Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.
Objective
The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.
Methods
We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.
Results
We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle–Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24–24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31–9.23), vitiligo (OR 5.30, 95% CI 1.86–15.10), metabolic syndrome (OR 5.03, 95% CI 4.18–6.06), and Hashimoto’s thyroiditis (OR 4.31, 95% CI 2.51–7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14–0.99) and colorectal cancer (OR 0.61, 95% CI 0.42–0.89).
Conclusion
These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
{"title":"Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis","authors":"Sophia Ly, Priya Manjaly, Kanika Kamal, Ali Shields, Bruna Wafae, Najiba Afzal, Lara Drake, Katherine Sanchez, Samantha Gregoire, Guohai Zhou, Carol Mita, Arash Mostaghimi","doi":"10.1007/s40257-023-00805-4","DOIUrl":"10.1007/s40257-023-00805-4","url":null,"abstract":"<div><h3>Background</h3><p>Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.</p><h3>Objective</h3><p>The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.</p><h3>Methods</h3><p>We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.</p><h3>Results</h3><p>We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle–Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24–24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31–9.23), vitiligo (OR 5.30, 95% CI 1.86–15.10), metabolic syndrome (OR 5.03, 95% CI 4.18–6.06), and Hashimoto’s thyroiditis (OR 4.31, 95% CI 2.51–7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14–0.99) and colorectal cancer (OR 0.61, 95% CI 0.42–0.89).</p><h3>Conclusion</h3><p>These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10190060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-03DOI: 10.1007/s40257-023-00790-8
Christopher J. Fay, Samantha Jakuboski, Beth Mclellan, Blair S. Allais, Yevgeniy Semenov, Cecilia A. Larocca, Nicole R. LeBoeuf
The advent of protein kinase inhibitors and immunotherapy has profoundly improved the management of advanced melanoma. However, with these therapeutic advancements also come drug-related toxicities that have the potential to affect various organ systems. We review dermatologic adverse events from targeted (including BRAF and MEK inhibitor-related) and less commonly used melanoma treatments, with a focus on diagnosis and management. As immunotherapy-related toxicities have been extensively reviewed, herein, we discuss injectable talimogene laherparepvec and touch on recent breakthroughs in the immunotherapy space. Dermatologic adverse events may severely impact quality of life and are associated with response and survival. It is therefore essential that clinicians are aware of their diverse presentations and management strategies.
{"title":"Diagnosis and Management of Dermatologic Adverse Events from Systemic Melanoma Therapies","authors":"Christopher J. Fay, Samantha Jakuboski, Beth Mclellan, Blair S. Allais, Yevgeniy Semenov, Cecilia A. Larocca, Nicole R. LeBoeuf","doi":"10.1007/s40257-023-00790-8","DOIUrl":"10.1007/s40257-023-00790-8","url":null,"abstract":"<div><p>The advent of protein kinase inhibitors and immunotherapy has profoundly improved the management of advanced melanoma. However, with these therapeutic advancements also come drug-related toxicities that have the potential to affect various organ systems. We review dermatologic adverse events from targeted (including BRAF and MEK inhibitor-related) and less commonly used melanoma treatments, with a focus on diagnosis and management. As immunotherapy-related toxicities have been extensively reviewed, herein, we discuss injectable talimogene laherparepvec and touch on recent breakthroughs in the immunotherapy space. Dermatologic adverse events may severely impact quality of life and are associated with response and survival. It is therefore essential that clinicians are aware of their diverse presentations and management strategies.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10187756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-29DOI: 10.1007/s40257-023-00807-2
Hai-Meng Wang, Jia-Ming Xu, Hong-Zhong Jin
Background and Objective
Pustular psoriasis is a chronic and recurrent autoimmune disease, although little is known about the disease burden of pustular psoriasis in China. We analyzed the characteristics and disease burdens of patients from Beijing who had generalized pustular psoriasis (GPP) or palmoplantar pustulosis (PPP).
Methods
This multicenter retrospective cohort study used a regional electronic health database that covered 30 public hospitals in Beijing. From June 2016 to June 2021, all patients with a diagnosis of GPP, PPP, or psoriasis vulgaris (PV) were identified by International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. The GPP and PPP cohorts were separately matched with patients with PV in a 3:1 ratio for comparisons. Demographic data, clinical characteristics, healthcare resource utilization, and costs were collected. Descriptive and comparative analyses were used to compare the cohorts.
Results
There were 744 patients with GPP (46.8% men; age 42.14 ± 21.47 years) and 4808 patients with PPP (35.5% men; age 51.65 ± 16.12 years); 14.5% of patients with GPP had concomitant PV and 7.5% of patients with PPP had concomitant PV. Relative to matched patients with PV, patients with GPP had a higher prevalence of erythrodermic psoriasis (5.9% vs 0.4%, p < 0.0001), psoriatic arthritis (3.1% vs 1.5%, p = 0.007), and organ failure (1.1% vs 0.2%, p = 0.002). Relative to matched patients with PV, patients with PPP had a higher prevalence of cerebrovascular disease (4.7% vs 1.2%, p < 0.0001), thyroid dysfunction (3.9% vs 3.3%, p = 0.035), and type 2 diabetes mellitus (6.8% vs 5.9%, p = 0.030). More patients with GPP than patients with PV received systemic non-biological agents (27.9% vs 3.3%, p < 0.0001) and biologic agents (4.8% vs 2.0%, p = 0.010). More patients with PPP than patients with PV received topical agents (50.9% vs 34.7%, p < 0.0001) and systemic non-biological agents (17.8% vs 2.7%, p < 0.0001). More patients with GPP than patients with PV required inpatient hospitalization (22.0% vs 7.8%, p < 0.0001). Hospitalization stay was longer in patients with GPP than patients with PV (11.72 ± 0.45 vs 10.38 ± 0.45 days, p = 0.022). More patients with PPP than patients with PV had emergency visits (16.3% vs 12.8%, p < 0.0001). The GPP and PPP cohorts and their matched PV cohorts had no significant differences in costs. However, patients with PPP had lower outpatient costs than patients with PV (368.20 ± 8.19 vs 445.38 ± 5.90 Chinese Yuan per patient per month, p < 0.0001).
Conclusions
Patients from Beijing with GPP and PPP had higher disease burdens than matched PV cohorts, including the prevalence of comorbidities, healthcare resource utilization, and medication burden. However, the economic burden of pustular psoria
背景与目的：脓疱性银屑病是一种慢性复发性自身免疫性疾病，但对我国脓疱性牛皮癣的疾病负担知之甚少。我们分析了北京地区全身性脓疱性银屑病（GPP）或掌跖脓疱病（PPP）患者的特征和疾病负担。方法：这项多中心回顾性队列研究使用了一个覆盖北京30家公立医院的区域电子健康数据库。从2016年6月到2021年6月，所有诊断为GPP、PPP或寻常型银屑病（PV）的患者均通过《国际疾病和相关健康问题统计分类》第10版代码进行识别。GPP和PPP队列分别与PV患者以3:1的比例进行比较。收集人口统计学数据、临床特征、医疗资源利用率和成本。使用描述性和比较分析来比较队列。结果：GPP患者744例（男性46.8%，年龄42.14±21.47岁），PPP患者4808例（男性35.5%，年龄51.65±16.12岁）；14.5%的GPP患者伴有PV，7.5%的PPP患者伴有PV。与匹配的PV患者相比，GPP患者的红皮病银屑病（5.9%vs 0.4%，p<0.0001）、银屑病关节炎（3.1%vs 1.5%，p=0.007）和器官衰竭（1.1%vs 0.2%，p=0.002）的患病率更高，甲状腺功能障碍（3.9%vs3.3%，p=0.035），和2型糖尿病（6.8%vs 5.9%，p=0.030）。接受全身非生物制剂治疗的GPP患者比PV患者多（27.9%vs 3.3%，p=0.001）和生物制剂治疗（4.8%vs 2.0%，p=0.010）。接受局部制剂治疗的PPP患者比PV病人多（50.9%vs 34.7%，p<0.001）和全身非生物剂治疗（17.8%vs 2.7%，p<0.0001）GPP患者比PV患者需要住院治疗（22.0%vs 7.8%，p＜0.0001）。GPP患者的住院时间比PV患者更长（11.72±0.45 vs 10.38±0.45天，p＝0.022）。PPP患者多于PV患者急诊就诊（16.3%vs 12.8%，p＞0.0001）成本。然而，PPP患者的门诊费用低于PV患者（368.20±8.19 vs 445.38±5.90元/月，p＜0.0001）。结论：来自北京的GPP和PPP患者的疾病负担高于匹配的PV队列，包括合并症的患病率、医疗资源利用率和药物负担。然而，脓疱性银屑病的经济负担与PV相似。需要实用和特异的治疗方法来减轻脓疱性银屑病的负担。
{"title":"Characteristics and Burdens of Disease in Patients from Beijing with Generalized Pustular Psoriasis and Palmoplantar Pustulosis: Multicenter Retrospective Cohort Study Using a Regional Database","authors":"Hai-Meng Wang, Jia-Ming Xu, Hong-Zhong Jin","doi":"10.1007/s40257-023-00807-2","DOIUrl":"10.1007/s40257-023-00807-2","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Pustular psoriasis is a chronic and recurrent autoimmune disease, although little is known about the disease burden of pustular psoriasis in China. We analyzed the characteristics and disease burdens of patients from Beijing who had generalized pustular psoriasis (GPP) or palmoplantar pustulosis (PPP).</p><h3>Methods</h3><p>This multicenter retrospective cohort study used a regional electronic health database that covered 30 public hospitals in Beijing. From June 2016 to June 2021, all patients with a diagnosis of GPP, PPP, or psoriasis vulgaris (PV) were identified by International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. The GPP and PPP cohorts were separately matched with patients with PV in a 3:1 ratio for comparisons. Demographic data, clinical characteristics, healthcare resource utilization, and costs were collected. Descriptive and comparative analyses were used to compare the cohorts.</p><h3>Results</h3><p>There were 744 patients with GPP (46.8% men; age 42.14 ± 21.47 years) and 4808 patients with PPP (35.5% men; age 51.65 ± 16.12 years); 14.5% of patients with GPP had concomitant PV and 7.5% of patients with PPP had concomitant PV. Relative to matched patients with PV, patients with GPP had a higher prevalence of erythrodermic psoriasis (5.9% vs 0.4%, <i>p</i> < 0.0001), psoriatic arthritis (3.1% vs 1.5%, <i>p</i> = 0.007), and organ failure (1.1% vs 0.2%, <i>p</i> = 0.002). Relative to matched patients with PV, patients with PPP had a higher prevalence of cerebrovascular disease (4.7% vs 1.2%, <i>p</i> < 0.0001), thyroid dysfunction (3.9% vs 3.3%, <i>p</i> = 0.035), and type 2 diabetes mellitus (6.8% vs 5.9%, <i>p</i> = 0.030). More patients with GPP than patients with PV received systemic non-biological agents (27.9% vs 3.3%, <i>p</i> < 0.0001) and biologic agents (4.8% vs 2.0%, <i>p</i> = 0.010). More patients with PPP than patients with PV received topical agents (50.9% vs 34.7%, <i>p</i> < 0.0001) and systemic non-biological agents (17.8% vs 2.7%, <i>p</i> < 0.0001). More patients with GPP than patients with PV required inpatient hospitalization (22.0% vs 7.8%, <i>p</i> < 0.0001). Hospitalization stay was longer in patients with GPP than patients with PV (11.72 ± 0.45 vs 10.38 ± 0.45 days, <i>p</i> = 0.022). More patients with PPP than patients with PV had emergency visits (16.3% vs 12.8%, <i>p</i> < 0.0001). The GPP and PPP cohorts and their matched PV cohorts had no significant differences in costs. However, patients with PPP had lower outpatient costs than patients with PV (368.20 ± 8.19 vs 445.38 ± 5.90 Chinese Yuan per patient per month, <i>p</i> < 0.0001).</p><h3>Conclusions</h3><p>Patients from Beijing with GPP and PPP had higher disease burdens than matched PV cohorts, including the prevalence of comorbidities, healthcare resource utilization, and medication burden. However, the economic burden of pustular psoria","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9699138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.1007/s40257-023-00796-2
Amit Garg, Yvonne Geissbühler, Emma Houchen, Nilesh Choudhary, Disha Arora, Varun Vellanki, Abhishek Srivastava, Priyanka, John Darcy II, Craig Richardson, Alexa B. Kimball
Introduction
Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval.
Methods
This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12–17 years) patients diagnosed with HS in the United States (US) using Optum’s de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018.
Results
Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively).
Conclusion
In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
{"title":"Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study","authors":"Amit Garg, Yvonne Geissbühler, Emma Houchen, Nilesh Choudhary, Disha Arora, Varun Vellanki, Abhishek Srivastava, Priyanka, John Darcy II, Craig Richardson, Alexa B. Kimball","doi":"10.1007/s40257-023-00796-2","DOIUrl":"10.1007/s40257-023-00796-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval.</p><h3>Methods</h3><p>This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12–17 years) patients diagnosed with HS in the United States (US) using Optum’s de-identified Clinformatics<sup>®</sup> Data Mart Database during the period 1 January 2016 to 31 December 2018.</p><h3>Results</h3><p>Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively).</p><h3>Conclusion</h3><p>In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/f0/40257_2023_Article_796.PMC10570206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Authors’ Reply to Chen and Chen: Comment on: “Isotretinoin Exposure and Risk of Inflammatory Bowel Disease: A Systematic Review with Meta-Analysis and Trial Sequential Analysis”","authors":"Chia-Ling Yu, Po-Yi Chou, Chih-Sung Liang, Li-Huei Chiang, Tzu-Yu Wang, Yu-Kang Tu, Ching-Chi Chi","doi":"10.1007/s40257-023-00803-6","DOIUrl":"10.1007/s40257-023-00803-6","url":null,"abstract":"","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41621548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-27DOI: 10.1007/s40257-023-00802-7
Shurong Chen, Yi Chen
{"title":"Comment on: “Isotretinoin Exposure and Risk of Inflammatory Bowel Disease: A Systematic Review with Meta-Analysis and Trial Sequential Analysis”","authors":"Shurong Chen, Yi Chen","doi":"10.1007/s40257-023-00802-7","DOIUrl":"10.1007/s40257-023-00802-7","url":null,"abstract":"","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46247580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-22DOI: 10.1007/s40257-023-00804-5
Michael J. Woodbury, Jeffrey S. Smith, Joseph F. Merola
Dupilumab is an interleukin (IL)-4/13 inhibitor approved by the US FDA for multiple atopic indications. It is well-known to have favorable efficacy and safety profiles; however, emerging reports of dupilumab-associated arthritis suggest an underrecognized potential adverse effect. In this article, we summarize the literature to date to better characterize this clinical phenomenon. Arthritic symptoms were most commonly peripheral, generalized, and symmetric. Onset was generally within 4 months following initiation of dupilumab, and most patients resolved fully after a matter of weeks following discontinuation. Mechanistic insights suggest that suppression of IL-4 may lead to increased activity of IL-17, a prominent cytokine in inflammatory arthritis. We propose a treatment algorithm that stratifies patients by severity, recommending that patients with more mild disease continue dupilumab and treat through symptoms, while patients with more severe disease discontinue dupilumab and consider switching to another class (e.g., Janus kinase inhibitors). Lastly, we discuss important ongoing questions that should be addressed in future studies.
{"title":"Dupilumab-Associated Arthritis: A Dermatology-Rheumatology Perspective","authors":"Michael J. Woodbury, Jeffrey S. Smith, Joseph F. Merola","doi":"10.1007/s40257-023-00804-5","DOIUrl":"10.1007/s40257-023-00804-5","url":null,"abstract":"<div><p>Dupilumab is an interleukin (IL)-4/13 inhibitor approved by the US FDA for multiple atopic indications. It is well-known to have favorable efficacy and safety profiles; however, emerging reports of dupilumab-associated arthritis suggest an underrecognized potential adverse effect. In this article, we summarize the literature to date to better characterize this clinical phenomenon. Arthritic symptoms were most commonly peripheral, generalized, and symmetric. Onset was generally within 4 months following initiation of dupilumab, and most patients resolved fully after a matter of weeks following discontinuation. Mechanistic insights suggest that suppression of IL-4 may lead to increased activity of IL-17, a prominent cytokine in inflammatory arthritis. We propose a treatment algorithm that stratifies patients by severity, recommending that patients with more mild disease continue dupilumab and treat through symptoms, while patients with more severe disease discontinue dupilumab and consider switching to another class (e.g., Janus kinase inhibitors). Lastly, we discuss important ongoing questions that should be addressed in future studies.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9677307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.1007/s40257-023-00801-8
Anna Aronovich, Ilya Novikov, Lev Pavlovsky
Background and Objective
The effectiveness of biologic treatments in slowing the progression of psoriatic arthritis is well established, but there is limited and conflicting evidence on their ability to prevent the development of psoriatic arthritis in patients with psoriasis. The objective of this review was to evaluate the role of biologic treatment for psoriasis in preventing or delaying subsequent psoriatic arthritis.
Methods
A literature search was performed using MEDLINE (PubMed), Embase, Web of Science, and the Cochrane Library for studies published in English from database inception to March 2022 that statistically compared the risk of psoriatic arthritis in patients aged > 16 years who were previously treated with biologic disease-modifying antirheumatic drugs or with other drugs for skin psoriasis.
Results
Four articles were eligible for analysis, all retrospective cohort studies. Three were conducted in preselected patients attending dermatology or dermatology–rheumatology collaboration centers and one was a large population-based study. In three studies, a primary two-step statistical analysis yielded a significantly lower risk of psoriatic arthritis in patients treated with biologic agents. These findings were not supported by the large retrospective electronic health record-based study.
Conclusions
Biologic treatments may be effective in preventing the development of psoriatic arthritis in patients with psoriasis. More research is needed given the retrospective cohort design of all studies included in the review limiting the generalizability of the results, and the conflicting results from the registry study. At present, biologic agents should not be prescribed to unselected patients with psoriasis for the sole purpose of preventing psoriatic arthritis.
背景和目的：生物治疗在减缓银屑病关节炎进展方面的有效性已得到充分证实，但关于其预防银屑病患者银屑病关节炎发展的能力，证据有限且相互矛盾。本综述的目的是评估银屑病的生物治疗在预防或延缓随后的银屑病关节炎中的作用。方法：使用MEDLINE（PubMed）、Embase、Web of Science和Cochrane Library进行文献检索，检索从数据库创建到2022年3月以英文发表的研究，这些研究对年龄>16岁的患者患银屑病关节炎的风险进行了统计比较，这些患者以前曾接受过生物疾病改良抗风湿药物或其他治疗皮肤银屑病的药物治疗。结果：4篇文章符合分析条件，均为回顾性队列研究。其中三项是在皮肤科或皮肤风湿病协作中心的预选患者中进行的，一项是基于人群的大型研究。在三项研究中，主要的两步统计分析显示，接受生物制剂治疗的患者患银屑病关节炎的风险显著降低。这些发现没有得到基于电子健康记录的大型回顾性研究的支持。结论：生物治疗可有效预防银屑病患者银屑病关节炎的发展。考虑到综述中所有研究的回顾性队列设计限制了结果的可推广性，以及注册研究的相互矛盾的结果，还需要更多的研究。目前，不应仅为了预防银屑病关节炎而给未经选择的银屑病患者开生物制剂。
{"title":"Do Biologic Treatments for Psoriasis Lower the Risk of Psoriatic Arthritis? A Systematic Review","authors":"Anna Aronovich, Ilya Novikov, Lev Pavlovsky","doi":"10.1007/s40257-023-00801-8","DOIUrl":"10.1007/s40257-023-00801-8","url":null,"abstract":"<div><h3>Background and Objective</h3><p>The effectiveness of biologic treatments in slowing the progression of psoriatic arthritis is well established, but there is limited and conflicting evidence on their ability to prevent the development of psoriatic arthritis in patients with psoriasis. The objective of this review was to evaluate the role of biologic treatment for psoriasis in preventing or delaying subsequent psoriatic arthritis.</p><h3>Methods</h3><p>A literature search was performed using MEDLINE (PubMed), Embase, Web of Science, and the Cochrane Library for studies published in English from database inception to March 2022 that statistically compared the risk of psoriatic arthritis in patients aged > 16 years who were previously treated with biologic disease-modifying antirheumatic drugs or with other drugs for skin psoriasis.</p><h3>Results</h3><p>Four articles were eligible for analysis, all retrospective cohort studies. Three were conducted in preselected patients attending dermatology or dermatology–rheumatology collaboration centers and one was a large population-based study. In three studies, a primary two-step statistical analysis yielded a significantly lower risk of psoriatic arthritis in patients treated with biologic agents. These findings were not supported by the large retrospective electronic health record-based study.</p><h3>Conclusions</h3><p>Biologic treatments may be effective in preventing the development of psoriatic arthritis in patients with psoriasis. More research is needed given the retrospective cohort design of all studies included in the review limiting the generalizability of the results, and the conflicting results from the registry study. At present, biologic agents should not be prescribed to unselected patients with psoriasis for the sole purpose of preventing psoriatic arthritis.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9661425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.1007/s40257-023-00782-8
Michael Sticherling, Arjen F. Nikkels, Ashraf M. Hamza, Pearl Kwong, Jacek C. Szepietowski, Mahira El Sayed, Pierre-Dominique Ghislain, Alkes A. Khotko, Manmath Patekar, Christine-Elke Ortmann, Pascal Forrer, Philemon Papanastasiou, Deborah Keefe
Background
Plaque psoriasis affects ~ 1% of the pediatric population, negatively impacting quality of life. The efficacy and safety of secukinumab in pediatric patients with moderate to severe or severe chronic plaque psoriasis have been established in two pivotal phase 3 trials (open-label, NCT03668613; double-blind, NCT02471144).
Objectives
The aims were to report the pooled safety of secukinumab up to 52 weeks from two studies in subgroups of pediatric patients stratified by age and bodyweight, and to present, alongside the pediatric data, the pooled safety data from four pivotal adult secukinumab trials.
Methods
The safety of secukinumab was evaluated in subgroups of pediatric patients defined by age (6 to < 12 and 12 to < 18 years) and bodyweight (< 25 kg, 25 to < 50 kg, and ≥ 50 kg) in the pooled population. Patients received secukinumab low dose (LD; 75/75/150 mg), secukinumab high dose (HD; 75/150/300 mg), placebo, or etanercept (0.8 mg/kg). For safety analyses, data were pooled from the pediatric studies NCT03668613 and NCT02471144, and presented alongside the pooled data from four adult pivotal studies (NCT01365455, NCT01636687, NCT01358578, NCT01555125).
Results
A total of 198 pediatric patients (overall exposure: 184.6 patient-years [PY]) and 1989 adult patients (1749.5 PY) receiving secukinumab up to week 52 were included in this analysis. At week 52, the incidence of adverse events (AEs) was lower in the lower age and bodyweight subgroups. The AEs reported within these subgroups were consistent with the overall AEs reported in this analysis. Overall, exposure-adjusted incidence rates for treatment-emergent AEs were lower in the secukinumab-treated pediatric pool (198.8/100 PY) compared with the etanercept (266.3/100 PY) and adult pools (256.1/100 PY). Up to 52 weeks, the incidence rates of the AEs in the secukinumab-treated patients in the 6 to < 12 years subgroup and 12 to < 18 years subgroup were 167.7/100 PY and 214.7/100 PY, respectively. Similarly, incidence rates of the AEs in the secukinumab-treated patients in the < 25 kg, 25 kg to < 50 kg, and ≥ 50 kg subgroups were 177.3/100 PY, 192.5/100 PY, and 206.8/100 PY, respectively. Nasopharyngitis was the most frequently reported AE in secukinumab-treated pediatric patients across age (< 12 years: 11.8/100 PY; ≥ 12 years: 42.4/100 PY) and bodyweight (< 25 kg: 22.8/100 PY; 25 kg to < 50 kg: 19.0/100 PY; ≥ 50 kg: 43.0/100 PY). Of the 198 secukinumab-treated pediatric patients, one reported nail Candida, one reported skin Candida, and two reported vulvovaginal Candida. Transient and mostly mild events of neutropenia were observed with secukinumab, none leading to study treatment discontinuation. No incidence of treatment-emergent anti-drug antibodies was reported in pediatric patients treated with secukinumab.
{"title":"Secukinumab in Pediatric Patients with Plaque Psoriasis: Pooled Safety Analysis from Two Phase 3 Randomized Clinical Trials","authors":"Michael Sticherling, Arjen F. Nikkels, Ashraf M. Hamza, Pearl Kwong, Jacek C. Szepietowski, Mahira El Sayed, Pierre-Dominique Ghislain, Alkes A. Khotko, Manmath Patekar, Christine-Elke Ortmann, Pascal Forrer, Philemon Papanastasiou, Deborah Keefe","doi":"10.1007/s40257-023-00782-8","DOIUrl":"10.1007/s40257-023-00782-8","url":null,"abstract":"<div><h3>Background</h3><p>Plaque psoriasis affects ~ 1% of the pediatric population, negatively impacting quality of life. The efficacy and safety of secukinumab in pediatric patients with moderate to severe or severe chronic plaque psoriasis have been established in two pivotal phase 3 trials (open-label, NCT03668613; double-blind, NCT02471144).</p><h3>Objectives</h3><p>The aims were to report the pooled safety of secukinumab up to 52 weeks from two studies in subgroups of pediatric patients stratified by age and bodyweight, and to present, alongside the pediatric data, the pooled safety data from four pivotal adult secukinumab trials.</p><h3>Methods</h3><p>The safety of secukinumab was evaluated in subgroups of pediatric patients defined by age (6 to < 12 and 12 to < 18 years) and bodyweight (< 25 kg, 25 to < 50 kg, and ≥ 50 kg) in the pooled population. Patients received secukinumab low dose (LD; 75/75/150 mg), secukinumab high dose (HD; 75/150/300 mg), placebo, or etanercept (0.8 mg/kg). For safety analyses, data were pooled from the pediatric studies NCT03668613 and NCT02471144, and presented alongside the pooled data from four adult pivotal studies (NCT01365455, NCT01636687, NCT01358578, NCT01555125).</p><h3>Results</h3><p>A total of 198 pediatric patients (overall exposure: 184.6 patient-years [PY]) and 1989 adult patients (1749.5 PY) receiving secukinumab up to week 52 were included in this analysis. At week 52, the incidence of adverse events (AEs) was lower in the lower age and bodyweight subgroups. The AEs reported within these subgroups were consistent with the overall AEs reported in this analysis. Overall, exposure-adjusted incidence rates for treatment-emergent AEs were lower in the secukinumab-treated pediatric pool (198.8/100 PY) compared with the etanercept (266.3/100 PY) and adult pools (256.1/100 PY). Up to 52 weeks, the incidence rates of the AEs in the secukinumab-treated patients in the 6 to < 12 years subgroup and 12 to < 18 years subgroup were 167.7/100 PY and 214.7/100 PY, respectively. Similarly, incidence rates of the AEs in the secukinumab-treated patients in the < 25 kg, 25 kg to < 50 kg, and ≥ 50 kg subgroups were 177.3/100 PY, 192.5/100 PY, and 206.8/100 PY, respectively. Nasopharyngitis was the most frequently reported AE in secukinumab-treated pediatric patients across age (< 12 years: 11.8/100 PY; ≥ 12 years: 42.4/100 PY) and bodyweight (< 25 kg: 22.8/100 PY; 25 kg to < 50 kg: 19.0/100 PY; ≥ 50 kg: 43.0/100 PY). Of the 198 secukinumab-treated pediatric patients, one reported nail <i>Candida</i>, one reported skin <i>Candida</i>, and two reported vulvovaginal <i>Candida</i>. Transient and mostly mild events of neutropenia were observed with secukinumab, none leading to study treatment discontinuation. No incidence of treatment-emergent anti-drug antibodies was reported in pediatric patients treated with secukinumab.</p><h3>Conclusions</h3><p>Secukinumab was well tolerated in pedi","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/9a/40257_2023_Article_782.PMC10460311.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10175627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-20DOI: 10.1007/s40257-023-00770-y
Annika Belzer, Eva Rawlings Parker
Climate change has a pervasive impact on health and is of clinical relevance to every organ system. Climate change-related factors impact the skin’s capacity to maintain homeostasis, leading to a variety of cutaneous diseases. Stratospheric ozone depletion has led to increased risk of melanoma and keratinocyte carcinomas due to ultraviolet radiation exposure. Atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoaging are all associated with rising levels of air pollution. Elevated temperatures due to global warming induce disruption of the skin microbiome, thereby impacting atopic dermatitis, acne vulgaris, and psoriasis, and high temperatures are associated with exacerbation of skin disease and increased risk of heat stroke. Extreme weather events due to climate change, including floods and wildfires, are of relevance to the dermatologist as these events are implicated in cutaneous injuries, skin infections, and acute worsening of inflammatory skin disorders. The health consequences as well as the economic and social burden of climate change fall most heavily on vulnerable and marginalized populations due to structural disparities. As dermatologists, understanding the interaction of climate change and skin health is essential to appropriately manage dermatologic disease and advocate for our patients.
{"title":"Climate Change, Skin Health, and Dermatologic Disease: A Guide for the Dermatologist","authors":"Annika Belzer, Eva Rawlings Parker","doi":"10.1007/s40257-023-00770-y","DOIUrl":"10.1007/s40257-023-00770-y","url":null,"abstract":"<div><p>Climate change has a pervasive impact on health and is of clinical relevance to every organ system. Climate change-related factors impact the skin’s capacity to maintain homeostasis, leading to a variety of cutaneous diseases. Stratospheric ozone depletion has led to increased risk of melanoma and keratinocyte carcinomas due to ultraviolet radiation exposure. Atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoaging are all associated with rising levels of air pollution. Elevated temperatures due to global warming induce disruption of the skin microbiome, thereby impacting atopic dermatitis, acne vulgaris, and psoriasis, and high temperatures are associated with exacerbation of skin disease and increased risk of heat stroke. Extreme weather events due to climate change, including floods and wildfires, are of relevance to the dermatologist as these events are implicated in cutaneous injuries, skin infections, and acute worsening of inflammatory skin disorders. The health consequences as well as the economic and social burden of climate change fall most heavily on vulnerable and marginalized populations due to structural disparities. As dermatologists, understanding the interaction of climate change and skin health is essential to appropriately manage dermatologic disease and advocate for our patients.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10174941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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