Review of Apremilast Combination Therapies in the Treatment of Moderate to Severe Psoriasis.

Psoriasis is a chronic inflammatory skin condition resulting from the dysregulation of cytokines. Apremilast, an oral phosphodiesterase-4 inhibitor is approved by the Federal Drug Administration (FDA) for the treatment of moderate to severe plaque psoriasis in patients who are eligible for phototherapy or systemic therapy. The drug increases cyclic adenosine monophosphate, cAMP, modulating the expression of pro-inflammatory cytokines. This review aims to explore and categorize current literature describing the efficacy and safety profile of the addition of apremilast to existing therapies including topicals, phototherapy, and systemic agents for the treatment of psoriasis. One database was used for the literature search. Seventeen studies with 617 patients met inclusion criteria and were included. Fifteen studies demonstrated beneficial results with excellent safety and efficacy of apremilast combination therapy (CT). Apremilast has been shown to improve the quality of life and reduce symptom severity in moderate to severe psoriasis. The drug’s simple dosing schedule with mild side effect profile makes it a practical option for patients as combination therapy. J Drugs Dermatol. 2021;20(8):837-843. doi:10.36849/JDD.5845.

Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation.

OBJECTIVE: We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD). METHODS: Cases of prenatally detected RPD referred between January 2002 and December 2008 were included. Severe RPD was defined as an anterior-posterior diameter of 15 mm, mild and moderate dilatation was defined as 6 to <10 mm and 10 to <15 mm, respectively. Postnatal diagnosis, the need for surgery and the correlation with the prenatal severity was ascertained. RESULTS: Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life. CONCLUSION: An obstructive cause is usually present in severe cases, which are more likely to require surgery if there is PUJ obstruction. A high male:female ratio was present in this group.

Estimating the susceptibility to SARS-CoV-2 infection with rituximab use for pemphigus vulgaris.

The occurrence of the COVID-19 pandemic has raised new uncertainties for dermatologists and their patients, importantly concerning initiation and continuation of immunosuppressants for dermatological conditions at this time. We review two phase III trials of rituximab, a chimeric CD20 monoclonal antibody, used for the treatment of pemphigus vulgaris. Without specific data studying rituximab use and susceptibility of SARS-CoV-2, we hope to utilize available data in order to assist clinician decision making for rituximab in the context of the pandemic.

Assessing the Risk of Omalizumab Add-on Therapy for Chronic Idiopathic Urticaria during the COVID-19 Pandemic.

Amid the current COVID-19 pandemic, there is concern for increased risk of infection while on immunomodulatory therapy. Omalizumab, a monoclonal antibody, is an add-on therapy for the treatment of chronic idiopathic urticaria (CIU) when first line therapy alone fails to achieve appropriate response. Current understanding of the response to COVID-19 infection is largely varied and actively under investigation. In the context of a pandemic, it is important to consider the safety profile of omalizumab as it modulates the immune system. We reviewed data from pivotal Phase III clinical trials investigating omalizumab use in CIU patients with a focus on reported respiratory-related adverse events (AEs) to assess these risks. Results from three phase III trials show that omalizumab adjunct therapy does not significantly increase infection risk and severity.

Management of psoriasis with biologics in clinical practice: an update for 2020.

This article aims to address updates on recent clinical trial findings (April 2019 to April 2020) regarding biologic therapy initiation and maintenance for adult patients. Prescribers should use this update as guidance for determining the appropriate biologic class based on patient characteristics and for approaching biologic-experienced patients with refractory psoriasis. This update also may serve as a reference for the recommended dosing regimens of the 11 approved biologics.