Drug survival of apremilast in a real‐world setting

Apremilast is a novel oral phosphodiesterase‐4 inhibitor approved for treatment of plaque psoriasis and psoriatic arthritis in Japan in December 2016. We have treated a substantial number of patients with psoriasis with apremilast and investigated the length of the treatment period with apremilast (drug survival of apremilast) in 138 patients with psoriasis who were treated at the Department of Dermatology in Jichi Medical University Hospital from 1 March 2017 to 31 August 2018 using the Kaplan–Meier survival curve. The drug survival rate of apremilast at 1 year was 53.4%. The median length of the drug survival period was 453 days. There were no statistical differences in the drug survival rate in terms of the type of psoriasis, previous systemic treatment or presence of one or more adverse events. Drug efficacy was investigated in 115 patients who were followed for more than 16 weeks. There was no correlation between drug efficacy and sex, previous systemic treatment or presence of one or more adverse events; however, there was a correlation between drug efficacy and plaque size (P < 0.01, rs = ?0.29). The result of our study indicates that apremilast is effective regardless of the history of prior systemic treatment, and it supports our previous finding that small plaque‐type psoriasis is more sensitive to treatment with apremilast.     

Levocetirizine for the treatment of itch in psoriasis patients: An open‐label pilot study in a real‐world setting

Itch is the most bothersome symptom in psoriasis, often leading to impaired quality of life. Treatment of psoriasis‐induced itch is frequently unsatisfactory as the various therapies employed have a delayed onset of effect. Histamine‐1 receptor (H1) antihistamines are not recommended in treatment guidelines as histamine is not considered a key mediator in psoriasis. However, patients using H1 antihistamines frequently report benefits in questionnaire‐based studies. To address these contradictions, we examined the short‐term effects of levocetirizine, a nonsedating H1 antihistamine, on psoriasis‐related itch and itch‐related quality of life. In this pilot study, patients with psoriasis‐related itch received levocetirizine 5–10 mg daily as a concomitant treatment for 5 days. Change of itch intensity as measured by hourly itch ratings and the change of itch‐related quality of life were measured at different time points. A total of 29 of 30 patients (96%) reported a decline in itch within 5 days. Mean itch reduction was 23% after Day 1 (p = .005), 40% after Day 3 (p < .001), and 41% after Day 5 (p < .001). Furthermore, itch‐related quality of life also significantly improved after 5 days (p < .001). Only 2 of 30 patients (6.7%) reported mild sleepiness. Levocetirizine 5–10 mg daily as an add‐on therapy seems to be an effective treatment to improve itch and itch‐related quality of life within only a few days.     

Integrated real‐time Raman system for clinical in vivo skin analysis

Background: Raman spectroscopy is a non‐invasive optical technique that can probe the molecular structure and conformation of biochemical constituents. The probability of Raman scattering is exceedingly low (∼10⁻¹⁰), and consequently up to now the practical application of Raman spectroscopy to clinical medicine has been limited by either the weak spectral signal or by the long data acquisition times. Recent advances in Raman hardware and probe design have reduced spectral acquisition times, paving the way for clinical applications. Methods: We present an integrated real‐time Raman spectroscopy system for skin evaluation and characterization, which combines customized hardware features and software implementation. Real‐time data acquisition and processing includes CCD dark‐noise subtraction, wavelength calibration, spectral response calibration, intensity calibration, signal saturation detection, cosmic ray rejection, fluorescence background removal, and composition modeling. Real‐time in vivo Raman measurement of volar forearm skin is presented to illustrate the methods and modeling. Results: The system design implemented full‐chip vertical hardware binning to improve the signal‐to‐noise ratio by 16‐fold. The total time for a single in vivo measurement with analysis can be reduced to 100 ms with this implementation. Human skin was well modeled using the base Raman spectra. Conclusion: In vivo real‐time Raman can be a very promising research and practical technique for skin evaluation.     

Impact of chronic urticaria on quality of life and work in Japan: Results of a real‐world study

Little attention has been given to the burden of chronic urticaria (CU) in Japan compared with other skin diseases, such as atopic dermatitis (AD) and psoriasis. The primary objective of the RELEASE study was to evaluate the real‐life quality‐of‐life impairment in CU patients in Japan. Data were collected from 1443 urticaria, 1668 AD and 435 psoriatic patients; 552 urticaria patients who presented urticaria symptoms for over 6 weeks were defined as CU. The mean Dermatology Life Quality Index (DLQI) total score was 4.8, 6.1 and 4.8 in CU, AD and psoriatic patients, respectively. Disease control of urticaria evaluated by the Urticaria Control Test (UCT) and DLQI exhibited a strong correlation with a Spearman's rank correlation coefficient of ?0.7158. CU and AD patients had relatively higher scores in all Work Productivity and Activity Impairment – General Health subscales except for absenteeism. At the time of the survey, approximately 64% of CU patients reported UCT scores of <12 and demonstrated higher work productivity loss and activity impairment versus patients with UCT scores of ≥12. Patients with lower UCT scores also displayed a higher percentage of dissatisfaction with their health state and the treatment they received. Approximately 85% of patients with CU had visited dermatology clinics, and less than 20% had visited hospital, indicating existence of a highly burdened population outside specialized centers. These results highlight the unmet medical needs of CU patients, suggesting the need to increase awareness of CU burden among both physicians and patients and to pursue improved real‐life patient care.     

Effectiveness of anti‐interleukin 23 biologic drugs in psoriasis patients who failed anti‐interleukin 17 regimens. A real‐life experience

Among the most recent biologic drugs available for psoriasis therapy, those targeting interleukin‐17 (secukinumab and ixekizumab) or its receptor (brodalumab) have been shown to be quickly effective. However, in those patients who failed one or more of the above‐cited drugs, real‐life data on the effectiveness of switching to one anti‐interleukin‐23 biologic (guselkumab, risankizumab, or tildrakizumab) are very scarce. Here, we report our experience in treating 12 multi‐failure psoriatic patients, prospectively followed‐up over 6 months, who showed a significant improvement in their psoriasis after switching from an anti‐interleukn‐17 to an anti‐interleukin‐23 drug.