinumab vs. etanercept on enabling patients with psoriasis to have more normal lives with respect to daily activities (DA) (e.g. choosing clothing) and personal relationships (PR) (e.g. sexual functioning). METHODS Baseline to Week 52 ERASURE and FIXTURE data for secukinumab 300 mg and etanercept were analyzed. Treatment differences in mean scores on the DA and PR subscales and items from the Dermatology Life Quality Index were compared. The proportions of subscale and item responders (score = 0) were compared. RESULTS Subjects receiving secukinumab (n = 572) achieved greater mean improvement in DA and items (q3 and q4) than subjects receiving etanercept (n = 326; all p < .01 through Week 52). Subjects receiving secukinumab achieved greater mean improvement in PR and items (q8 and q9) than subjects receiving etanercept (subscale: p < .05 at Weeks 8 and 12). Response rates were significantly higher for secukinumab than for etanercept for DA (all p < .0001) and PR (all p < .05 except Weeks 4 and 36). CONCLUSIONS Secukinumab 300 mg provides greater improvements and more effective relief from psoriasis impact on DA and PR than etanercept.
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Affiliation(s)
- Neil J Korman
- a University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - Howard Sofen
- b Department of Medicine/Dermatology , University of California at Los Angeles , Los Angeles , CA , USA
| | - Scott Fretzin
- c Dawes Fretzin Dermatology Group , Indianapolis , IN , USA
| | - Phoebe Rich
- d Oregon Dermatology and Research Center , Portland , OR , USA
| | - Yang Zhao
- e Novartis Pharmaceuticals Corporation , One Health Plaza , East Hanover , NJ , USA
| | - Vivian Herrera
- e Novartis Pharmaceuticals Corporation , One Health Plaza , East Hanover , NJ , USA
| | - Judit Nyirady
- e Novartis Pharmaceuticals Corporation , One Health Plaza , East Hanover , NJ , USA
| | | | | | - Stephen Tyring
- h Department of Dermatology , University of Texas Health Science Center , Houston , TX , USA
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Rajiah P, Hojjati M, Lu Z, Kosaraju V, Partovi S, O’Donnell JK, Longenecker C, McComsey GA, Golden JB, Muakkassa F, Santilli S, McCormick TS, Cooper KD, Korman NJ. Feasibility of carotid artery PET/MRI in psoriasis patients. Am J Nucl Med Mol Imaging 2016; 6:223-233. [PMID: 27648374 PMCID: PMC5004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
We report our initial experience of performing integrated PET/MR imaging of the carotid arteries in psoriatic patients. Eleven patients with psoriasis and ten controls underwent carotid PET/MRI. Following injection of the FDG tracer, 3d T1w gradient echo sequence (atMR) was obtained for attenuation correction of PET data. High resolution images of carotid artery were then obtained, including pre-and post-contrast T1-w, T2-w and proton-density images as well as TOF images followed by PET imaging of the torso. From the fused axial PET/MRI, the arterial wall SUVmax and TBRmax was quantified in each slice. MRI images were also evaluated for vessel wall volume, plaque and internal composition. SUVmax and TBRmax were respectively, 1.72 ± 0.38 & 1.17 ± 0.27 in L- CCA, 1.75 ± 0.39 & 1.24 ± 0.19 in R-CCA, 1.59 ± 0.24 & 1.08 ± 0.14 in L-ICA and 1.62 ± 0.27 & 1.15 ± 0.17 in R-ICA in psoriatic patients and 1.74 ± 0.22 & 1.28 ± 0.44 in L- CCA, 1.74 ± 0.33 & 1.07 ± 0.28 in R-CCA, 1.78 ± 0.32 & 1.29 ± 0.39 in L-ICA and 1.60 ± 0.29 & 0.98 ± 0.25 in R-ICA in the controls. No discrete plaques were identified in any of the vessel segments in MRI. PET/MRI is feasible in evaluation of carotid arteries in psoriatic patients.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical CenterDallas, Texas, United States
| | - Mojgan Hojjati
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Ziang Lu
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Vijaya Kosaraju
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Sasan Partovi
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - James K O’Donnell
- Department of Radiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Christopher Longenecker
- Department of Cardiology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Grace A McComsey
- Department of Pediatrics and Medicine, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Jackelyn B Golden
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Fuad Muakkassa
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Scott Santilli
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Thomas S McCormick
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Kevin D Cooper
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
| | - Neil J Korman
- Department of Dermatology, University Hospital Cleveland Case Medical Center, Case Western Reserve University School of MedicineCleveland, Ohio, United States
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Armstrong AW, Feldman SR, Korman NJ, Meng X, Guana A, Nyirady J, Herrera V, Zhao Y. Assessing the overall benefit of a medication: cumulative benefit of secukinumab over time in patients with moderate-to-severe plaque psoriasis. J DERMATOL TREAT 2016; 28:200-205. [DOI: 10.1080/09546634.2016.1214667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, Armstrong AW, Kerdel F, Gold MH, Forman SB, Korman NJ, Giamarellos-Bourboulis EJ, Crowley JJ, Lynde C, Reguiai Z, Prens EP, Alwawi E, Mostafa NM, Pinsky B, Sundaram M, Gu Y, Carlson DM, Jemec GBE. Two Phase 3 Trials of Adalimumab for Hidradenitis Suppurativa. N Engl J Med 2016; 375:422-34. [PMID: 27518661 DOI: 10.1056/nejmoa1504370] [Citation(s) in RCA: 431] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hidradenitis suppurativa is a painful, chronic inflammatory skin disease with few options for effective treatment. In a phase 2 trial, adalimumab, an antibody against tumor necrosis factor α, showed efficacy against hidradenitis suppurativa. METHODS PIONEER I and II were similarly designed, phase 3 multicenter trials of adalimumab for hidradenitis suppurativa, with two double-blind, placebo-controlled periods. In period 1, patients were randomly assigned in a 1:1 ratio to 40 mg of adalimumab weekly or matching placebo for 12 weeks. In period 2, patients were reassigned to adalimumab at a weekly or every-other-week dose or to placebo for 24 weeks. The primary end point was a clinical response, defined as at least a 50% reduction from baseline in the abscess and inflammatory-nodule count, with no increase in abscess or draining-fistula counts, at week 12. RESULTS We enrolled 307 patients in PIONEER I and 326 in PIONEER II. Clinical response rates at week 12 were significantly higher for the groups receiving adalimumab weekly than for the placebo groups: 41.8% versus 26.0% in PIONEER I (P=0.003) and 58.9% versus 27.6% in PIONEER II (P<0.001). Patients receiving adalimumab had significantly greater improvement than the placebo groups in rank-ordered secondary outcomes (lesions, pain, and the modified Sartorius score for disease severity) at week 12 in PIONEER II only. Serious adverse events in period 1 (excluding worsening of underlying disease) occurred in 1.3% of patients receiving adalimumab and 1.3% of those receiving placebo in PIONEER I and in 1.8% and 3.7% of patients, respectively, in PIONEER II. In period 2, the rates of serious adverse events were 4.6% or less in all the groups in both studies, with no significant between-group differences. CONCLUSIONS Treatment with adalimumab (40 mg weekly), as compared with placebo, resulted in significantly higher clinical response rates in both trials at 12 weeks; rates of serious adverse events were similar in the study groups. (Funded by AbbVie; ClinicalTrials.gov numbers, NCT01468207 and NCT01468233 for PIONEER I and PIONEER II, respectively.).
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Affiliation(s)
- Alexa B Kimball
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Martin M Okun
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - David A Williams
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Alice B Gottlieb
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Kim A Papp
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Christos C Zouboulis
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - April W Armstrong
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Francisco Kerdel
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Michael H Gold
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Seth B Forman
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Neil J Korman
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Evangelos J Giamarellos-Bourboulis
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Jeffrey J Crowley
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Charles Lynde
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Ziad Reguiai
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Errol-Prospero Prens
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Eihab Alwawi
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Nael M Mostafa
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Brett Pinsky
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Murali Sundaram
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Yihua Gu
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Dawn M Carlson
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
| | - Gregor B E Jemec
- From Harvard Medical School and Massachusetts General Hospital (A.B.K.) and Tufts Medical Center (A.B.G.) - all in Boston; AbbVie, North Chicago, IL (M.M.O., D.A.W., E.A., N.M.M., B.P., M.S., Y.G., D.M.C.); Probity Medical Research and K Papp Clinical Research, Waterloo, ON (K.A.P.), and the Lynde Centre for Dermatology and Probity Medical Research, Markham, ON (C.L.) - both in Canada; the Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany (C.C.Z.); University of Southern California, Los Angeles (A.W.A.), and Bakersfield Dermatology, Bakersfield (J.J.C.) - both in California; Florida Academic Dermatology Centers, Miami (F.K.), and Forward Clinical Trials, Tampa (S.B.F.) - both in Florida; Tennessee Clinical Research Center, Nashville (M.H.G.); University Hospitals Case Medical Center, Cleveland (N.J.K.); 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens (E.J.G.-B.); CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims, France (Z.R.); Erasmus University Medical Center, Rotterdam, the Netherlands (E.-P.P.); and the Department of Dermatology, Roskilde Hospital, and Health Sciences Faculty, University of Copenhagen, Copenhagen (G.B.E.J.)
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Santilli S, Kast DR, Grozdev I, Cao L, Feig RL, Golden JB, Debanne SM, Gilkeson RC, Orringer CE, McCormick TS, Ward NL, Cooper KD, Korman NJ. Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center. J Transl Med 2016; 14:217. [PMID: 27448600 PMCID: PMC4957305 DOI: 10.1186/s12967-016-0947-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/17/2016] [Indexed: 02/08/2023] Open
Abstract
Background Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. Methods We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch’s t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. Results 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. Conclusions A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0947-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Santilli
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - D R Kast
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - I Grozdev
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - L Cao
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - R L Feig
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - J B Golden
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,Department of Pathology, Case Western Reserve University, Cleveland, USA
| | - S M Debanne
- Center For Clinical Investigation, Case Western Reserve University, Cleveland, USA.,Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, USA
| | - R C Gilkeson
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - C E Orringer
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,University of Miami, Miller School of Medicine, Miami, FL, 33125, USA
| | - T S McCormick
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA. .,The Murdough Family Center for Psoriasis, Cleveland, USA.
| | - N L Ward
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - K D Cooper
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - N J Korman
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
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Korman NJ, Zhao Y, Roberts J, Pike J, Sullivan E, Tsang Y, Karagiannis T. Impact of psoriasis flare and remission on quality of life and work productivity: a real-world study in the USA. Dermatol Online J 2016. [DOI: 10.5070/d3227031643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E, Kemhus M. Satisfaction with current psoriasis treatment: misalignment between physician and patient perceptions. Dermatol Online J 2016. [DOI: 10.5070/d3227031659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Korman NJ, Zhao Y, Roberts J, Pike J, Sullivan E, Tsang Y, Karagiannis T. Impact of psoriasis flare and remission on quality of life and work productivity: a real-world study in the USA. Dermatol Online J 2016; 22:13030/qt4vb7q7rr. [PMID: 27617715] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023] Open
Abstract
Although psoriasis patients often report a negative impact on health-related quality of life (HRQoL) and work productivity, less is known about how disease burden varies between periods of flare and remission. The aim of this study was tocompare HRQoL and work productivity by disease activity level. Data were extracted from Adelphi 2011/2013 Disease Specific Programmes, two real world surveys of US dermatologists and psoriasis patients. HRQoL was measured using the EuroQOL 5-Dimension Health Questionnaire (EQ-5D) and Dermatology Life Quality Index (DLQI). Work productivity was measured using the Work Productivity Activity index (WPAI). Three levels of disease activity were constructed based on physician reports: remission, active not flaring, active, and flaring. Multivariable regression analyses explored the relationship between disease activity, HRQoL and work productivity, controlling for differences in demographics and comorbidities. Out of 681 psoriasis patients 24% were in remission, 62% had active disease without flaring, and 15% experienced active disease and were currently flaring. Greater disease activity was associated with worse HRQoL. EQ-5D scores decreased with more active disease (remission vs. active not flaring vs. active and flaring: 0.93 vs. 0.90 vs. 0.82; p<0.05), while DLQI scores increased (remission vs. active not flaring vs. active and flaring: 2.0 vs. 5.00 vs. 8.7; p<0.05). WPAI scores increased with disease activity indicating increased productivity loss (remission vs. active not flaring vs. active and flaring: 5.9 vs. 14.8 vs. 26.9; p<0.05). The same trends were confirmed by multivariable regression analyses.
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Affiliation(s)
- N J Korman
- University Hospitals Case Medical Center, Cleveland, Ohio, USA.
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E, Kemhus M. Satisfaction with current psoriasis treatment: misalignment between physician and patient perceptions. Dermatol Online J 2016; 22:13030/qt7405k1nn. [PMID: 27617714] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023] Open
Abstract
Psoriasis patients often report dissatisfaction with treatment. However, the extent to which patients and their treating dermatologists are aligned regarding satisfaction with psoriasis therapy is largely unknown. This was explored using data derived from the Adelphi 2011/2013 Psoriasis Disease Specific Programmes, two real world surveys of US dermatologists and their patients. Physicians and patients independently reported their satisfaction with psoriasis control (satisfied, dissatisfied). Two levels of satisfaction alignment between physician and patient responses were constructed: aligned (same responses) and misaligned (different responses). In addition, dermatologists provided patient treatment history and disease/symptom severity whereas patients reported data on health-related quality of life (HRQoL), using the EuroQOL 5-Dimension Health Questionnaire (EQ-5D) and Dermatology Life Quality Index (DLQI), and work productivity using the Work Productivity Activity index (WPAI). Multivariate regressions were employed to examine the relationship between satisfaction alignment, overall disease and symptom severity, HRQoL, and work productivity controlling for differences in patient demographics and comorbidities.From 627 paired dermatologist and psoriasis patient records, 512 (81.7%) and 115 (18.3%) cases fell into the 'aligned' and 'misaligned' groups, respectively. Compared with patients in the aligned group, those in the misaligned group had more moderate to severe psoriasis (82.3% vs. 43.7%), moderate to severe itching (45.6% vs. 27.8%), pain (23.0% vs. 10.6%), and scaling (54.8% vs. 36.1%), and had lower current biologics use (27.0% vs. 42%) (all p<0.05). The misaligned group was associated with reduced HRQoL (lower EQ-5D score: 0.86 vs. 0.91; higher DLQI score: 7.06 vs. 4.23) and greater work productivity loss (higher WPAI scores: 18.27 vs. 11.43) (all p<0.05). Multivariate analyses confirmed these results (p<0.05). Almost 1 in 5 patients were misaligned with their dermatologist's level of satisfaction with their psoriasis treatment; misalignment was associated with increased disease and symptom severity, reduced HRQoL, and reduced work productivity.
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Affiliation(s)
- N J Korman
- 1University Hospitals Case Medical Center, Cleveland, Ohio.
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Keller JJ, Kittridge AL, Debanne SM, Korman NJ. Evaluation of ELISA testing for BP180 and BP230 as a diagnostic modality for bullous pemphigoid: a clinical experience. Arch Dermatol Res 2016; 308:269-72. [PMID: 26895534 DOI: 10.1007/s00403-016-1631-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 05/13/2015] [Revised: 10/17/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering disorder of the elderly. Several diagnostic modalities are available, including clinical impression, histopathology, direct and indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) detection of pathogenic antibodies. In this study, we aim to examine the utility of the newest test, ELISA, in comparison to the constellation of other tests. We describe our clinical experience in which 170 patients diagnosed with bullous pemphigoid had multiple tests performed. BP180 alone showed a sensitivity of 54 % and specificity of 94 %. The positive predictive value (PPV) is 95 % while the negative predictive value (NPV) is 52 %. BP230 alone yielded a sensitivity of 48 % and specificity of 94 %. The PPV is 94 % and the NPV is 49 %. Using both tests in combination yielded a sensitivity of 66 % and specificity of 89 %. The PPV of at least one of two tests returning positive is 92 % while the NPV of dual negative tests is 58 %. Use of ELISAs for suspected cases of BP are an inadequate standalone test, and are only helpful in making the diagnosis should they return positive. However, they would appear to miss about one-third of cases.
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Affiliation(s)
- Jesse J Keller
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA.
| | | | - Sara M Debanne
- Department of Epidemiology, Case Western Reserve University, 10900 Euclid Ave, Wood Building WG51, Cleveland, OH, 44106, USA
| | - Neil J Korman
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA
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Korman NJ, Zhao Y, Pike J, Roberts J. Relationship between psoriasis severity, clinical symptoms, quality of life and work productivity among patients in the USA. Clin Exp Dermatol 2016; 41:514-21. [PMID: 27061102 DOI: 10.1111/ced.12841] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Psoriasis is a chronic disease, and many patients experience itching, painful skin and scaling. The relationship between psoriasis severity and symptom severity, quality of life (QoL) and work productivity is not fully understood. AIM To examine how QoL, work productivity and clinical symptoms vary between patients with mild, moderate and severe psoriasis. METHODS During a recent US survey, dermatologists provided information on overall disease severity, symptom severity and comorbidities. Patients with psoriasis completed QoL and work productivity instruments: the EuroQoL 5-Dimension Health (EQ-5D) questionnaire, the Dermatology Life Quality Index (DLQI), and the Work Productivity and Activity Impairment (WPAI) questionnaire. Multivariate regression was used to explore the relationship between these outcome variables and psoriasis severity, controlling for differences in demographics and comorbidities. RESULTS The study analysed 694 patients (55% male; mean age: 44 years); 48%, 46% and 6% had mild, moderate and severe psoriasis, respectively. Scaling was the most common symptom, which was experienced by 82% of patients, followed by itching (73%) and pain (32%). Increased psoriasis severity was associated with increased itching, pain and scaling, and with reduced QoL (decrease in EQ-5D scores: moderate vs. mild -0.04, severe vs. mild -0.18; increase in DLQI: moderate vs. mild 2.97, severe vs. mild 7.95). WPAI scores increased with severity, indicating greater impairment (moderate vs. mild: 11.77, severe vs. mild 18.73). CONCLUSIONS Patients with more severe psoriasis experienced more severe symptoms and had a greater reduction in QoL and work productivity. It is important that physicians recognize the impact of severe disease on patients' lives and take steps to address this.
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Affiliation(s)
- N J Korman
- Clinical Trials Unit, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Y Zhao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - J Pike
- Adelphi Real World, Macclesfield, UK
| | - J Roberts
- Adelphi Real World, Macclesfield, UK
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Bhushan R, Lebwohl MG, Gottlieb AB, Boyer K, Hamarstrom E, Korman NJ, Kirsner RS, Sober AJ, Menter A. Translating psoriasis guidelines into practice: Important gaps revealed. J Am Acad Dermatol 2016; 74:544-51. [DOI: 10.1016/j.jaad.2015.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 01/18/2023]
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E. Patient satisfaction with current psoriasis treatment: a real-world study in the USA. Dermatol Online J 2016; 22. [PMID: 27267186 DOI: 10.1177/247553031600100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022] Open
Abstract
Psoriasis patients often report dissatisfaction with treatment. However, it is less clear how the severity of key psoriasis symptoms (painful skin, itching, and scaling) as well as overall disease severity influence patient dissatisfaction levels. Using the Adelphi 2011/2013 Psoriasis Disease Specific Programmes, two "real world" surveys of US dermatologists and their patients, patient satisfaction was evaluated. Dermatologists provided data on disease characteristics, while patients indicated their satisfaction with existing treatment. Physician-reported severity (none, mild, moderate/severe) of psoriasis-related itching, pain, and scaling, overall disease severity (mild, moderate and severe) and therapy type were compared by patient satisfaction levels (satisfied vs. dissatisfied). Multivariate regressions examined the relationship between patient satisfaction, clinical symptoms, and psoriasis overall disease severity, controlling for differences in patient demographics and comorbidities. The sample comprised 633 psoriasis patients (56% male) with a mean age of 45. Overall, 18% of patients reported dissatisfaction with their psoriasis treatment. Dissatisfied patients were more likely to have moderate (65% vs. 40%) or severe (21% vs 3%) psoriasis compared to patients who were satisfied (both p<0.05). Dissatisfied patients were also more likely to have more severe pain (30% moderate-to-severe pain vs. 9%), more severe itching (61% moderate-to-severe itching vs. 25%), and more severe scaling (68% moderate-to-severe scaling vs. 33%) than satisfied patients (all p< 0.05). Multivariate analyses confirmed these results. Clinicians should be aware that some psoriasis patients, especially those with severe overall disease or symptoms, may be dissatisfied and are in need of better treatment.
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Affiliation(s)
- N J Korman
- University Hospitals Case Medical Center,
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E. Patient satisfaction with current psoriasis treatment: a real-world study in the USA. Dermatol Online J 2016. [DOI: 10.5070/d3222030081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E. Increased severity of itching, pain, and scaling in psoriasis patients is associated with increased disease severity, reduced quality of life, and reduced work productivity. Dermatol Online J 2015; 21:13030/qt1x16v3dg. [PMID: 26632793] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Psoriasis patients report that this disease can impact on their health-related quality of life (HR-QoL) and work productivity. It is important to understand how this is influenced by the clinical characteristics of psoriasis such as symptom severity. Common symptoms include itching, pain, and scaling but the psychosocial impact these features have on patients is not well understood. OBJECTIVE To explore the impact of psoriasis symptoms (itching, pain, and scaling) on HR-QoL and work productivity. METHOD Data were extracted from the Adelphi 2011 and 2013 Psoriasis Disease Specific Programmes - two real world surveys of US dermatologists and their psoriasis patients. HR-QoL was measured using the Dermatology Life Quality Index (DLQI) and EuroQOL 5-Dimension Health Questionnaire (EQ-5D). Work productivity loss was measured by the Work Productivity and Activity Impairment (WPAI) questionnaire. The impact of symptom severity (none, mild, moderate/severe) for itching, pain, and scaling on DLQI, EQ-5D, and WPAI scores were examined, controlling for differences in demographics and co-morbidities. RESULTS Patient mean age was 44 years and 55% were male. Moderate/severe itching, pain, and scaling were experienced by 33%, 13%, and 41% of patients, respectively. Controlling for differences in demographics and co-morbidities, increased symptom severity was associated with reduced HR-QoL. Accordingly, EQ-5D scores decreased with itching severity (moderate/severe vs. none: -0.07; 95% confidence interval [CI] =-0.09, -0.04), whereas DLQI scores increased (moderate/severe versus none: 4.9; CI = 3.9, 5.9) (both p<0.05). WPAI scores increased with itching severity, indicating increased work productivity loss (moderate/severe versus none: 17.6, CI = 11.8, 23.5, p<0.05). The same pattern was observed for pain and scaling. CONCLUSIONS Among the patients studied, increased severity of psoriasis-related itching, pain, and scaling was associated with reduced health-related QoL and work productivity.
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Affiliation(s)
- N J Korman
- University Hospitals Case Medical Center
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Doherty SD, Lebwohl MG, Van Voorhees AS, Korman NJ, Hsu S. Annual screening for tuberculosis in patients on TNF-alfa antagonists. J Am Acad Dermatol 2015; 73:e123. [DOI: 10.1016/j.jaad.2015.04.071] [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] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
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Korman NJ, Zhao Y, Lu J, Tran MH. Psoriasis disease severity affects patient satisfaction with treatment. Dermatol Online J 2015; 21:13030/qt69h903m6. [PMID: 26436965] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Patients with psoriasis are often dissatisfied with available treatments, but contributing factors are not well defined. OBJECTIVE Examine relationships between psoriasis severity, patient characteristics, and treatment satisfaction. METHODS Patients with psoriasis were classified into mild and moderate-to-severe groups based on self-reported data. Demographics, comorbidities, symptoms, and multiple treatment satisfaction outcomes were compared between groups. Predictors of patient satisfaction with treatment were examined using linear regression models. RESULTS The analyses included 773 patients (407 mild; 366 moderate-to-severe). The percentage of patients reporting satisfaction with treatment was low overall, ranging from 8.6% to 61.7% for the mild and 13.9% to 49.5% for the moderate-to-severe group. Satisfaction among biologics users was also low (≤53%; 50% of satisfaction rates <40%). Regression results consistently showed greater dissatisfaction with current treatment among moderately to severely affected patients. CONCLUSION Many psoriasis patients were dissatisfied with their treatment; moderate-to-severe patients expressed significantly less satisfaction than mild patients.
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Korman NJ, Zhao Y, Li Y, Liao M, Tran MH. Clinical symptoms and self-reported disease severity among patients with psoriasis - Implications for psoriasis management. J DERMATOL TREAT 2015; 26:514-9. [PMID: 25886083 DOI: 10.3109/09546634.2015.1034074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pain, itching, burning and irritation are common symptoms of psoriasis but have not been well characterized by overall psoriasis severity. METHODS Using 2012 syndicated psoriasis patient survey data, 1050 subjects were classified into mild (n = 610) and moderate-to-severe (n = 440) psoriasis severity groups based on self-reporting. Demographics, comorbid medical conditions and patient-reported key symptoms (i.e. flare-up frequency, psoriasis-related pain, itching, burning, hurting, irritation) were compared between groups. Multiple regressions were employed to examine the impact of overall psoriasis severity on each key symptom, controlling for demographics and comorbidities. RESULTS Mild patients were older; more than 20% in both groups had joint pain and depression. Over 35 and 68% of the moderate-to-severe patients reported severe pain between or during flare-ups, respectively, and over 79% reported frequent bothersome itching. Controlling for between-group differences, moderate-to-severe patients had worse pain, were more likely to have continual flare-ups (odds ratio = 3.0) and flare-ups more than once monthly (odds ratio = 3.0), and reported more bothersome symptoms than patients with mild disease (all p < 0.05). CONCLUSION The presence and level of particular symptoms increase with self-reported disease severity in patients with psoriasis. Careful investigation of symptoms in tandem with clinical observation is important for effective psoriasis management.
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Affiliation(s)
- Neil J Korman
- a Department of Dermatology , University Hospitals Case Medical Center , Cleveland , OH , USA
| | - Yang Zhao
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
| | - Yunfeng Li
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
| | - Minlei Liao
- c KMK Consulting Inc . , Florham Park , NJ , USA
| | - Mary Helen Tran
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
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Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E. Increased severity of itching, pain, and scaling in psoriasis patients is associated with increased disease severity, reduced quality of life, and reduced work productivity. Dermatol Online J 2015. [DOI: 10.5070/d32110028943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Murrell DF, Marinovic B, Caux F, Prost C, Ahmed R, Wozniak K, Amagai M, Bauer J, Beissert S, Borradori L, Culton D, Fairley JA, Fivenson D, Jonkman MF, Marinkovich MP, Woodley D, Zone J, Aoki V, Bernard P, Bruckner-Tuderman L, Cianchini G, Venning V, Diaz L, Eming R, Grando SA, Hall RP, Hashimoto T, Herrero-González JE, Hertl M, Joly P, Karpati S, Kim J, Chan Kim S, Korman NJ, Kowalewski C, Lee SE, Rubenstein DR, Sprecher E, Yancey K, Zambruno G, Zillikens D, Doan S, Daniel BS, Werth VP. Definitions and outcome measures for mucous membrane pemphigoid: Recommendations of an international panel of experts. J Am Acad Dermatol 2015; 72:168-74. [DOI: 10.1016/j.jaad.2014.08.024] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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