The Journal of dermatology最新文献

Dupilumab is an FDA-approved biologic widely used in clinical practice for moderate to severe atopic dermatitis (AD). Concordance between physician and patient outcome assessment from medical records is relatively unknown. We examined patient-reported and physician-reported improvement patterns with dupilumab in outpatient dermatology practice. We conducted a single-center, retrospective cohort study of adults with moderate to severe atopic dermatitis who initiated dupilumab between 2017 and 2023. Improvement was abstracted from physician notes in the electronic medical record at each visit as a binary outcome (yes/no). Patient-reported improvement was defined as documentation of symptomatic benefit (e.g., reduced itch, fewer flares), and physician-reported improvement as clinical improvement on physical exam or overall disease control. Visits were grouped into predefined intervals from treatment initiation (0-14, 15-30, 31-60, up to > 365 days). 405 patients contributed 1064 visits (mean age 46.7 years, 55.8% male). Mean treatment duration was 3.2 years, with 59.0% remaining on therapy at study conclusion. Patient-reported improvement was documented in 948/1064 visits (89.1%), and physician-reported improvement was noted in 868/1064 visits (81.6%). Patient-reported improvement rates were 79.7% at 0-14 days and 93.9% at 91-120 days from dupilumab initiation. Patient-physician concordance occurred in 946/1064 visits (88.9%). Treatment persistence was 86.2% at 12 months and 73.1% at 36 months. The most common reasons for treatment discontinuation were inefficacy (23.9%), adverse events (21.1%), and clinical improvement (21.1%). Dupilumab was associated with high rates of patient- and physician-reported improvement and treatment persistence in adults with moderate to severe atopic dermatitis.

In Japan, rosacea has attracted increasing interest. However, because rosacea had been thought to be relatively rare in Japan, the perception of this disease varies among dermatologists. To address these challenges, this study developed a consensus regarding the diagnosis, classification, and treatment of rosacea using a modified Delphi method based on the expertise of Japanese specialists in rosacea. Ten Japanese dermatologists were included in the expert panel based on their expertise in rosacea treatment and contributions to the field of rosacea. For each item that mentioned rosacea, the specialists responded with "disagree," "neither agree nor disagree," "agree," or "don't know/can't answer." Consensus was defined as ≥ 80% agreement among panel members. Panel consensus was obtained for all 50 items related to rosacea (e.g., disease types, characteristics, diagnosis, factors for onset and exacerbation, and treatment). An online survey on the consensus statements revealed discrepancies between general dermatologists and panel members. In the postsurvey meeting, the panel members discussed the differentiation between rosacea and similar diseases and proposed an algorithm for differentiating rosacea. The panel members concluded that the goal of rosacea treatment in Japan should be to "maintain a state wherein the patient's daily life is not affected by symptoms over the long term" rather than "complete cure." Thus, this study integrated the findings of the expert panel and proposed a consensus statement on rosacea treatment in Japan. The organization of knowledge and dissemination of information regarding rosacea among general dermatologists will improve the treatment outcomes of patients with rosacea.

The efficacy and safety of ritlecitinib, a dual inhibitor of Janus kinase 3 (JAK3) and tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinases, have been demonstrated in the ALLEGRO phase 2b/3 trial that enrolled patients aged ≥ 12 years with alopecia areata (AA) and ≥ 50% scalp hair loss. The present analysis evaluated the cost-effectiveness of ritlecitinib compared with no treatment for patients with AA and ≥ 50% scalp hair loss in Japan from a societal perspective. A Markov model stratified by health states based on the Severity of Alopecia Tool (SALT) was developed to estimate the lifetime costs, including productivity loss, and quality-adjusted life years (QALYs) associated with the treatment of AA. The comparator was no treatment, and clinical parameters were based on the ALLEGRO phase 2b/3 trial. Costs and QALYs were discounted at an annual rate of 2%, and the incremental cost-effectiveness ratio (ICER) was calculated. Over a lifetime horizon and with the base-case societal perspective, the incremental QALYs and incremental costs of ritlecitinib 50 mg were 1.09 QALYs and 5 262 471 Japanese yen (JPY) (34 766 United States dollars [USD]), respectively. The ICER was 4 816 589 JPY (31 820 USD) per QALY, which was below the cost-effectiveness threshold in Japan of 5 000 000 JPY (33 032 USD) per QALY. A one-way sensitivity analysis showed that parameters with the most notable effect on the ICER were the utility for patients with SALT score ≥ 50, percentage of work time missed due to presenteeism for patients with SALT score ≥ 50, and the discontinuation rate of ritlecitinib 50 mg. These results indicate that ritlecitinib 50 mg is cost-effective compared with no treatment for patients with AA and hair loss on ≥ 50% of the scalp from a societal perspective in Japan.