Tildrakizumab: A Review in Moderate-to-Severe Plaque Psoriasis

American Journal of Clinical Dermatology - Tildrakizumab (tildrakizumab-asmn in the USA) [Ilumetri®; Ilumya™] is a humanized monoclonal antibody (mAb) that selectively targets the p19...     

Treatment of Medicare Patients with Moderate-to-Severe Psoriasis who Cannot Afford Biologics or Apremilast

American Journal of Clinical Dermatology - Elderly patients are a group with a high frequency of psoriasis. Their disease burden has negative impacts on their quality of life. While there is a...     

Understanding the New Clinical Landscape for Psoriasis: A Comparative Review of Biologics

Background Encouraging results from clinical trials suggest that biologic therapies are effective treatments for psoriasis.Objective The aim of our study was to evaluate the scientific evidence for the efficacy and safety of biologic drugs for psoriasis.Methods The studies reviewed include data on the biologies alefacept, efalizumab, etanercept, and infliximab. This article reviews all data published in the dermatology literature listed in the MEDLINE database, as well as data presented as abstracts and posters at dermatology society meetings, including the annual meetings of the American Academy of Dermatology.Results The majority of the studies used an improvement from baseline of 75% or more in the psoriasis area and severity index (PASI 75) as the primary measure of efficacy.Conclusions Overall, biologics represent an important addition to the psoriatic therapies and have a great impact on the disease course and life quality of those afflicted with psoriasis.

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SommaireAntécédents Des résultats encourageants d’essais cliniques indiquent que les biothérapies sont efficaces dans le traitement du psoriasis.Objectif Évaluer les preuves scientifiques montant l’innocuité et l’efficacité des medicaments biologiques dans le traitement du psoriasis.Méthodes Les études examinées comprennent des données sur les médicaments biologiques alefacept, efalizumab, etanercept et infliximab. Le présent article passe en revue l’ensemble des données publiées dans les périodiques spécialisés en dermatologie et listés sur la base MEDLINE, ainsi que les données présentées dans les résumés et sur les affiches des congrès de sociétés de dermatologues, notamment la réunion annuelle de la American Academy of Dermatology.Résultats La majorité des études ont utilisé comme principale mesure d’efficacité une amélioration de 75 % de l’indice de surface et de sévérité du psoriasis (PASI 75).Conclusion En général, la biothérapie représente un ajout important au traitement du psoriasis; elle a une grande incidence sur le cours de la maladie et la qualité de vie de ceux qui en sont atteints.

     

Integrating Biologic Agents into Management of Moderate-to-Severe Psoriasis: A Consensus of the Canadian Psoriasis Expert Panel

Background Approximately 2% of people worldwide have psoriasis, with as many as 1 million people with psoriasis in Canada alone.1,2 The severity of psoriasis ranges from mild to severe. It can lead to substantial morbidity and psychological stress and have a profound negative impact on patient quality of life.3,4 Although available therapies reduce therapies reduce the extent and severity of the disease and improve quality of life,3 reports have indicated a patient preference for more aggressive therapy and a dissatisfaction with the effectiveness of current treatment options.5Objective A Canadian Expert Panel, comprising Canadian dermatologists, convened in Toronto on 27 February 2004 to reach a consensus on unmet needs of patients treated with current therapies and how to include the pending biologic agents in and improve the current treatment algorithm for moderate-to-severe psoriasis. Current treatment recommendations suggest a stepwise strategy starting with topical agents followed by phototherapy and then systemic agents.3,6,7 The Panel evaluated the appropriate positioning of the biologic agents, once approved by Health Canada, for the treatment of moderate-to-severe psoriasis.Methods The Panel reviewed available evidence and quality of these data on current therapies and from randomized, controlled clinical trials.8–14 Subsequently, consensus was achieved by small-group workshops followed by plenary discussion.Results The Panel determined that biologic agents are an important addition to therapies currently available for moderate-to-severe psoriasis and proposed an alternative treatment algorithm to the current step wise paradigm.Conclusion The Panel recommended a new treatment algorithm for moderate-to-severe psoriasis whereby all appropriate treatment options, including biologic agents, are considered together and patients’ specific characteristics and needs are taken into account when selecting the most appropriate treatment option.

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SommaireAntècèdents Près de 2 % de la population mondiale est atteinte de psoriasis, dont un million de personnes au Canada.1,2 Le psoriasis peut varier de bénin à grave. Cette affection entraîne arfois une morbidité accrue et une détresse psychologique en plus d’avoir un impact négatif profond’sur la qualité de vie du patient.3,4 Bien que les traitements disponibles réduisent I’étendue et la gravité de la maladie et améliorent la qualité de vie,3 les rapports ont dénoté une préférence pour les traitements plus agressifs et une insatisfaction à I’égard de I’efficacite des options de traitement actuelles.5Objectif Un panel d’experts canadiens, formé de dermatologues, s’est réuni á Toronto le 27 février 2004 en vue d’atteindre un consensus sur les besoins non comblés des patients traités au moyen des thérapies actuelles, ainsi que d’évaluer les façons d’inclure les agents biologiques et d’améliorer les algorithmes de traitement du psoriasis modéré à grave. Actuellement, les traitements recommandés sont axés sur une stratégic par étapes, débutant avec des agents topiques, suivis d’une phototherapie et enfin des agents systémiques.3,6,7 panel a évalué le positionnement approprié des agents biologiques, une fois approuvés par Santé Canada, dans le traitement du psoriasis modéré à grave.Méthodes Le panel a passé en revue les rapports disponibles et la qualite des données relativement à ces thérapies ainsi que ceux des essais cliniques randomisés.8–14 Par la suite, un consensus a été atteint au moyen de petits ateliers de travail suivis d’une discussion plénière.Résultats Le panel a déterminé que les agents biologiques étaient un important ajout aux options thérapeutiques offertes actuellement dans le traitement du psoriasis modéré à grave et a proposé un algorithme de traitement en replacement à I’algorithme par étapes actuel.Conclusion Le panel a recommandé un nouvel algorithme de traitement pour le psoriasis modéré à grave, où on considère toutes les options thérapeutiques, y compris les agents biologiques, dans leur ensemble et on tient compte des caractéristiques et des besoins specifiques de chaque patient dans le choix de I’option adéquate.

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The Canadian Expert Panel meeting was supported by an educational grant from Serono Canada Inc. The opinions expressed are those of the authors and not of Serono. All participants have been involved in clinical trials involving at least one of the therapeutic agents discussed.

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At the time of the Canadian Expert Panel meeting, biologic agents such as alefacept, efalizumab, etanercept, and infliximab were not approved in Canada for the treatment of psoriasis. Upon final submission of this article, alefacept had just received approval for the treatment of psoriasis.     

Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies

American Journal of Clinical Dermatology - Previous studies have reported the occurrence of psoriasis together with multiple sclerosis (MS). Although similar predisposing genes and pathomechanisms...     

《银屑病的生物制剂治疗》读后感

拜读了《银屑病的生物制剂治疗》一书,收获良多,提出了一些个人看法。     

Comparison of Treatment Goals for Moderate-to-Severe Psoriasis between Korean Dermatologists and the European Consensus Report

BackgroundThe development of therapies for psoriasis has led to the need for a new strategy to the treatment of patients with moderate-to-severe psoriasis. New consensus guidelines for psoriasis treatment have been developed in some countries, some of which have introduced treatment goals to determine the timing of therapeutic regimens for psoriasis.ObjectiveTo investigate the opinions held by Korean dermatologists who specialize in psoriasis about treatment goals, and to compare these with the European consensus.MethodsKorean dermatologists who specialize in psoriasis were asked 11 questions about defining the treatment goals for psoriasis. The questionnaire included questions about the factors used to classify the severity of psoriasis, defining the induction and maintenance phases of psoriasis treatment, defining treatment responses during the induction phase, and defining treatment responses during the maintenance phase.ResultsThe Korean consensus showed responses that were almost similar to the European consensus, even without using the Delphi technique, which uses repeated rounds of questions to reach a consensus. Only one response that related to psoriasis severity in the context of the quality of patients'' lives differed from the European consensus.ConclusionThe concept of using treatment goals in the treatment of moderate-to-severe psoriasis can be applied to Korean psoriasis patients. Since a tool for assessing the quality of patients'' lives is not commonly used in Korea, the development of a simple, rapidly completed, and region-specific health-related quality of life assessment tool would enable treatment goals to be used in routine clinical practice.     

A 5-Year Review of Faith-Based Sexuality Education and HIV Prevention Programs

We conducted a systematic review of the literature to identify faith-based sexuality programs in order to examine current trends and practices. Sixty-two articles were screened with 16 meeting the inclusion criteria. Many of the articles on faith-based prevention programs reported feasibility studies with short-term outcomes (3- to 12-month follow-up). Seven of the studies were quantitative and used surveys. The qualitative studies (n?=?8) involved a case study, focus groups, telephone, or in-depth face-to-face interviews. There was one article that was a review of faith-based sexuality education (n?=?1). One study specifically addressed the sexuality education needs of adolescents only. This paper provides an overview of current trends in faith-based sexuality education and HIV prevention programs. Faith-based prevention programs have been slow to emerge over the past 5 years. With the exception of the YOUR Blessed Health Program, all of the programs were limited to one church or one geographic region. While many programs have existed for decades, we have limited knowledge about the effectiveness of their outcomes in reducing risky sexual behaviors. The studies reviewed showed that individuals infected because of sexual promiscuity were stigmatized most by church congregants. Future research with faith-based sexuality programs should increase the focus on a family-based approach to HIV prevention education.     

Alopecia Areata in the Elderly: A 10-Year Retrospective Study

Background

Alopecia areata (AA) is an organ-specific autoimmune disease that typically occurs in young adults. AA in the elderly is relatively rare, thus little data have been reported.

Objective

This study aimed to understand the clinical characteristics of AA in the elderly.

Methods

We performed a 10-year retrospective study of AA in the elderly who visited our dermatologic clinic from January 2002 to December 2011. A clinical review of medical records and telephone interviews were performed by two dermatologists.

Results

Among 1,761 patients with newly diagnosed AA, 61 (3.5%) were older than 60 years at the first visit. Among those who completed a telephone interview, 74.3% (26/35) had less than 50% of scalp-localized hair loss. There was no association between the extent of AA and hair graying (p=0.679). Favorable therapeutic response was observed in 62.9% (22/35) of cases.

Conclusion

AA in the elderly shows mild disease severity and favorable treatment response. There is no association between graying and the extent of AA. However, the influence of aging on the pathogenesis of AA in the elderly deserves further investigation.     

英夫利昔单抗治疗中、重度斑块状银屑病系统评价

目的系统评价英夫利昔单抗治疗中重度斑块状银屑病的疗效和安全性。方法检索MEDLINE、Cochrane图书馆、EMBASE、ISI、CNKI、CBM和VIP,收集所有关于英夫利昔单抗治疗银屑病的随机对照试验。根据纳入与排除标准筛选文献、评价质量、提取资料,采用RevMan5.0软件进行Meta分析。结果共纳入5个随机对照试验,包括1 549例患者。Meta分析结果显示:静滴英夫利昔单抗能显著提高达到PASI 75的例数(P<0.001);静滴英夫利昔单抗与安慰剂组比较,在1个或多个不良反应的发生率方面有统计学意义(P<0.001),而在严重不良反应的发生率方面无统计学意义(P=0.22)。结论现有证据表明,静滴英夫利昔单抗对中重度斑块状银屑病具有良好的疗效和较好的耐受性。