RESUMO
BACKGROUND: For psoriatic patients who need to receive nonlive or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. OBJECTIVE: To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving nonlive or live vaccines. METHODS: Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. RESULTS: Key recommendations include continuing most oral and biologic therapies without modification for patients receiving nonlive vaccines; consider interruption of methotrexate for nonlive vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of live vaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4 weeks after live vaccination. LIMITATIONS: Studies regarding infection rates after vaccination are lacking. CONCLUSION: Interruption of antipsoriatic oral and biologic therapies is generally not necessary for patients receiving nonlive vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases.
Assuntos
Artrite Psoriásica , Produtos Biológicos , Consenso , Técnica Delphi , Psoríase , Humanos , Psoríase/tratamento farmacológico , Artrite Psoriásica/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Produtos Biológicos/administração & dosagem , Administração Oral , Vacinação/normas , Adulto , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , SARS-CoV-2 , Metotrexato/uso terapêutico , Metotrexato/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêuticoRESUMO
BACKGROUND: As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE: To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS: A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS: Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS: Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS: Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/terapia , Estudos Transversais , Humanos , Queratinócitos , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias Cutâneas/terapia , Estados UnidosRESUMO
The aim of this review is to compare and contrast evidence-based clinical practice guidelines from global dermatological organizations for the use of ustekinumab in psoriasis. Clinical practice guidelines from the American Academy of Dermatology, National Psoriasis Foundation, British Association of Dermatologists, and European S3 were reviewed and compared. Practice guidelines from the three dermatological organizations are similar with regards to treatment dosage and initiation but differ in their recommendations for baseline screening and interval laboratory monitoring, treatment in patients undergoing surgery or receiving live vaccines, and treatment contraindications. Ustekinumab is an effective and well-tolerated systemic treatment for patients with psoriasis and should be considered in the line of therapy that dermatologists discuss with their patients. Consideration should be given to evidence-based practice guidelines of global dermatology organizations to effectively guide treatment decisions in patients with psoriasis.
Assuntos
Psoríase , Ustekinumab , Europa (Continente) , Humanos , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Reino Unido , Estados UnidosRESUMO
BACKGROUND: Little is known regarding differential effects of systemic anti-acne treatments on mental health. OBJECTIVE: To determine whether differences exist in mental health outcomes between acne patients treated with isotretinoin versus oral antibiotics (doxycycline, minocycline, or tetracycline). METHODS: Population study utilizing the 2004-2017 Medical Expenditure Panel Survey. Depressive symptoms were assessed using Patient Health Questionnaire 2 (PHQ-2); psychological distress was measured by the Kessler 6-Item Psychological Distress Scale (K6). Acne patients completed both the PHQ-2 and K6 during treatment with isotretinoin or oral antibiotics. Lower scores on both measures indicate better mental health outcomes. RESULTS: After adjusting for socio-demographic characteristics, patients on isotretinoin had fewer depressive symptoms than patients on oral antibiotics, as measured by mean PHQ-2 scores (isotretinoin 0.280 vs oral antibiotics 0.656, difference=0.337, P<0.01). The adjusted comparison also showed patients on isotretinoin had less psychological distress than patients on oral antibiotics, as measured by K6 scores (isotretinoin 2.494 vs oral antibiotics 3.433, difference=0.759, P=0.043). LIMITATIONS: No direct assessment of acne severity. CONCLUSION: Acne patients on isotretinoin experienced less depressive symptoms and psychological distress as compared to oral antibiotics. J Drugs Dermatol. 2021;20(2):172-177. doi:10.36849/JDD.5559.
Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/administração & dosagem , Depressão/diagnóstico , Isotretinoína/administração & dosagem , Angústia Psicológica , Acne Vulgar/complicações , Acne Vulgar/psicologia , Administração Oral , Adulto , Antibacterianos/efeitos adversos , Estudos Transversais , Depressão/etiologia , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Isotretinoína/efeitos adversos , Masculino , Saúde Mental/estatística & dados numéricos , Questionário de Saúde do Paciente/estatística & dados numéricos , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Resultado do TratamentoRESUMO
Mild to moderate atopic dermatitis (AD) occurs frequently in children and adults and is usually managed through the use of pharmacologic treatments, such as topical corticosteroids (TCS) and topical calcineurin inhibitors (TCIs), and good skin care practices. As chronic TCS or TCI can lead to the development of adverse effects, there is a need for safe, alternative treatments for patients with resistant AD. A systemic literature review was performed to examine the safety and efficacy of topical agents currently in phase II and phase III clinical trials for AD. Our team searched the databases, PubMed, Google Scholar, and ClinicalTrials.gov, on March 2020 for studies pertaining to the use of topical agents in AD. Key words included each drug (tapinarof, crisaborole, ARQ-151 cream, ruxolitinib) or "topical agents"; combined with "atopic dermatitis"; Articles published within the last 5 years were included as references. References within retrieved articles were also reviewed to identify potentially missed studies. A total of 24 articles were included in this review. Tapinarof, crisaborole, and ruxolitinib lead to statistically significant improvements in multiple disease severity scores. ARQ-151 cream achieved statistical significance in secondary endpoints, including vIGA-AD and EASI-75, but not in the primary endpoint of the study. All topical agents were well-tolerated by study participants. The findings demonstrate that tapinarof, crisaborole, ARQ-151 cream, and ruxolitinib are safe, effective treatment options for patients with mild to moderate AD. J Drugs Dermatol. 2020;19(10):956-959. doi: 10.36849/JDD.2020.5214.
Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Creme para a Pele/administração & dosagem , Administração Cutânea , Aminopiridinas/administração & dosagem , Aminopiridinas/efeitos adversos , Benzamidas/administração & dosagem , Benzamidas/efeitos adversos , Compostos de Boro/administração & dosagem , Compostos de Boro/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Ciclopropanos/administração & dosagem , Ciclopropanos/efeitos adversos , Dermatite Atópica/diagnóstico , Fármacos Dermatológicos/efeitos adversos , Humanos , Nitrilas , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Pirimidinas , Resorcinóis/administração & dosagem , Resorcinóis/efeitos adversos , Índice de Gravidade de Doença , Creme para a Pele/efeitos adversos , Estilbenos/administração & dosagem , Estilbenos/efeitos adversos , Resultado do TratamentoAssuntos
Vitiligo , Humanos , Nitrilas , Pomadas , Pirazóis , Pirimidinas , Vitiligo/tratamento farmacológicoAssuntos
COVID-19 , Dermatologia , Internato e Residência , Dermatologia/educação , Humanos , Pandemias , SARS-CoV-2Assuntos
COVID-19/epidemiologia , Inibidores da Fosfodiesterase 4/uso terapêutico , Psoríase/tratamento farmacológico , Talidomida/análogos & derivados , Anti-Inflamatórios não Esteroides/efeitos adversos , COVID-19/imunologia , Ensaios Clínicos Fase III como Assunto/métodos , Humanos , Inibidores da Fosfodiesterase 4/efeitos adversos , Psoríase/diagnóstico , Psoríase/imunologia , Fatores de Risco , Talidomida/efeitos adversos , Talidomida/uso terapêuticoAssuntos
COVID-19/complicações , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/etiologia , Inibidores Enzimáticos/uso terapêutico , Janus Quinase 1/antagonistas & inibidores , Pirimidinas/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/etiologia , Sulfonamidas/uso terapêutico , HumanosAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Dermatite Atópica/tratamento farmacológico , Pneumonia Viral/epidemiologia , COVID-19 , Tomada de Decisão Clínica , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Dermatite Atópica/imunologia , Dermatologia/normas , Humanos , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Subunidade alfa de Receptor de Interleucina-4/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , SARS-CoV-2 , Resultado do TratamentoAssuntos
Adalimumab/efeitos adversos , Infecções por Coronavirus/epidemiologia , Hidradenite Supurativa/tratamento farmacológico , Imunossupressores/efeitos adversos , Pneumonia Viral/epidemiologia , Betacoronavirus/imunologia , COVID-19 , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Hidradenite Supurativa/imunologia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , SARS-CoV-2 , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologiaAssuntos
Infecções por Coronavirus/prevenção & controle , Dermatologia/organização & administração , Controle de Infecções/normas , Internato e Residência/organização & administração , Candidatura a Emprego , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dermatologia/normas , Humanos , Internato e Residência/normas , Seleção de Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , SARS-CoV-2RESUMO
BACKGROUND: In late 2019 a viral pneumonia began to spread across the world. The viral disease, COVID-19, is now officially a pandemic, causing concern for the potential risk of systemic therapies for patients with psoriasis. OBJECTIVE: The purpose of this review is to analyze what is currently known about COVID-19 in regard to the safety of systemic treatment, and to provide guidelines for use in psoriasis during this pandemic. METHODS: Review of guidelines from various dermatologic regulatory bodies regarding the use of systemic medications during the COVID-19 pandemic was performed and summarized. RESULTS: The AAD, NPF and IPC are in agreement regarding their recommendation that patients with active COVID-19 infection should discontinue any biologic therapy. CONCLUSION: Patients with active COVID-19 infections should discontinue systemic treatment for psoriasis. Patients with risk factors should discuss continuing treatment on a case by case basis.
Assuntos
COVID-19 , Pneumonia Viral , Psoríase , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Psoríase/complicações , Psoríase/tratamento farmacológico , Psoríase/epidemiologiaRESUMO
Topical medications have high utility in the treatment of psoriasis because of their localized effect and ability to be used as both monotherapy and adjunctive therapy. The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) published guidelines in 2020 regarding the management of psoriasis with topical therapies. These guidelines are a framework that assist clinicians treating psoriasis patients with topical agents including steroids, calcineurin inhibitors (CNIs), vitamin D analogues, retinoids (tazarotene), emollients, keratolytics (salicylic acid), anthracenes (anthralin), and keratoplastics (coal tar). This review presents these evidence-based recommendations in a form that dermatologists can readily apply to their clinical practice. The selection of an appropriate topical therapy, effective combination therapies, duration of use, and adverse events are addressed.
Assuntos
Alcatrão , Fármacos Dermatológicos , Psoríase , Administração Tópica , Antralina/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Alcatrão/efeitos adversos , Emolientes/uso terapêutico , Humanos , Psoríase/induzido quimicamente , Psoríase/tratamento farmacológico , Retinoides/uso terapêutico , Ácido Salicílico , Esteroides/uso terapêutico , Vitamina DRESUMO
Biologic medications are recent advances that have clinical significance in the treatment of moderate-to-severe AD. A systemic literature review was performed to examine the efficacy and safety of biologic therapies currently in phase II and phase III of clinical trials for moderate-to-severe AD. Our team searched the databases, PubMed, Google Scholar, and ClinicalTrials.gov, on September 2019 for studies pertaining to the use of biologic drugs in AD. Key words included each drug (lebrikizumab, tralokinumab, fezakinumab, etokimab, nemolizumab, tezepelumab, and GBR 830) or 'biologic drugs' or 'immunotherapies' combined with 'atopic dermatitis.' References within retrieved articles were also reviewed to identify potentially missed studies. A total of 19 articles were included in this review. Lebrikizumab, tralokinumab, fezakinumab, nemolizumab, and GBR 830 lead to statistically significant improvements in disease severity and multiple endpoint outcome scores. Tezepelumab and etokimab, however, did not demonstrate statistically significant changes in primary outcome endpoints. Further assessment of tezepelumab and etokimab are needed to assess their safety and efficacy in patients with moderate-to-severe AD. Tralokinumab, lebrikizumab, fezakinumab, nemolizumab, and GBR 830 are effective treatment options for adults with moderate-to-severe AD, but further large-scale studies are needed to confirm their efficacy as monotherapy in children with moderate-to-severe AD.
Assuntos
Dermatite Atópica , Eczema , Adulto , Terapia Biológica , Criança , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Dermatite Atópica/tratamento farmacológico , Humanos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Psoriasis is a systemic immune-mediated inflammatory disease that requires consistent treatment and follow-up. Given that COVID-19 will persist in the coming years, dermatologists need to adjust their practices accordingly to care for their patients, particularly psoriasis patients managed with systemic therapies. We provide guidelines for optimizing care for psoriasis patients, including considerations for medication management, lifestyle adjustments, and utilization of telemedicine.
Assuntos
Produtos Biológicos , COVID-19 , Psoríase , Telemedicina , Produtos Biológicos/uso terapêutico , Humanos , Pandemias , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , SARS-CoV-2RESUMO
BACKGROUND: Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. OBJECTIVE: To compare biologic medication use for psoriasis patients with differing English proficiency levels. METHODS: Population study of US psoriasis patients using the 2013-2017 Medical Expenditure Survey. RESULTS: Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001-0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. LIMITATIONS: Psoriasis disease severity not specified. CONCLUSIONS: Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.
Assuntos
Produtos Biológicos , Psoríase , Produtos Biológicos/uso terapêutico , Gastos em Saúde , Humanos , Idioma , Aceitação pelo Paciente de Cuidados de Saúde , Psoríase/tratamento farmacológico , Estados UnidosRESUMO
BACKGROUND: Many patients with atopic dermatitis seek care from both primary care physicians and dermatologists. However, little is known regarding topical corticosteroid prescribing patterns among these specialties. OBJECTIVE: We sought to determine if differences exist in topical corticosteroid prescribing patterns among dermatologists, family medicine physicians, and internal medicine physicians. METHODS: We conducted a population-based, cross-sectional analysis using data from the U.S. National Ambulatory Medical Care Survey from 2006 to 2016. RESULTS: Compared to dermatologists, internal medicine physicians were 22 times less likely to prescribe a topical corticosteroid for atopic dermatitis (52.2% versus 5.1%, p = .001; adjusted OR 0.045, 95%CI 0.007-0.277). There was not a statistically significant difference in the rate of topical corticosteroid prescriptions for atopic dermatitis between family medicine physicians and dermatologists (39.1% vs. 52.2%, p = .27; adjusted OR 0.468, 95%CI 0.174-1.257). Family medicine physicians had a higher rate of prescribing topical corticosteroids for atopic dermatitis than internal medicine physicians (39.1% vs. 5.1%, p = .002). LIMITATIONS: Severity of atopic dermatitis was not assessed. CONCLUSIONS: Atopic dermatitis patients seen by internal medicine physicians are much less likely to receive topical corticosteroid prescriptions as compared to those seen by dermatologists.
Assuntos
Dermatite Atópica , Fármacos Dermatológicos , Estudos Transversais , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Fármacos Dermatológicos/uso terapêutico , Dermatologistas , Glucocorticoides/uso terapêutico , Humanos , Atenção Primária à SaúdeRESUMO
BACKGROUND: Interleukin (IL)-17 inhibitors are a newer class of biologic used to treat patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. OBJECTIVE: We compared evidence-based clinical practice guidelines (CPGs) from leading dermatological organizations for the use of IL-17 inhibitors in psoriasis. METHODS: Guidelines from the Joint American Academy of Dermatology-National Psoriasis Foundation (AAD-NFP) Guidelines, British Association of Dermatologists guidelines (BAD), and European S3 group (ES3) were all reviewed and compared. RESULTS: This analysis revealed significant overlap in the recommendations made by experts from each CPG. However, our review highlights differences in routine laboratory recommendations and the relative and absolute contraindications to use with IL-17 inhibitors. CONCLUSION: IL-17 inhibitors are an effective treatment option for psoriasis. This analysis and review of guidelines for IL-17 inhibitor use highlights the consensus in treatment protocols and areas of disagreement between CPGs.