ABSTRACT
BACKGROUND: Biologic patent expiration, accelerated approval pathways, and business interests of third party payers and the biopharmaceutical industry are driving the development of biosimilars to treat immune-mediated disorders like psoriasis. No studies have investigated dermatologists' familiarity and perspectives of biosimilars.
OBJECTIVES: To assess: (1) dermatologists' familiarity with biosimilars and interchangeability and (2) their perspectives toward biosimilar properties, including interchangeability, indication extrapolation, and immunogenicity risk.
METHODS: For this prospective survey study, we distributed electronic and paper questionnaires to dermatologists from selected societies and attendees at the 73rd annual American Academy of Dermatology meeting between March 20, 2015 and May 30, 2015. Primary outcome was dermatologists' familiarity with biosimilars. Secondary aims included dermatologists' confidence in biosimilar efficacy and safety, familiarity concerning the concept of interchangeability and perspectives regarding indication extrapolation, interchangeability, and immunogenicity risk.
RESULTS: Of the 116 total dermatologists who completed the questionnaire, 73 (62.9%) were slightly to very unfamiliar with biosimilars. On a 5-point Likert scale, dermatologists were somewhat to very concerned with the practice of interchangeability (3.4±1.1) and slightly uncomfortable to fairly comfortable in prescribing biosimilars for an extrapolated indication (3.3±1.0).
CONCLSUIONS: Our survey identified that the majority of dermatologists were unfamiliar with biosimilars. Dermatologists were consistently concerned regarding safety issues surrounding the practice of interchangeability without provider knowledge.
J Drugs Dermatol. 2017;16(4):336-343.
.Subject(s)
Biosimilar Pharmaceuticals/therapeutic use , Dermatologists/education , Drug Substitution , Psoriasis/drug therapy , Biosimilar Pharmaceuticals/adverse effects , Cross-Sectional Studies , Dermatologists/psychology , Drug Prescriptions , Humans , Prospective Studies , Psoriasis/immunology , Recognition, Psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
BACKGROUND: HIV-associated psoriasis is well-documented. Genetic, cellular, and cytokine profiles have been used as evidence to suggest psoriasis activates antiviral pathways. There has been a lack of epidemiologic evidence investigating whether psoriasis patients have lower HIV viral counts compared to non-psoriasis patients.
OBJECTIVE: Compare the viral load set point of HIV positive patients with and without psoriasis.
METHODS: A retrospective matched cohort study of HIV positive patients with and without psoriasis using the Kaiser Permanente Southern California Health Plan database.
RESULTS: We identified 101 HIV-positive psoriasis cases; 19 met inclusion criteria and were matched with 3-5 control patients; 94 total patients were analyzed. The mean age was 41.4 (12.07) years and 83% were male. Overall, the median log of the viral load of cases was slightly higher than controls (4.3 vs 4.2; P less than 0.01).
CONCLUSIONS: The serum viral load set point of patients with HIV and psoriasis was slightly higher than the viral load set point of HIV patients without psoriasis.
J Drugs Dermatol. 2017;16(4):372-377.
.Subject(s)
HIV Infections/blood , HIV/isolation & purification , Psoriasis/blood , Viral Load , Adult , Aged , California , Case-Control Studies , Female , HIV Infections/complications , HIV Infections/virology , Humans , Male , Middle Aged , Psoriasis/complications , Retrospective Studies , Young AdultABSTRACT
Tumor necrosis factor (TNF) inhibitors are becoming more common in the treatment of moderate-to-severe chronic plaque psoriasis. These medications have a low incidence of serious adverse events and are generally considered safe; however, they do make patients more susceptible to tuberculosis (TB) infection both through latent reactivation and primary infection. We describe a case of a patient who had an initial negative tuberculin skin test (TST), began TNF inhibitor therapy, and then 11 years later was diagnosed with active TB. After the initial screening, the patient did not have any subsequent screenings for TB and no apparent change to his TB risk status. TB is still common in many areas of the United States and travel is not necessary to be exposed. Patients on TNF inhibitors that develop active TB have increased morbidity and mortality than those who are not. It is necessary that dermatologists limit the risk of TB to patients by screening them before initiation and annually when they are on the TNF inhibitor.
Subject(s)
Adalimumab/adverse effects , Etanercept/adverse effects , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Psoriasis/drug therapy , Tuberculosis, Pulmonary/etiology , Humans , Male , Middle Aged , Tuberculin Test , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitorsSubject(s)
Cardiovascular Diseases/prevention & control , Dermatology/trends , Practice Patterns, Physicians'/trends , Psoriasis/complications , Alcohol Drinking , Diabetes Mellitus/diagnosis , Directive Counseling , Dyslipidemias/complications , Dyslipidemias/diagnosis , Humans , Hypertension/complications , Hypertension/diagnosis , Obesity/complications , Obesity/diagnosis , Practice Patterns, Physicians'/standards , Referral and Consultation , Risk Factors , Surveys and Questionnaires , Tobacco UseSubject(s)
Hepatitis B virus/physiology , Hepatitis B, Chronic/prevention & control , Immunosuppressive Agents/adverse effects , Psoriasis/drug therapy , Virus Activation/drug effects , Hepatitis B, Chronic/complications , Humans , Practice Guidelines as Topic , Psoriasis/complications , Recurrence , Serologic TestsSubject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Immunoglobulin G/administration & dosage , Psoriasis/diagnosis , Psoriasis/drug therapy , Receptors, Tumor Necrosis Factor/administration & dosage , Adalimumab , Antibodies, Monoclonal, Humanized/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Etanercept , Female , Follow-Up Studies , Humans , Immunoglobulin G/adverse effects , Male , Patient Safety , Pulse Therapy, Drug , Randomized Controlled Trials as Topic , Risk Assessment , Severity of Illness Index , Treatment OutcomeSubject(s)
Dermatologic Agents/therapeutic use , Interleukin-17/antagonists & inhibitors , Psoriasis/drug therapy , Clinical Trials as Topic/methods , Dermatologic Agents/adverse effects , Dermatologic Agents/pharmacology , Endpoint Determination , Humans , Psoriasis/pathology , Severity of Illness IndexABSTRACT
INTRODUCTION: Hailey-Hailey disease is an adult-onset skin condition characterized by lesions in the intertriginous regions of the body. The lesions can be pruritic, painful, and associated with physical and social impairment. CASE PRESENTATION: We present a case of psoriasiform Hailey-Hailey disease in a 60-year-old white woman who exhibited erythematous psoriasiform plaques in many areas of her body. The patient's condition was successfully treated with a twice-daily regimen of doxycycline, mometasone, and clindamycin. DISCUSSION: It is important to recognize this variant of Hailey-Hailey disease so it can be diagnosed and treated promptly. Hailey-Hailey disease can be treated with topical corticosteroids and antibiotics and usually is associated with a positive prognosis.
Subject(s)
Pemphigus, Benign Familial/pathology , Psoriasis/pathology , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Female , Humans , Middle Aged , Pemphigus, Benign Familial/drug therapy , Psoriasis/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Although oral methotrexate is an effective first-line traditional systemic therapy for psoriasis, the use of the subcutaneous form of methotrexate for the treatment of psoriasis has not been fully established. OBJECTIVE: This study is a literature review of the research related to the safety, efficacy, and patient acceptability of subcutaneous methotrexate for its application in the treatment of severe recalcitrant psoriasis. METHODS: Systematic literature searches were conducted of the PubMed, Ovid, and ClinicalTrials.gov databases. RESULTS: Only three relevant sources of literature were found studying subcutaneous methotrexate specifically in the context of psoriasis. Of these, only one clinical trial was found to directly study the use of subcutaneous methotrexate in psoriasis patients; however, results of this study have not been published. The other two literature sources involved a cost-effectiveness analysis and a literature review for subcutaneous methotrexate. Otrexup™ and Rasuvo™ are two particular single-use auto-injector modalities of subcutaneous methotrexate that are approved by the US Food and Drug Administration. The equivalents of Rasuvo available in countries outside of the USA are advertised as Metoject® or Metex®. Much more research has been conducted on the use of subcutaneous methotrexate in rheumatoid arthritis patients. CONCLUSION: There is a lack of original evidence-based studies evaluating the use of subcutaneous methotrexate specifically for the treatment of psoriasis. Based on the more extensively researched data on the safety, efficacy, and patient acceptability of subcutaneous methotrexate in rheumatoid arthritis patients, its application for the treatment of moderate-to-severe psoriasis is promising. More evidence-based studies on psoriasis subjects are needed to explore the practical application of subcutaneous methotrexate as a treatment option for severe recalcitrant psoriasis.