ABSTRACT
BACKGROUND: There are currently no independent data available comparing infliximab and etanercept for the treatment of psoriasis. OBJECTIVES: To compare these biologics without funding from pharmaceutical companies. METHODS: Overall, 50 patients were randomized to etanercept (n = 23) 50 mg subcutaneously twice weekly or infliximab (n = 25) 5 mg kg-1 intravenously at week 0, 2, 6, 14 and 22. After 24 weeks, 19 patients stopped and 22 continued treatment and were followed up to week 48. The primary outcome was ≥ 75% improvement of Psoriasis Area and Severity Index (PASI 75) at week 24. The secondary outcomes included PASI 75 at week 6 (onset of action) and week 12, Investigator's Global Assessment (IGA), Patient Global Assessment, impact on quality of life (Skindex-17 and SF-36), Treatment Satisfaction Questionnaire of Medication, duration of remission, maintenance treatment and safety. RESULTS: At week 24, PASI 75 was achieved in 72% (infliximab) vs. 35% (etanercept) (P = 0·01). The onset of action was achieved in 52% (infliximab) and 4% (etanercept). At week 12, 76% (infliximab) and 22% (etanercept) achieved PASI 75 (P < 0·001). At week 24, IGA 'clear or almost clear' was observed in 76% (infliximab) and 30% (etanercept) (P = 0·01). Skindex-17 symptom score was significantly better for infliximab. Maintenance treatment achieved PASI 75 for 67% (n = 6) infliximab vs. 50% (n = 5) etanercept, at week 48 (P = 0·65). Mild adverse events were reported in 76% (infliximab) vs. 66% (etanercept). CONCLUSIONS: Infliximab showed a rapid and significant higher level of efficacy until week 24 compared with etanercept. Long-term data showed no significant differences between both groups at week 48. Safety parameters were comparable.
Subject(s)
Dermatologic Agents/administration & dosage , Etanercept/administration & dosage , Infliximab/administration & dosage , Psoriasis/drug therapy , Adolescent , Adult , Aged , Chronic Disease , Drug Administration Schedule , Etanercept/adverse effects , Female , Humans , Infliximab/adverse effects , Injections, Subcutaneous , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Quality of Life , Single-Blind Method , Treatment Outcome , Young AdultABSTRACT
AIMS: To evaluate the efficacy of bath psoralen-ultraviolet A (PUVA) therapy in severe cases of atopic dermatitis (AD) in adults using the extended Six Area, Six Sign Atopic Dermatitis (SASSAD) score. METHODS: Thirty-five adult subjects with severe AD underwent bath PUVA therapy for a maximum of 30 sessions ranging from one to three times a week. The only other treatment allowed during the study was topical application of hydrocortisone. RESULTS: There were a total of six drop-outs, three due to aggravation of symptoms. After the maximum 30 sessions the remaining 29 subjects showed 82.1% improvement in the severity of lesions, 75.2% reduction in extension of lesions, 74% improvement in itching and 79% improvement in night-time rest. Patient evaluations gave an overall score of 8.8 on a scale of 0-10.
Subject(s)
Dermatitis, Atopic/drug therapy , PUVA Therapy/methods , Adolescent , Adult , Aged , Baths , Child , Female , Humans , Male , Middle Aged , Patient Dropouts , Patient Satisfaction , Pilot ProjectsABSTRACT
A patient is described with proven delayed type allergy for heparin and a low molecular heparin. A literature survey shows that the dermatological picture varies. Occurrence of erythematous plaques without a superficial dermatitis is possible. Epicutaneous tests are often not sufficient, and intracutaneous or even subcutaneous tests are necessary to demonstrate the allergy.
Subject(s)
Eczema/chemically induced , Heparin, Low-Molecular-Weight/adverse effects , Heparin/adverse effects , Hypersensitivity, Delayed/chemically induced , Female , Humans , Hypersensitivity, Delayed/diagnosis , Middle Aged , Skin TestsABSTRACT
In an in vitro model, the release and penetration through a silicon membrane of different cream formulations and ointments containing 0.5% dithranol were studied. The results indicated that the method is not suitable for predicting in vivo release and penetration. Experiments with rabbits showed that the degree of skin irritation produced by a hospital-prepared product containing 0.5% dithranol was comparable to that of of a commercial product. Clinical efficacy and side-effects of these two products were investigated in a double-blind left-right comparative study in 35 patients with chronic plaque psoriasis. The two creams proved to be equally effective and showed the same incidence of side-effects.
Subject(s)
Anthralin/administration & dosage , Animals , Anthralin/adverse effects , Anthralin/chemistry , Double-Blind Method , Female , Humans , Irritants , Male , Ointments , Psoriasis/drug therapy , Rabbits , SolubilityABSTRACT
We describe the treatment of 196 patients with psoriasis, in the psoriasis day care centre at Ede. Treatments involve salt water baths followed by radiation of UVB, additional radiation of the scalp and therapy-resistant parts of the skin and anthralin 'short contact therapy'. During the anthralin therapy the hairy scalp is treated with liq. carb. dexerg. 5% in soya oleum. The results were evaluated by means of the psoriasis area and severity index (PASI) and of a questionnaire which was completed by 144 patients. In an average course of 28.4 treatment sessions (range 9-51), the PASI decreased by 84.3%. Evaluation of the PASI included the hairy scalp, the axillae and the inguinal region. The answers to the questionnaire indicated a risk of rather rapid relapse however, according to many patients, only a small part of the skin surface was affected. The additional value of the treatment is attributed to the setting of the psoriasis day care centre and the relatively safe therapeutic possibilities offered there.