Subject(s)
Interleukin-23 , Psoriasis , Humans , Psoriasis/drug therapy , Etanercept , Treatment Outcome , Severity of Illness IndexABSTRACT
Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Of the 3946 patients in the registry, 24 were aged 21 years or younger. They had mean age of 16.1 years on starting treatment. When the registry was started, they had a Psoriasis Area and Severity Index of 9.4 and 67% were being treated with a conventional systemic drug. Treatment was discontinued in 14 patients (58%) due to adverse events or a loss or lack of effectiveness. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.
Subject(s)
Biological Products , Psoriasis , Adolescent , Biological Products/therapeutic use , Child , Humans , Psoriasis/chemically induced , Psoriasis/drug therapy , Psoriasis/epidemiology , RegistriesABSTRACT
Antecedentes y objetivos Es conveniente ampliar el conocimiento del manejo de apremilast en práctica clínica. El estudio APPRECIATE (NCT02740218) pretende describir las características de pacientes con psoriasis tratados con apremilast, evaluar sus perspectivas y las de sus dermatólogos, y los resultados obtenidos en la práctica clínica española. Métodos Estudio observacional, retrospectivo, transversal y multicéntrico en pacientes con psoriasis crónica en placas, a los que se visitó seis (± 1) meses después de iniciar apremilast. Los datos se obtuvieron de las historias clínicas y cuestionarios realizados por pacientes y dermatólogos. Resultados Se evaluaron 80 pacientes, al iniciar apremilast presentaban Psoriasis Area and Severity Index (PASI) medio (desviación estándar, DE) = 8,3 (5,3) y Dermatology Life Quality Index (DLQI) medio (DE) = 8,9 (6,6). A los seis meses, el 58,8% (n = 47) continuaba con apremilast (discontinuaciones: falta de eficacia [16,3%], seguridad/tolerabilidad [20,0%]). En pacientes que continuaban en tratamiento, el PASI75 fue alcanzado por el 36,7%; la puntuación DLQI media (IC 95%) fue 2,2 (0,7-3,6) y Patient Benefit Index medio (DE) 2,8 (0,8). El cumplimiento de las expectativas de los dermatólogos se correlacionó con los beneficios descritos por los pacientes (r = 0,636). El 56,3% reportó acontecimientos adversos (diarrea y náuseas los más frecuentes). Conclusiones Los pacientes que recibieron apremilast durante seis meses en la práctica clínica en España reportaron una mejoría en su calidad de vida (DLQI medio se redujo más de seis puntos) y en la gravedad de la enfermedad (PASI75 alcanzado por más de un tercio de los pacientes), a pesar de presentar una afectación cutánea menor que aquellos pacientes incluidos en ensayos clínicos (AU)
Background and objectives It is necessary to expand the knowledge in the use of apremilast in clinical practice. The APPRECIATE study (NCT02740218) aims to describe the characteristics of patients with psoriasis treated with apremilast, to evaluate their perspectives and those of dermatologists, as well as the outcomes obtained in clinical practice in Spain. Methods Observational, retrospective, cross-sectional, multicenter study of patients with chronic plaque psoriasis who could be contacted 6 (±1) months after apremilast initiation. The data were obtained from medical records and questionnaires from patients and physicians. Results A total of 80 patients were evaluated; at apremilast onset, they showed mean (standard deviation, SD) Psoriasis Area and Severity Index (PASI) = 8.3 (5.3), mean (SD) Dermatology Life Quality Index (DLQI) = 8.9 (6.6). At six months, 58.8% (n=47) of patients continued apremilast treatment (discontinuations due to lack of efficacy [16.3%], safety/tolerability [20.0%]). In patients continuing treatment, PASI75 was achieved by 36.7% of patients; mean (95% CI) DLQI score was 2.2 (0.7-3.6) and mean (SD) Patient Benefit Index score was 2.8 (0.8). Compliance with physicians expectations was correlated with benefits reported by patients (r=0.636). Adverse events were reported by 56.3% of patients (the most common were diarrhoea and nausea). Conclusions Patients receiving apremilast for 6 months in Spanish clinical practice, reported substantial improvements in their quality of life (mean DLQI reduced by more than 6 points) and disease severity (PASI75 achieved by over one-third of patients), despite less skin involvement than patients who enrolled in clinical trials (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Thalidomide/analogs & derivatives , Practice Patterns, Physicians' , Psoriasis/drug therapy , Severity of Illness Index , Treatment Outcome , Retrospective Studies , Cross-Sectional StudiesABSTRACT
BACKGROUND AND OBJECTIVES: It is necessary to expand the knowledge in the use of apremilast in clinical practice. The APPRECIATE study (NCT02740218) aims to describe the characteristics of patients with psoriasis treated with apremilast, to evaluate their perspectives and those of dermatologists, as well as the outcomes obtained in clinical practice in Spain. METHODS: Observational, retrospective, cross-sectional, multicenter study of patients with chronic plaque psoriasis who could be contacted 6 (±1) months after apremilast initiation. The data were obtained from medical records and questionnaires from patients and physicians. RESULTS: A total of 80 patients were evaluated; at apremilast onset, they showed mean (standard deviation, SD) Psoriasis Area and Severity Index (PASI) = 8.3 (5.3), mean (SD) Dermatology Life Quality Index (DLQI) = 8.9 (6.6). At six months, 58.8% (n=47) of patients continued apremilast treatment (discontinuations due to lack of efficacy [16.3%], safety/tolerability [20.0%]). In patients continuing treatment, PASI75 was achieved by 36.7% of patients; mean (95% CI) DLQI score was 2.2 (0.7-3.6) and mean (SD) Patient Benefit Index score was 2.8 (0.8). Compliance with physicians' expectations was correlated with benefits reported by patients (r=0.636). Adverse events were reported by 56.3% of patients (the most common were diarrhoea and nausea). CONCLUSIONS: Patients receiving apremilast for 6 months in Spanish clinical practice, reported substantial improvements in their quality of life (mean DLQI reduced by more than 6 points) and disease severity (PASI75 achieved by over one-third of patients), despite less skin involvement than patients who enrolled in clinical trials.
ABSTRACT
BACKGROUND AND OBJECTIVES: Current psoriasis guidelines do not usually include recommendations about first line classical or biologic treatment. The objectives of this study were: to describe shifts in the prescription of the first biological treatment, and to compare treatment withdrawal and rates of adverse events over ten years. MATERIAL AND METHODS: Biobadaderm registry was analyzed to describe: first biological prescription in bio-naïve patients, adverse events rate and reasons for drug withdrawal comparing three periods of time (2008-2010, 2011-2014, 2015-2018). RESULTS: Anti-TNF drugs were the most prescribed biological drug from 2008 to 2010. Ustekinumab has become the most prescribed first biologic since 2014. The main reasons for drug discontinuation were adverse events, lack of efficacy and remission. In each period any treatment was less likely to be discontinued due to any of these three reasons comparing to the previous period. CONCLUSIONS: The present study identifies trends in prescription of the first biological antipsoriatic drug in clinical practice from 2008 to 2018. It suggests that we have become more comfortable with the safety profile and more exigent with the efficacy of the drugs.
Subject(s)
Biological Products , Psoriasis , Drug Prescriptions , Humans , Psoriasis/drug therapy , Registries , Tumor Necrosis Factor InhibitorsABSTRACT
BACKGROUND: Little has been published on the real-world effectiveness and safety of apremilast in psoriasis. OBJECTIVES: To evaluate the effectiveness, safety and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. METHODS: Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. RESULTS: We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI-75 (≥75% reduction in PASI score) and 26.5% achieved PASI-90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. CONCLUSIONS: Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.
Subject(s)
Psoriasis , Thalidomide , Adult , Humans , Psoriasis/drug therapy , Retrospective Studies , Severity of Illness Index , Thalidomide/adverse effects , Thalidomide/analogs & derivatives , Treatment OutcomeABSTRACT
The common use of etanercept in the treatment of psoriasis entails that the dermatologist may encounter situations in which the need for temporary interruption of treatment may arise. In this article, an attempt has been made to establish guidelines on the interruption of etanercept within some circumstances, such as surgeries or vaccinations, the suspension time and when to reintroduce the drug.
Subject(s)
Immunoglobulin G/administration & dosage , Psoriasis/drug therapy , Receptors, Tumor Necrosis Factor/administration & dosage , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Aged , Etanercept , Humans , Male , Practice Guidelines as Topic , Time FactorsSubject(s)
Graft vs Host Disease/immunology , Lichenoid Eruptions/immunology , Lymphocyte Transfusion , Acute Disease , Adult , Bone Marrow Transplantation , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Lichenoid Eruptions/drug therapy , MaleABSTRACT
We report two patients who developed intense livedo reticularis clearly related to the administration of interferon alpha 2b as an adjuvant therapy for melanoma. Histological studies showed scattered perivascular infiltrates without vasculitis. Laboratory tests excluded any underlying condition. Resolution of the symptoms was observed in both patients when interferon alpha was withdrawn. These cases highlight the occurrence of livedo reticularis as an uncommon side-effect of interferon alpha treatment.
Subject(s)
Antineoplastic Agents/adverse effects , Interferon-alpha/adverse effects , Melanoma/drug therapy , Skin Diseases, Vascular/chemically induced , Skin Neoplasms/drug therapy , Aged , Antineoplastic Agents/therapeutic use , Female , Humans , Interferon alpha-2 , Interferon-alpha/therapeutic use , Male , Middle Aged , Recombinant ProteinsSubject(s)
Hodgkin Disease/complications , Skin Diseases/pathology , Skin/pathology , Viral Matrix Proteins/analysis , Adult , CD3 Complex/analysis , Epstein-Barr Virus Infections/complications , HIV Infections/complications , Humans , Immunohistochemistry , Leukocyte Common Antigens/analysis , Leukosialin/analysis , Lymph Nodes/chemistry , Lymph Nodes/pathology , Male , Skin/chemistry , Skin Diseases/metabolismSubject(s)
Mucins/metabolism , Penile Diseases/pathology , Penis/pathology , Administration, Oral , Administration, Topical , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Male , Metaplasia/pathology , Middle Aged , Penile Diseases/drug therapy , Penile Diseases/metabolism , Penis/metabolism , Treatment OutcomeABSTRACT
Acral erythema is a well-known side-effect of chemotherapy treatment but it is not common in patients undergoing bone marrow transplant. We report a post-transplant patient with clinical and histological acute graft-versus-host disease (GVHD) who concurrently developed acral erythema presenting as painful, well-defined and self-limiting palmar erythema with pustules. A skin biopsy from the palm showed abnormal keratinocyte maturation and eccrine squamous syringometaplasia. This case illustrates the difficulties in establishing the differential diagnosis of cutaneous eruptions in patients undergoing bone marrow transplant.
Subject(s)
Bone Marrow Transplantation/adverse effects , Graft vs Host Disease/pathology , Skin Diseases, Vesiculobullous/etiology , Skin Diseases, Vesiculobullous/pathology , Adrenal Cortex Hormones/therapeutic use , Adult , Biopsy, Needle , Bone Marrow Transplantation/methods , Disease Progression , Erythema/drug therapy , Erythema/etiology , Erythema/pathology , Fatal Outcome , Graft vs Host Disease/diagnosis , Hand Dermatoses/drug therapy , Hand Dermatoses/etiology , Hand Dermatoses/pathology , Humans , Immunohistochemistry , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Male , Severity of Illness Index , Skin Diseases, Vesiculobullous/drug therapySubject(s)
Acrylic Resins/adverse effects , Dental Prosthesis/adverse effects , Dermatitis, Allergic Contact/diagnosis , Stomatitis, Denture/diagnosis , Aged , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/pathology , Diagnosis, Differential , Female , Humans , Patch Tests , Stomatitis, Denture/chemically induced , Stomatitis, Denture/pathologySubject(s)
Antineoplastic Agents, Alkylating/adverse effects , Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Agents/adverse effects , Cyclophosphamide/adverse effects , Dermatomyositis/chemically induced , Etoposide/adverse effects , Hydroxyurea/adverse effects , Adult , Dermatomyositis/pathology , Female , Humans , MaleABSTRACT
BACKGROUND: Scrotal calcinosis is a benign entity characterized by the appearance of calcific masses within the dermis of scrotal skin. Its pathogenesis has not been fully elucidated. OBJECTIVE: A 36-year-old man with massive scrotal calcinosis is described. Our aim was to perform a histologic examination of the surgical piece with subsequent closure of the defect achieving satisfactory cosmetic results. METHODS: Case report and literature review. RESULTS: Histologic studies of multiple nodules showed no epithelial lining and one calcified epidermal cyst. Subtotal excision of the scrotal wall was performed with excellent results. CONCLUSION: Even though the pathogenic mechanism of this entity is still unclear, our findings support the theory of dystrophic calcification of epidermoid cysts. Surgical treatment is the only definitive treatment. Subtotal excision of the scrotal wall in cases of massive calcinosis may be performed with good results.
