Pub Date : 2024-12-01Epub Date: 2024-07-22DOI: 10.1080/09546634.2024.2310631
Neal Bhatia, Jayme Heim, J Gabriel Vasquez, Tina Bhutani, Brad Schenkel, Ranga Gogineni, John Koo
Background: Tildrakizumab is an anti-interleukin-23 p19 monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis. This report describes final primary results of a 64-week real-world study of the effect of tildrakizumab on patients' health-related quality of life (HRQoL).
Materials and methods: In this open-label phase 4 study (NCT03718299), patients with moderate-to-severe plaque psoriasis received tildrakizumab 100 mg at week 0, week 4, and every 12 weeks thereafter through week 52. The primary endpoint was improvement from baseline in HRQoL measured by Psychological General Well-Being Index (PGWBI) total score at weeks 28 and 52. Secondary HRQoL endpoints included change from baseline in Dermatology Life Quality Index (DLQI) score through week 64. Missing data were not imputed.
Results: Of 55 patients enrolled, 45 were assessed at week 64. Mean ± standard deviation (SD) total PGWBI score improved from 78.1 ± 14.1 at baseline to 85.2 ± 12.0 at week 52 (p < .001). Mean ± SD DLQI score improved from 9.4 ± 5.2 at baseline to 2.0 ± 2.6 (p < .001) at week 64 with 62.2% of patients having a DLQI score of 0 or 1 at week 64.
Conclusions: Tildrakizumab improved long-term HRQoL in patients with psoriasis in a real-world setting.
{"title":"Long-term quality of life outcomes from a phase 4 study of tildrakizumab in patients with moderate-to-severe plaque psoriasis in a real-world setting.","authors":"Neal Bhatia, Jayme Heim, J Gabriel Vasquez, Tina Bhutani, Brad Schenkel, Ranga Gogineni, John Koo","doi":"10.1080/09546634.2024.2310631","DOIUrl":"https://doi.org/10.1080/09546634.2024.2310631","url":null,"abstract":"<p><strong>Background: </strong>Tildrakizumab is an anti-interleukin-23 p19 monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis. This report describes final primary results of a 64-week real-world study of the effect of tildrakizumab on patients' health-related quality of life (HRQoL).</p><p><strong>Materials and methods: </strong>In this open-label phase 4 study (NCT03718299), patients with moderate-to-severe plaque psoriasis received tildrakizumab 100 mg at week 0, week 4, and every 12 weeks thereafter through week 52. The primary endpoint was improvement from baseline in HRQoL measured by Psychological General Well-Being Index (PGWBI) total score at weeks 28 and 52. Secondary HRQoL endpoints included change from baseline in Dermatology Life Quality Index (DLQI) score through week 64. Missing data were not imputed.</p><p><strong>Results: </strong>Of 55 patients enrolled, 45 were assessed at week 64. Mean ± standard deviation (SD) total PGWBI score improved from 78.1 ± 14.1 at baseline to 85.2 ± 12.0 at week 52 (<i>p</i> < .001). Mean ± SD DLQI score improved from 9.4 ± 5.2 at baseline to 2.0 ± 2.6 (<i>p</i> < .001) at week 64 with 62.2% of patients having a DLQI score of 0 or 1 at week 64.</p><p><strong>Conclusions: </strong>Tildrakizumab improved long-term HRQoL in patients with psoriasis in a real-world setting.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-19DOI: 10.1080/09546634.2024.2368066
Le Han, Yuchen Jiang, Miaojian Wan
Purpose: To evaluate the efficacy of Mohs micrographic surgery (MMS) combined with photodynamic therapy (PDT) in treating non-invasive extramammary Paget's disease (EMPD).
Materials and methods: A 77-year-old male patient with non-invasive EMPD was treated with MMS followed by PDT. Preoperative fluorescence localization using 5-aminolevulinic acid (ALA) was performed to determine the surgical scope. MMS was conducted under lumbar anesthesia with intraoperative frozen-section pathology. Postoperative PDT was administered weekly for three sessions.
Results: The patient achieved negative surgical margins after two rounds of intraoperative pathology. Postoperative follow-up over two years showed no recurrence, and the patient did not experience significant adverse reactions.
Conclusion: The combination of MMS and PDT was effective in treating non-invasive EMPD, demonstrating favorable clinical outcomes and no recurrence over the two-year follow-up period.
{"title":"Preliminary analysis of the efficacy of Mohs micrographic surgery combined with photodynamic therapy in a case of noninvasive extramammary Paget's disease.","authors":"Le Han, Yuchen Jiang, Miaojian Wan","doi":"10.1080/09546634.2024.2368066","DOIUrl":"https://doi.org/10.1080/09546634.2024.2368066","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of Mohs micrographic surgery (MMS) combined with photodynamic therapy (PDT) in treating non-invasive extramammary Paget's disease (EMPD).</p><p><strong>Materials and methods: </strong>A 77-year-old male patient with non-invasive EMPD was treated with MMS followed by PDT. Preoperative fluorescence localization using 5-aminolevulinic acid (ALA) was performed to determine the surgical scope. MMS was conducted under lumbar anesthesia with intraoperative frozen-section pathology. Postoperative PDT was administered weekly for three sessions.</p><p><strong>Results: </strong>The patient achieved negative surgical margins after two rounds of intraoperative pathology. Postoperative follow-up over two years showed no recurrence, and the patient did not experience significant adverse reactions.</p><p><strong>Conclusion: </strong>The combination of MMS and PDT was effective in treating non-invasive EMPD, demonstrating favorable clinical outcomes and no recurrence over the two-year follow-up period.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-05DOI: 10.1080/09546634.2024.2363318
Aviv Barzilai, Shir Toubiana, Adam Dalal, Sharon Baum
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Most patients with moderate-to-severe disease require long-term antibiotic treatment, or biologic treatments to control their disease. Despite these interventions, relapses are common. This study evaluated the effectiveness of piperacillin/tazobactam treatment in patients with Hurley stage II and III HS who experienced disease flares and did not respond to conventional antibiotic and biologic treatment. Methods: Patients with HS hospitalized at the Department of Dermatology, Sheba Medical Center between August 2021 and January 2023 were retrospectively analyzed. Results: A cohort of ten such patients were treated with piperacillin/tazobactam for 6-21 days. Eight (80%) and two (20%) patients respectively demonstrated 2- and 1-grade improvements, from their baseline HS-Physician Global Assessment score. During the follow-up period, nine patients were monitored. HS Clinical Response (HiSCR) was achieved in six (66.7%) and five (55.6%) patients at the 3- and 6-month follow-up visits, respectively. Conclusions: In conclusion, Piperacillin/tazobactam emerges as a promising therapeutic option for disease flare-up in patients with Hurley stage II and III HS who do not respond to conventional treatment. Thus, piperacillin/tazobactam should be considered as crisis therapy for this patient subset.
背景:化脓性扁平湿疹(HS)是一种慢性炎症性皮肤病。大多数中重度患者需要长期接受抗生素治疗或生物制剂治疗来控制病情。尽管采取了这些干预措施,复发仍很常见。本研究评估了哌拉西林/他唑巴坦治疗Hurley II期和III期HS患者的效果,这些患者病情复发,且对常规抗生素和生物制剂治疗无效。研究方法回顾性分析2021年8月至2023年1月期间在谢巴医疗中心皮肤科住院的HS患者。结果10名此类患者接受了为期6-21天的哌拉西林/他唑巴坦治疗。八名患者(80%)和两名患者(20%)的HS-医生总体评估评分分别比基线评分提高了2级和1级。在随访期间,对 9 名患者进行了监测。在 3 个月和 6 个月的随访中,分别有 6 名(66.7%)和 5 名(55.6%)患者获得了 HS 临床反应(HiSCR)。结论总之,哌拉西林/他唑巴坦是治疗对常规治疗无效的赫氏 II 期和 III 期 HS 患者疾病复发的一种很有前景的治疗方案。因此,应考虑将哌拉西林/他唑巴坦作为这类患者的危机疗法。
{"title":"The role of piperacillin/tazobactam in the treatment of Hidradenitis suppurativa.","authors":"Aviv Barzilai, Shir Toubiana, Adam Dalal, Sharon Baum","doi":"10.1080/09546634.2024.2363318","DOIUrl":"https://doi.org/10.1080/09546634.2024.2363318","url":null,"abstract":"<p><p><b>Background:</b> Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Most patients with moderate-to-severe disease require long-term antibiotic treatment, or biologic treatments to control their disease. Despite these interventions, relapses are common. This study evaluated the effectiveness of piperacillin/tazobactam treatment in patients with Hurley stage II and III HS who experienced disease flares and did not respond to conventional antibiotic and biologic treatment. <b>Methods:</b> Patients with HS hospitalized at the Department of Dermatology, Sheba Medical Center between August 2021 and January 2023 were retrospectively analyzed. <b>Results:</b> A cohort of ten such patients were treated with piperacillin/tazobactam for 6-21 days. Eight (80%) and two (20%) patients respectively demonstrated 2- and 1-grade improvements, from their baseline HS-Physician Global Assessment score. During the follow-up period, nine patients were monitored. HS Clinical Response (HiSCR) was achieved in six (66.7%) and five (55.6%) patients at the 3- and 6-month follow-up visits, respectively. <b>Conclusions:</b> In conclusion, Piperacillin/tazobactam emerges as a promising therapeutic option for disease flare-up in patients with Hurley stage II and III HS who do not respond to conventional treatment. Thus, piperacillin/tazobactam should be considered as crisis therapy for this patient subset.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141895125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-11DOI: 10.1080/09546634.2024.2389174
April Armstrong, Melodie Young, Melissa S Seal, Robert C Higham, Teri Greiling
Background: Topical treatments are the foundation for patients with psoriasis; however, adherence can be limited by patient preferences and treatment burden.
Methods: The Harris Poll conducted an online survey of US patients with psoriasis who use prescription topical therapy to examine their preferences and perspectives on topical treatments.
Results: Among patients with psoriasis who use topical treatment (n = 507), most participants described their psoriasis symptoms as mild (31%) or moderate (59%). The body areas most often reported to be affected by psoriasis were the scalp, elbows, legs, intertriginous areas, arms, and knees. Participants reported psoriasis affecting the scalp (39%), elbows (20%), and legs (excluding knees; 19%) caused the greatest impact on quality of life. Most participants (76%) preferred topical therapies to treat their psoriasis, while 20% preferred pills, and 4% preferred injections. The most common product attributes that participants wanted in a topical psoriasis treatment and that would help them to continue to use the treatment were: improvement in plaques (68%), itch relief (68%), and easy to apply (63%).
Conclusion: The respondents to this survey reported that they prefer topical treatments to pills or injections (76%) and most (89%) reported they are interested in trying a new topical treatment.
{"title":"Treatment burden and the perspectives of patients with psoriasis using topical treatments: results from a national survey of adults with psoriasis in the United States.","authors":"April Armstrong, Melodie Young, Melissa S Seal, Robert C Higham, Teri Greiling","doi":"10.1080/09546634.2024.2389174","DOIUrl":"https://doi.org/10.1080/09546634.2024.2389174","url":null,"abstract":"<p><strong>Background: </strong>Topical treatments are the foundation for patients with psoriasis; however, adherence can be limited by patient preferences and treatment burden.</p><p><strong>Methods: </strong>The Harris Poll conducted an online survey of US patients with psoriasis who use prescription topical therapy to examine their preferences and perspectives on topical treatments.</p><p><strong>Results: </strong>Among patients with psoriasis who use topical treatment (<i>n</i> = 507), most participants described their psoriasis symptoms as mild (31%) or moderate (59%). The body areas most often reported to be affected by psoriasis were the scalp, elbows, legs, intertriginous areas, arms, and knees. Participants reported psoriasis affecting the scalp (39%), elbows (20%), and legs (excluding knees; 19%) caused the greatest impact on quality of life. Most participants (76%) preferred topical therapies to treat their psoriasis, while 20% preferred pills, and 4% preferred injections. The most common product attributes that participants wanted in a topical psoriasis treatment and that would help them to continue to use the treatment were: improvement in plaques (68%), itch relief (68%), and easy to apply (63%).</p><p><strong>Conclusion: </strong>The respondents to this survey reported that they prefer topical treatments to pills or injections (76%) and most (89%) reported they are interested in trying a new topical treatment.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-30DOI: 10.1080/09546634.2024.2339440
Saxon D Smith, Simon Fifer, Meredith Edwards, Anne Walter, Yichen Zhong, Joe Zhuo, Bronwyn West, Lynda Spelman
Background: Oral systemic and injectable biologic treatments are available in Australia to treat moderate to severe psoriasis.
Objective: To examine how patients and dermatologists in Australia choose between oral and injectable treatments for psoriasis.
Methods: In this discrete choice experiment (DCE), adults with moderate to severe psoriasis and dermatologists were asked to choose between 2 treatments labeled by mode of administration ('oral' or 'subcutaneous injection'), each with randomly assigned levels for 9 treatment attributes. Needle fear was rated by patients.
Results: Completed surveys from 178 patients and 43 dermatologists were included in the analysis. Symptom reduction, safety, and mode of administration were attributes found to have a significant impact on treatment choice; dosing frequency was a significant attribute for the injectable option. When treatment attributes were held equal, patients and dermatologists preferred oral versus injectable treatments for moderate disease. Patients with higher levels of needle fear were more likely to favor an oral treatment versus patients with lower levels of needle fear.
Limitations: Participation bias may limit the generalizability of these findings.
Conclusion: Participants preferred oral over injectable treatment for moderate psoriasis. These findings corroborate the need for efficacious oral therapies to treat the disease.
{"title":"Tradeoffs and decision-making in moderate to severe psoriasis for oral versus injectable treatments: data from patients and dermatologists in Australia.","authors":"Saxon D Smith, Simon Fifer, Meredith Edwards, Anne Walter, Yichen Zhong, Joe Zhuo, Bronwyn West, Lynda Spelman","doi":"10.1080/09546634.2024.2339440","DOIUrl":"https://doi.org/10.1080/09546634.2024.2339440","url":null,"abstract":"<p><strong>Background: </strong>Oral systemic and injectable biologic treatments are available in Australia to treat moderate to severe psoriasis.</p><p><strong>Objective: </strong>To examine how patients and dermatologists in Australia choose between oral and injectable treatments for psoriasis.</p><p><strong>Methods: </strong>In this discrete choice experiment (DCE), adults with moderate to severe psoriasis and dermatologists were asked to choose between 2 treatments labeled by mode of administration ('oral' or 'subcutaneous injection'), each with randomly assigned levels for 9 treatment attributes. Needle fear was rated by patients.</p><p><strong>Results: </strong>Completed surveys from 178 patients and 43 dermatologists were included in the analysis. Symptom reduction, safety, and mode of administration were attributes found to have a significant impact on treatment choice; dosing frequency was a significant attribute for the injectable option. When treatment attributes were held equal, patients and dermatologists preferred oral versus injectable treatments for moderate disease. Patients with higher levels of needle fear were more likely to favor an oral treatment versus patients with lower levels of needle fear.</p><p><strong>Limitations: </strong>Participation bias may limit the generalizability of these findings.</p><p><strong>Conclusion: </strong>Participants preferred oral over injectable treatment for moderate psoriasis. These findings corroborate the need for efficacious oral therapies to treat the disease.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-10DOI: 10.1080/09546634.2024.2347440
Kecen Liu, Jingru Sun
Purpose: The incidence of cutaneous paradoxical reactions associated with IL-17 inhibitors has gained attention in recent literature. Our report aims to investigate the characteristics of one rare paradoxical reaction, presenting as Behcet's disease.
Methods: We reported one case of Behcet's-like disease induced by secukinumab in a patient with psoriasis. This patient, a young woman with a long history of psoriasis, showed significant improvement in her psoriatic condition after receiving four doses of secukinumab. Unexpectedly, she developed symptoms such as high fever, painful oral and genital ulcers, facial maculopapules, and erythema nodosum-like lesions on her lower limbs. Despite neutrophilia, there was no evidence of infection found in her laboratory tests. Histological analysis of a skin biopsy highlighted subcutaneous panniculitis and a mixed inflammatory cell infiltrate in the dermis. The patient was consequently diagnosed with secukinumab-induced Behcet's-like disease. Additionally, we have reviewed nine other documented cases of Behcet's-like disease triggered by IL-17 inhibitors.
Results: This group showed no significant gender preference, suffering from conditions such as psoriasis, ankylosing spondylitis, and hidradenitis suppurativa. Oral and genital ulcers were prevalent among the paradoxical reactions noted. Marked improvement was observed in all patients upon discontinuation of the IL-17 inhibitors.
Conclusions: Our report serves to alert physicians to this uncommon but significant paradoxical effect that may arise with anti-IL-17 treatment.
{"title":"Behcet's-like disease induced by secukinumab in a patient with psoriasis: a case report and literature review.","authors":"Kecen Liu, Jingru Sun","doi":"10.1080/09546634.2024.2347440","DOIUrl":"10.1080/09546634.2024.2347440","url":null,"abstract":"<p><p><b>Purpose:</b> The incidence of cutaneous paradoxical reactions associated with IL-17 inhibitors has gained attention in recent literature. Our report aims to investigate the characteristics of one rare paradoxical reaction, presenting as Behcet's disease.</p><p><p><b>Methods:</b> We reported one case of Behcet's-like disease induced by secukinumab in a patient with psoriasis. This patient, a young woman with a long history of psoriasis, showed significant improvement in her psoriatic condition after receiving four doses of secukinumab. Unexpectedly, she developed symptoms such as high fever, painful oral and genital ulcers, facial maculopapules, and erythema nodosum-like lesions on her lower limbs. Despite neutrophilia, there was no evidence of infection found in her laboratory tests. Histological analysis of a skin biopsy highlighted subcutaneous panniculitis and a mixed inflammatory cell infiltrate in the dermis. The patient was consequently diagnosed with secukinumab-induced Behcet's-like disease. Additionally, we have reviewed nine other documented cases of Behcet's-like disease triggered by IL-17 inhibitors.</p><p><p><b>Results:</b> This group showed no significant gender preference, suffering from conditions such as psoriasis, ankylosing spondylitis, and hidradenitis suppurativa. Oral and genital ulcers were prevalent among the paradoxical reactions noted. Marked improvement was observed in all patients upon discontinuation of the IL-17 inhibitors.</p><p><p><b>Conclusions:</b> Our report serves to alert physicians to this uncommon but significant paradoxical effect that may arise with anti-IL-17 treatment.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2023-12-20DOI: 10.1080/09546634.2023.2292962
Anouk G M Caron, Manja Bloem, Hajar El Khattabi, Ayla C de Waal, Astrid M van Huizen, Nerissa P Denswil, Louise A A Gerbens, Phyllis I Spuls
Background:Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side effects. This systematic review summarizes the available evidence on dosing regimens.Materials and methods:A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.Results:Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m2/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.Conclusion:This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.
{"title":"The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review.","authors":"Anouk G M Caron, Manja Bloem, Hajar El Khattabi, Ayla C de Waal, Astrid M van Huizen, Nerissa P Denswil, Louise A A Gerbens, Phyllis I Spuls","doi":"10.1080/09546634.2023.2292962","DOIUrl":"https://doi.org/10.1080/09546634.2023.2292962","url":null,"abstract":"<p><p><b>Background:</b>Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side effects. This systematic review summarizes the available evidence on dosing regimens.<b>Materials and methods:</b>A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.<b>Results:</b>Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m<sup>2</sup>/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.<b>Conclusion:</b>This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2023-12-26DOI: 10.1080/09546634.2023.2295816
Alvaro Sanabria, Pilar Pinillos, Carlos Chiesa-Estomba, Orlando Guntinas-Lichius, Luiz P Kowalski, Antti A Mäkitie, Karthik N Rao, Alfio Ferlito
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
{"title":"Comparing Mohs micrographic surgery and wide local excision in the management of head and neck dermatofibrosarcoma protuberans: a scoping review.","authors":"Alvaro Sanabria, Pilar Pinillos, Carlos Chiesa-Estomba, Orlando Guntinas-Lichius, Luiz P Kowalski, Antti A Mäkitie, Karthik N Rao, Alfio Ferlito","doi":"10.1080/09546634.2023.2295816","DOIUrl":"10.1080/09546634.2023.2295816","url":null,"abstract":"<p><p>Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-01-31DOI: 10.1080/09546634.2024.2310643
Teppei Hagino, Mai Yoshida, Risa Hamada, Hidehisa Saeki, Eita Fujimoto, Naoko Kanda
Background: Janus kinase 1 inhibitor upadacitinib is therapeutically effective for atopic dermatitis (AD). However, predictive factors for high responders to upadacitinib have not been established in real-world clinical practice.
Objectives: To identify predictive factors for responders to upadacitinib 15 mg or 30 mg, defined as achievers of investigator's global assessment (IGA) 0/1 with ≥ 2-point improvement from basal IGA.
Methods: A retrospective study was conducted from August 2021 to July 2023 on 159 AD patients treated with upadacitinib 15 mg and 52 patients with 30 mg. Patients in each group were categorized into responders (achievers of IGA 0/1 at week 12) and non-responders (non-achievers). We compared baseline values of clinical and laboratory parameters between responders and non-responders. Logistic regression analysis was used to detect variables predicting responders. Receiver-operating characteristic curves were used for evaluating prediction capabilities of the variables.
Results: In logistic regression analysis, responders to 15 mg upadacitinib were associated with lower total EASI and higher age whereas responders to 30 mg were associated with lower LDH and lower IgE.
Conclusions: Lower total EASI and higher age may predict responders to upadacitinib 15 mg while lower IgE and lower LDH may predict responders to 30 mg.
{"title":"Predictive factors for responders to upadacitinib treatment in patients with atopic dermatitis.","authors":"Teppei Hagino, Mai Yoshida, Risa Hamada, Hidehisa Saeki, Eita Fujimoto, Naoko Kanda","doi":"10.1080/09546634.2024.2310643","DOIUrl":"10.1080/09546634.2024.2310643","url":null,"abstract":"<p><strong>Background: </strong>Janus kinase 1 inhibitor upadacitinib is therapeutically effective for atopic dermatitis (AD). However, predictive factors for high responders to upadacitinib have not been established in real-world clinical practice.</p><p><strong>Objectives: </strong>To identify predictive factors for responders to upadacitinib 15 mg or 30 mg, defined as achievers of investigator's global assessment (IGA) 0/1 with ≥ 2-point improvement from basal IGA.</p><p><strong>Methods: </strong>A retrospective study was conducted from August 2021 to July 2023 on 159 AD patients treated with upadacitinib 15 mg and 52 patients with 30 mg. Patients in each group were categorized into responders (achievers of IGA 0/1 at week 12) and non-responders (non-achievers). We compared baseline values of clinical and laboratory parameters between responders and non-responders. Logistic regression analysis was used to detect variables predicting responders. Receiver-operating characteristic curves were used for evaluating prediction capabilities of the variables.</p><p><strong>Results: </strong>In logistic regression analysis, responders to 15 mg upadacitinib were associated with lower total EASI and higher age whereas responders to 30 mg were associated with lower LDH and lower IgE.</p><p><strong>Conclusions: </strong>Lower total EASI and higher age may predict responders to upadacitinib 15 mg while lower IgE and lower LDH may predict responders to 30 mg.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-01-08DOI: 10.1080/09546634.2023.2301435
Rand Murshidi, Salsabiela Bani Hamad, Assem Al Refaei, Nour Shewaikani, Moayad Shaf'ei, Sara N Alshoubaki, Tala A Haddad, Tawfiq Khasawneh, Taima Fkheideh, Mahmoud Abdallat
Introduction: Isotretinoin is a widely used, effective medication for moderate to severe acne. It is typically used for several months, which necessitates regular laboratory monitoring. However, consensus on the optimal assessment frequency is lacking.
Method: This is a single-center retrospective study on 1182 patients who received isotretinoin for acne at the Dermatology Clinic in Jordan University Hospital over 5 years.
Results: Of the 1182 patients, 892 (76.57% females) met the inclusion criteria. An increase in the proportion of patients with abnormal triglycerides and total cholesterol levels from baseline to the sixth month was observed (p < 0.05). Conversely, differences in the number of patients with abnormal AST, ALT, and CBC were not found throughout treatment (p > 0.05). Moreover, there was a decrease in the neutrophil-to-lymphocyte ratio (NLR) ratio and systemic inflammatory index (SII) after the sixth month of isotretinoin treatment compared to the baseline (p = 0.012 and p = 0.021, respectively).
Conclusions: We found that a baseline cholesterol level of 163.9 mg/dl and a baseline triglycerides level of 85.5 mg/dL are highly specific and sensitive in detecting grade 1 abnormalities at the one-month follow-up. This novel prediction approach serves as an effective risk stratification method for isotretinoin acne patients.
简介异维A酸是一种广泛使用的治疗中重度痤疮的有效药物。该药通常使用数月,因此需要定期进行实验室监测。然而,对于最佳的评估频率还缺乏共识:这是一项单中心回顾性研究,研究对象是约旦大学医院皮肤科诊所 5 年来接受异维A酸治疗痤疮的 1182 名患者:在1182名患者中,892人(76.57%为女性)符合纳入标准。从基线到第六个月,观察到甘油三酯和总胆固醇水平异常的患者比例有所增加(P P > 0.05)。此外,与基线相比,异维A酸治疗第六个月后,中性粒细胞与淋巴细胞比率(NLR)和全身炎症指数(SII)有所下降(分别为 p = 0.012 和 p = 0.021):我们发现,基线胆固醇水平为 163.9 mg/dL 和基线甘油三酯水平为 85.5 mg/dL 在一个月的随访中对检测 1 级异常具有高度的特异性和敏感性。这种新颖的预测方法是异维A酸痤疮患者进行风险分层的有效方法。
{"title":"A novel predictive method for risk stratification in acne patients receiving isotretinoin: an analysis of laboratory abnormalities and changes in inflammatory parameters.","authors":"Rand Murshidi, Salsabiela Bani Hamad, Assem Al Refaei, Nour Shewaikani, Moayad Shaf'ei, Sara N Alshoubaki, Tala A Haddad, Tawfiq Khasawneh, Taima Fkheideh, Mahmoud Abdallat","doi":"10.1080/09546634.2023.2301435","DOIUrl":"10.1080/09546634.2023.2301435","url":null,"abstract":"<p><strong>Introduction: </strong>Isotretinoin is a widely used, effective medication for moderate to severe acne. It is typically used for several months, which necessitates regular laboratory monitoring. However, consensus on the optimal assessment frequency is lacking.</p><p><strong>Method: </strong>This is a single-center retrospective study on 1182 patients who received isotretinoin for acne at the Dermatology Clinic in Jordan University Hospital over 5 years.</p><p><strong>Results: </strong>Of the 1182 patients, 892 (76.57% females) met the inclusion criteria. An increase in the proportion of patients with abnormal triglycerides and total cholesterol levels from baseline to the sixth month was observed (<i>p</i> < 0.05). Conversely, differences in the number of patients with abnormal AST, ALT, and CBC were not found throughout treatment (<i>p</i> > 0.05). Moreover, there was a decrease in the neutrophil-to-lymphocyte ratio (NLR) ratio and systemic inflammatory index (SII) after the sixth month of isotretinoin treatment compared to the baseline (<i>p</i> = 0.012 and <i>p</i> = 0.021, respectively).</p><p><strong>Conclusions: </strong>We found that a baseline cholesterol level of 163.9 mg/dl and a baseline triglycerides level of 85.5 mg/dL are highly specific and sensitive in detecting grade 1 abnormalities at the one-month follow-up. This novel prediction approach serves as an effective risk stratification method for isotretinoin acne patients.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139379089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}