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1.
BMC Health Serv Res ; 21(1): 924, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488749

RESUMO

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory skin disease which can also involve joints. It is often associated with burdensome comorbidities which negatively impact prognosis and quality of life (QoL). Biologic agents have been shown to be effective in controlling disease progression, but their use is associated with higher costs compared with traditional systemic treatments. The economic analysis of the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: an obserVAtional longitudinal study of real-life clinical practice) study aims to assess the costs and cost-effectiveness of biologics in a real-world context in Italy. METHODS: The annualised overall direct costs of moderate-to-severe plaque psoriasis management, the annualised cost of biologic drugs and the cost per responder in the Italian National Health System perspective were assessed. More specifically, the cost per response and cost per sustained response of the most prescribed biologic therapies for the treatment of moderate-to-severe plaque psoriasis within the CANOVA study were assessed using the Psoriasis Area Severity Index (PASI) at several score levels (75, 90 and 100%). RESULTS: The most frequently used biologic therapies for plaque psoriasis were secukinumab, ustekinumab, adalimumab originator, and ixekizumab. Cost of biologics was the driver of expenditure, accounting for about 98% of total costs. Adalimumab originator was the biologic with the lowest cost per responder ratio (range: €7848 - €31,378), followed by secukinumab (range: €9015 - €33,419). Ustekinumab (range: €11,689 - €39,280) and ixekizumab (range: €11,092 - €34,289) ranked respectively third and fourth, in terms of cost-effectiveness ratio. As concerns the cost per sustained response analysis, secukinumab showed the lowest value observed (€21,375) over the other options, because of its high response rate (86% vs. 60-80%), which was achieved early in time. CONCLUSION: Biologic therapy is a valuable asset for the treatment of moderate-to-severe plaque psoriasis. Concomitant assessment of treatment costs against the expected therapeutic response over time can provide physicians and payers additional insights which can complement the traditional risk-benefit profile assessment and drive treatment decisions.


Assuntos
Psoríase , Qualidade de Vida , Anticorpos Monoclonais/uso terapêutico , Terapia Biológica , Humanos , Itália , Estudos Longitudinais , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Cells ; 10(8)2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34440863

RESUMO

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1ß, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.

3.
Dermatol Ther ; : e15102, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34436817

RESUMO

INTRODUCTION: Vitiligo is an acquired skin disorder clinically characterized by hypopigmentated macules and patches. Psoriasis is a chronic-inflammatory-skin-condition characterized by erythematous-plaques covered with scales particularly over the extensor-surfaces, scalp, and lumbosacral region. Recent major-researches-advancements have significantly expanded our understanding of psoriasis-pathophysiology, resulting in the development of highly effective targeted-therapies, such as anti TNFα, IL-12/23-inhibitors, IL-17-inhibitors, or IL-23-inhibitors. Particularly, ixekizumab, a humanized-monoclonal immunoglobulin-G 4 antibody, specifically binding IL-17A, demonstrated strong efficacy in threating recalcitrant psoriasis. Nevertheless, paradoxical reactions due to IL-17 inhibitors have been described. CASE REPORT: Herein, we report the case of a 53-year-old Caucasian man who obtained complete skin clearance of psoriasis plaques after 16 weeks of ixekizumab treatment together with the appearance of vitiligo patches localized on the facial area. He had never suffered of vitiligo and his family history excluded vitiligo diagnosis. We also could exclude post inflammatory psoriasis hypopigmentation because of absence of facial involvement at baseline. Our experience suggests that vitiligo might be considered a rare adverse effects of anti-IL-17 therapy.

8.
J Clin Med ; 10(5)2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33802255

RESUMO

Psoriasis is an immune-mediated, chronic inflammatory disease, which mainly affects the skin, although it has systemic pathological effects. Comorbidities of psoriasis include ocular disorders, which are often nonspecific or mildly symptomatic. The aim of this study was to show the importance of ocular-disease screening in psoriatic patients using the Ocular Manifestations in Psoriasis Screening (OcMaPS) questionnaire. Patients suffering from moderate-to-severe psoriasis referring at our outpatient-clinic were consecutively enrolled. Each patient was asked to complete a screening questionnaire (OcMaPS). Patients reporting ocular symptoms were referred for an ophthalmological examination. A total of 372 patients were enrolled in the study. Ocular symptoms were detected in 39 patients (10.5%), and 37 patients were referred to ophthalmological examination which confirmed the presence of ocular manifestation in 30 patients. There were three cases (10%) of uveitis, 14 (46.6%) of dry eye and 13 (43.3%) of cataract, in progress or already treated with surgery. In the remaining seven patients, no ocular manifestations were found. Ocular manifestations in psoriatic patients are not rare. It is important to be aware of ocular symptoms in psoriatic patients, screening patients (with a consultation or OcMaPS questionnaire), which leads to earlier diagnosis and treatment.

9.
Ital J Dermatol Venerol ; 156(3): 366-373, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33913665

RESUMO

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has become pandemic on March 11th, 2020. COVID-19 has a range of symptoms that includes fever, fatigue, dry cough, aches, and labored breathing to acute respiratory distress and possibly death. Health systems and hospitals have been completely rearranged since March 2020 in order to limit the high rate of virus spreading. Hence, a great debate on deferrable visits and treatments including phototherapy for skin diseases is developing. In particular, as regards phototherapy very few data are currently available regarding the chance to continue it, even if it may be a useful resource for treating numerous dermatological patients. However, phototherapy has an immunosuppressive action possibly facilitating virus infection. In the context of COVID-19 infection risk it is important to pointed out whether sunlight, phototherapy and in particular ultraviolet radiation (UV-R) constitute or not a risk for patients. In this review we aimed to focus on the relationship between UV-R, sunlight, phototherapy, and viral infections particularly focusing on COVID-19.


Assuntos
COVID-19/epidemiologia , Pandemias , SARS-CoV-2/efeitos da radiação , Luz Solar , Raios Ultravioleta , Vitamina D/fisiologia , Imunidade Adaptativa/efeitos da radiação , Animais , Peptídeos Catiônicos Antimicrobianos/biossíntese , Peptídeos Catiônicos Antimicrobianos/fisiologia , Citocinas/metabolismo , Modelos Animais de Doenças , Suscetibilidade a Doenças , Humanos , Imunidade Inata/efeitos da radiação , Imunossupressão , Interleucina-6/sangue , Padrões Moleculares Associados a Patógenos , SARS-CoV-2/genética , SARS-CoV-2/patogenicidade , Dermatopatias/radioterapia , Luz Solar/efeitos adversos , Receptores Toll-Like/fisiologia , Raios Ultravioleta/efeitos adversos , Terapia Ultravioleta/efeitos adversos , Vírus/efeitos da radiação , Vitamina D/biossíntese , Vitamina D/uso terapêutico
10.
Artigo em Inglês | MEDLINE | ID: mdl-33913664

RESUMO

BACKGROUND: Psoriasis represents one of the most common skin diseases in Italy, with a prevalence of 2.9%. It has been defined as a noncommunicable disease, due to its high burden and impact on patients' quality of life. AIMS: The aim of our observational study was to assess the actual knowledge and perception of psoriasis in Italian population by administering an online 10-question survey to a representative sample general population. METHODS: An online 10-question survey was administered to a representative sample general population from September 2019 to December 2019. A representative sample of general population (age ≥ 18 years) was enrolled by promoting the online survey through multiple means of communication such as social sites (Facebook, Instagram) or delivering a questionnaire link in public spaces (outpatient clinic, pharmacy). All results were then collected and analyzed in graphs by the Google form platform. RESULTS: 151 individuals participated in the survey. Results showed that 7.3% (n=11) of general population were not familiar with the term psoriasis; 4.6% (n=7) thought to psoriasis as an infectious disease and 6% (n=9) thought that psoriasis was contagious. Interestingly, 39.1% (n=59) of participants have never heard about targeted/biologic therapy. LIMITATIONS: Our study is limited by the small sample size as well as lack of data regarding sex, age and education level of the study participant. CONCLUSIONS: There is still lack of knowledge of psoriasis among general population, representing an obstacle for patients' everyday activities and quality of life. Future studies to investigate the details of this impaired knowledge and new psoriasis campaign on large scale should fill this gap are required.

12.
Dermatol Ther ; 34(2): e14857, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33559275

RESUMO

Scalp psoriasis represents the most common difficult-to-treat area in psoriasis patients. Its presence is linked to severe discomfort and impairment of quality of life given the associated symptoms (most of all, scaling and pruritus) and the location in a highly visible area, thus a prompt treatment is required. Its management may be challenging as the scalp is quite sensitive to long-term treatment with topical corticosteroids and usually resistant to topical and systemic agents. Likely, the currently available therapeutic armamentarium has been enriched with biologicals and small molecules that revolutionized psoriasis treatment and that of scalp psoriasis. Nevertheless, the lack of international dedicated guidelines pushed us to perform a comprehensive review on the efficacy and safety of biologics and small molecules on scalp psoriasis with the aim to put the basis for a therapeutic algorithm. After reviewing all the available evidence on the short-term and long-term efficacy of biologics and small molecules on scalp psoriasis the use of the newest biologics (anti-IL-17 and anti-IL-23) seems to be linked to the highest clinical performances in controlling scalp psoriasis. However, head-to-head comparisons between different biologics or biologics and small molecules are lacking. Hence, treatment selection should always be individualized.


Assuntos
Produtos Biológicos , Psoríase , Dermatoses do Couro Cabeludo , Produtos Biológicos/efeitos adversos , Humanos , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Qualidade de Vida , Couro Cabeludo , Dermatoses do Couro Cabeludo/diagnóstico , Dermatoses do Couro Cabeludo/tratamento farmacológico
15.
Arch Dermatol Res ; 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33609180

RESUMO

No data on real-life experiences of risankizumab efficacy and safety are reported, apart from two isolated case reports. We carried out a single-centre, prospective study to assess the efficacy and safety of risankizumab. Fourteen patients were included (mean age 44.5 ± 14.2 years). Mean PASI decreased from 12.3 ± 5.2 (baseline) to 4.4 ± 2.7 at week 4 (p < 0.01), and to 2.7 ± 1.7 at week 16 (p < 0.001). A similar trend was observed for BSA. In patients previously treated with biologics (71.4%, n = 10) versus the naïve ones, mean baseline PASI was similar (12.7 ± 5.8 vs 11.3 ± 3.8). Mean BSA was higher in multifailure (23.5 ± 11.8 vs 15.5 ± 11.8). At 4 and 16 weeks, a significant improvement in PASI and BSA was observed in both groups. An improvement in NAPSI score, mean scalp, and palmo-plantar area reduction was noticed during follow-up. No AEs were reported up to week 16 and few and mild grade laboratory tests were reported. Our initial data confirm the promising results on efficacy and safety of Risankizumab, even in a more challenging and "real" population, composed of a high percentage of multi-failure psoriatic patients who have benefitted from a new class agent.

17.
Int J Dermatol ; 60(3): 352-357, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32989759

RESUMO

BACKGROUND: Tuberculosis (TB) screening is mandatory for psoriasis biologic treatment. However, evidences regarding TB screening results during biologic treatment are conflicting. OBJECTIVES: The aim of this study is to evaluate the rate of QuantiFERON TB Gold test (QFT) conversion in psoriasis patients during biologics over time. METHODS: A 9-year single center retrospective study was performed in order to evaluate the rate of QFT conversion in patients affected by moderate-to-severe plaque psoriasis under available biological therapies (anti-TNF-α, IL-12/23, IL-17). For each patient, demographic data, age, gender, comorbidities, previous psoriasis therapy, as well as ongoing treatment type were registered. Five-hundred twenty-six patients (61.2% male, with a mean age of 52.6 ± 13.9 years) treated with biologics were enrolled. RESULTS: QFT conversion occurred in 6.5% of patients over a mean treatment duration of 3.2 years. On average, QFT conversion occurred after 34.05 months of treatment. Anti-TNF-α drugs, and among them, adalimumab above all (35.5% of all cases), were the most commonly involved treatment during QFT conversion, followed by anti-IL-12/23 (17.6%) and anti-IL-17 (14.7%). However, differences among biologics class or single biologics (adalimumab, etanercept, infliximab, golimumab, certolizumab, ustekinumab, ixekizumab, secukinumab) did not approach statistical significance. CONCLUSIONS: Annual TB screening is important in psoriasis patients under biologic treatment in order to avoid possible latent TB infection reactivation. Indeed, our data showed that even in a low TB prevalence country like Italy, QFT may convert over time in psoriasis patients under biologics in 6.5% of the cases.


Assuntos
Produtos Biológicos , Psoríase , Adulto , Idoso , Produtos Biológicos/uso terapêutico , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Estudos Retrospectivos , Inibidores do Fator de Necrose Tumoral
18.
Dermatology ; 237(2): 262-276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32554971

RESUMO

BACKGROUND: In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. SUMMARY: With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options.

20.
Australas J Dermatol ; 62(2): e207-e211, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33070319

RESUMO

BACKGROUND: Autoimmune diseases share a significant part of their genetic background and tend to coexist in the same patient. Some studies have investigated the possible association between autoimmune thyroiditis and psoriasis or psoriatic arthritis (PsA), with conflicting results. This study aimed to investigate the prevalence of autoimmune thyroiditis in psoriatic patients with (PsA) or without (PsC) joint involvement. METHODS: 208 patients with psoriasis and/or PsA were recruited. These patients were divided into two groups: psoriasis patients (without PsA) (PsC group: 100 patients; mean age of 50.1 ± 11.7 years) and subjects with psoriasis and psoriatic arthritis (PsA group: 108 subjects: mean age of 39.8 ± 10.8 years). Assessment of psoriasis severity was conducted using the Psoriasis Area and Severity Index (PASI) score. The diagnosis of psoriatic arthritis was made according to CASPAR criteria. All patients had thyroid evaluation through evaluation of thyroid function, thyroperoxidase antibodies and thyroid ultrasound examination. RESULTS: A statistically significant difference was found between the prevalence of autoimmune thyroiditis in the PsA group than the PsC group (25.9 vs 9.0 %; P = 0.018) with higher trends to hypothyroidism in the PsA group compared to the PsC group (13.9% vs 2.0%, P = 0.0018). CONCLUSIONS: The higher prevalence of autoimmune thyroiditis in the PsA group may be due to an immune dysfunction pathway in patients with psoriatic arthritis with a higher risk to develop other autoimmune diseases. This evidence confirms that psoriatic arthritis is an autoimmune disease with an overactive immune system that can involve multiple organs. Thyroid function evaluation should be part of the clinical and laboratory examination of patients with psoriatic arthritis.

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