Drug survival in patients with psoriasis is associated with the availability of biologic medications.

BACKGROUND: Drug survival rates in patients with psoriasis had been described extensively. Different survival rates of TNF-α inhibitors (TNFIs), ustekinumab and secukinumab were reported. OBJECTIVES: To investigate drug survival rates of TNFIs, ustekinumab and secukinumab, with particular emphasis on the difference between ustekinumab and secukinumab. METHODS: Survival analysis was performed in patients with moderate-to-severe psoriasis who received adalimumab, infliximab, etanercept, ustekinumab and secukinumab treatment in 2002-2018, using the Clalit Health Services database. Stratified analysis was performed according to biologic treatment lines. Multivariate analysis was performed adjusting for demographic variables, calendar year, metabolic syndrome, psoriatic arthritis, biologic treatment line, biologic naivety, co-administration of oral treatments and previous oral systemic treatment exposure. RESULTS: Among 1459 patients treated with 3070 biologic medication courses, ustekinumab had a significantly higher crude survival as compared with TNFIs and secukinumab. The mean drug survival of ustekinumab, adalimumab, etanercept, infliximab and secukinumab was 43.5 (CI: 39.7-47.2), 38.2 (CI: 34.8-41), 33.9 (CI: 30.8-37.1), 28.2 (CI: 22.5-33.8) and 17.1 (CI: 15.6-18.6) months, respectively, with significant statistical differences for all comparisons (P < 0.001). The differences between ustekinumab and secukinumab were not significant following adjustment to factors that included treatment line (hazard rate 1.16, CI: 0.93-1.43). CONCLUSION: Different drug survival rates between ustekinumab and secukinumab are determined by the treatment line and calendar year, reflecting the availability of biologic medications, and not only by the biologic attributes of each medication.

Atopic dermatitis and the metabolic syndrome: a cross-sectional study of 116 816 patients.

BACKGROUND: Data regarding the association between atopic dermatitis (AD) and the metabolic syndrome are controversial. OBJECTIVE: To evaluate the prevalence of the metabolic syndrome and its components in a large group of patients with AD compared to a matched reference group. METHODS: A cross-sectional study of AD patients diagnosed by a dermatologist between 1998 and 2016, and a matched comparison group was performed. We analysed the association between AD and metabolic syndrome, its components and possible complications for the entire study population, adults (age > 18) and adults with moderate-to-severe AD. RESULTS: The study included 116 816 patients with AD and 116 812 comparison enrollees. AD in the entire group of patients and in the adult patients was associated with a higher prevalence of dyslipidaemia and a lower prevalence of diabetes and metabolic syndrome. Moderate and severe AD were associated, respectively, with higher prevalence rates of the metabolic syndrome (17.0% vs. 9.4%), its components (obesity: 22.2% vs. 18.6%; diabetes: 15.9% vs. 9.2%; hypertension 27.9% vs. 15.3%; dyslipidaemia 47.1% vs. 28.5%, all P values < 0.001) and cardiovascular morbidity (all P values < 0.001). Multivariate analysis demonstrated a significant overrepresentation of the metabolic syndrome in moderate-to-severe AD (P = 0.04). CONCLUSIONS: Severely affected patients with AD may have one or more undiagnosed components of metabolic syndrome.

Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease. OBJECTIVES: To evaluate the association between HS and metabolic syndrome and its component morbidities in a large, community-based cohort of patients with HS, using the database of Clalit Health Services, the largest public healthcare provider in Israel. METHODS: A cross-sectional study was performed. Metabolic syndrome was defined as the presence of at least three of the following conditions: diabetes, hyperlipidaemia, hypertension and obesity. The association between HS and metabolic syndrome was assessed by a multivariate logistic regression model, adjusting for age, sex, diabetes, hypertension, hyperlipidaemia, obesity and smoking status. RESULTS: The study included 3207 patients with HS (general frequency of 0·07%) diagnosed by a dermatologist in primary-care centres, and 6412 age- and sex-matched control patients without HS. HS was significantly associated with metabolic syndrome [odds ratio (OR) 1·61, 95% confidence interval (CI) 1·36-1·89], diabetes (OR 1·41, 95% CI 1·19-1·66), obesity (OR 1·71, 95% CI 1·53-1·91), hyperlipidaemia (OR 1·14, 95% CI 1·02-1·28) and hypertension (OR 1·19, 95% CI 1·03-1·38). CONCLUSIONS: We found an association between HS and diabetes, hyperlipidaemia, obesity, hypertension and metabolic syndrome among a large community-based cohort of patients with HS. Clinicians should take into account that patients with HS may have one or more undiagnosed components of metabolic syndrome despite their young age. Thus, appropriate targeted screening is advised.

Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory disease affecting skin that bears apocrine glands. Only anecdotal reports and a few small studies have demonstrated a possible association between HS and depression, but these studies were uncontrolled or were based on small sample sizes. To the best of our knowledge, the association between HS and other psychiatric disorders has never been investigated. OBJECTIVES: To investigate the association between HS and psychiatric disorders: depression, anxiety, psychoses, schizophrenia and bipolar disorder. METHODS: A cross-sectional study was conducted utilizing the database of Clalit Health Services (over 4,100,000 patients). Case patients were defined as having HS when diagnosed by a dermatologist. Control patients without HS were age and gender matched in a 2 : 1 manner. The proportions of patients with psychiatric diseases were compared between patients with and without HS. The association between HS and psychiatric diseases was assessed in multivariate models using logistic regression analyses. RESULTS: The study included 3207 patients with HS and 6412 age- and gender-matched controls. Depression was diagnosed in 5.9% of patients with HS vs. 3.5% of patients without HS (P < 0.001). Anxiety was diagnosed in 3.9% of patients with HS vs. 2.4% of patients without HS (P < 0.001). These associations were significant after controlling for the confounders age and gender (Depression: OR = 1.7, 95% CI: 1.4-2.1; Anxiety: OR = 1.7, 95% CI: 1.3-2.1). CONCLUSIONS: Hidradenitis suppurativa was associated with depression and anxiety. Dermatologists treating patients with HS should be aware of this important association.

Cardiovascular disease in psoriatic post-menopausal women.

BACKGROUND: It is generally accepted that the risk of cardiovascular disease (CVD) in women is significantly increased after the menopause. Hormonal changes associated with the menopausal transition may also alter the course of autoimmune diseases. It has been reported that menopause may exacerbate the symptoms of rheumatoid arthritis, systemic sclerosis and giant cell arteritis, but attenuate the course of systemic lupus erythemathosus. There is a growing body of literature indicating that the course of psoriasis may be altered by menopausal hormone changes. Considering the fact that both psoriasis and menopause are independent risk factors for CVD, and that menopause may exacerbate the course of psoriasis, a possible additive effect between these two conditions may be crucial for proper monitoring and treatment of peri- and post-menopausal psoriatic patients. OBJECTIVE: The aim of this study is to analyse potential relationship between psoriasis, menopausal status and risk of CVD. MATERIALS AND METHODS: A retrospective analysis of the Clalit Health Services database was performed in an attempt to provide new data and the available literature concerning these issues was reviewed. Data on cardiovascular events in 10 872 female psoriatic patients and 19 471 controls were extracted and compared. RESULTS: In both psoriatic and control patients the association of CVD increased with age. The association of CVD was significantly greater in psoriatic patients, but no significant differences were found between any of age groups. CONCLUSIONS: The association of psoriasis and CVD in women increases with age but there is insufficient evidence to confirm that menopause increases the risk of psoriasis. Further studies directly addressing this issue are needed.

Constipation does not develop following elective hysterectomy: a prospective, controlled study.

Although there have been reports that women develop constipation following hysterectomy, previous studies were either retrospective or uncontrolled. The aim of this prospective, controlled study was to assess whether constipation develops after elective hysterectomy. Women undergoing elective gynaecological surgery were compared to matched non-surgery controls at enrollment and 3 and 12 months after surgery. The subset of women who underwent elective hysterectomy was the study group for the present report. Fifty-eight of the 132 elective surgery patients underwent hysterectomy and were compared to 123 controls. There was no difference between the groups at any follow-up point in functional constipation (P = 1.0), frequency of stools (P = 0.92), stool consistency (P = 0.42), straining (P = 0.43), feeling of obstruction (P = 0.6) or need to manually evacuate stool (P = 1.0). Significantly, more hysterectomy patients without baseline pain did develop abdominal pain at 3 or 12 months than non-surgery controls (16.7% vs 3.6%, P = 0.008). We conclude that there was no significant change in bowel habit or stool characteristics in women undergoing hysterectomy even though many developed abdominal pain. This prospective, controlled study challenges existing data regarding the effect of hysterectomy on constipation.