scholarly journals Slow responder against methotrexate 50 mg intramuscular in severe psoriatic patients: A case series

2019 ◽  
Author(s):  
Niken Kusumaningrum ◽  
Danar Wicaksono ◽  
Dwi Retno Adi Winarni ◽  
Yohanes Widodo Wirohadidjojo ◽  
Sunardi Radiono
Keyword(s):  
Risk Factor ◽  
Treatment Modality ◽  
Case Series ◽  
Severity Index ◽  
Severe Psoriasis ◽  
Slow Response ◽  
Psoriasis Area Severity Index ◽  
Oral Tablet ◽  
Drug Of Choice ◽  
Slow Responder

Methotrexate is the drug of choice used on moderate to severe psoriasis. The limited availability of oral tablet methotrexate stimulates the initiation of the protocol therapy 50 mg intramuscular methotrexate weekly in six consecutive weeks for severe psoriasis cases. There were 30 cases treated using this treatment modality. Twenty-six cases (86%) showed a good response and achieved PASI-90(Psoriasis Area Severity Index-90), four cases (13%) showed a slow response and did not achieve PASI-90. This case report collected slow response cases and identified their risk factor of slow responsiveness with this treatment modality. The comorbidity condition like metabolic syndrome, drugs induced psoriasis, continuous trauma, the side effect of methotrexate administration (ulceration), or the possibility of allergic or irritant contact dermatitis from occupation are suspected to be the risk factor for slow responders in this treatment modality.

scholarly journals Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e032552 ◽  
Author(s):  
Bernd Schweikert ◽  
Chiara Malmberg ◽  
Mercedes Núñez ◽  
Tatiana Dilla ◽  
Christophe Sapin ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Cost Effectiveness ◽  
Maintenance Therapy ◽  
Induction Period ◽  
Severity Index ◽  
Cost Effectiveness Analysis ◽  
Severe Psoriasis ◽  
Base Case ◽  
Psoriasis Area Severity Index ◽  
Effectiveness Analysis

ObjectiveTo conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab.DesignA Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biological disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, maintenance therapy, best supportive care (BSC) and death. Treatment response was assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and ≥90% improvement in the Psoriasis Area Severity Index score (PASI90). At the end of the induction period, responders transitioned to maintenance therapy. Non-responders and patients who discontinued maintenance therapy transitioned to BSC. Clinical efficacy data were derived from a network meta-analysis. Health utilities were generated by applying a regression analysis to Psoriasis Area Severity Index and Health Assessment Questionnaire‒Disability Index scores collected in the ixekizumab SPIRIT studies. Results were subject to extensive sensitivity and scenario analysis.SettingSpanish NHS.ParticipantsA hypothetical cohort of bDMARD-naïve patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis was modelled.InterventionsIxekizumab and secukinumab.ResultsIxekizumab performed favourably over secukinumab in the base-case analysis, although cost savings and quality-adjusted life-year (QALY) gains were modest. Total costs were €153 901 compared with €156 559 for secukinumab (difference −€2658). Total QALYs were 9.175 vs 9.082 (difference 0.093). Base-case results were most sensitive to the annual bDMARD discontinuation rate and the modification of PsARC and PASI90 response to ixekizumab or secukinumab.ConclusionIxekizumab provided more QALYs at a lower cost than secukinumab, with differences being on a relatively small scale. Sensitivity analysis showed that base-case results were generally robust to changes in most input parameters.Trial registration numberSPIRIT-P1: NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results.

scholarly journals Treatment of moderate to severe psoriasis with apremilast over 2 years in the context of long-term treated HIV infection: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984519 ◽  
Author(s):  
Misha Zarbafian ◽  
Benoit Cote ◽  
Vincent Richer
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections ◽  
Total Body Surface Area ◽  
Undetectable Viral Load ◽  
Severity Index ◽  
Severe Psoriasis ◽  
Psoriasis Area Severity Index ◽  
Quality Of Life Index ◽  
Pasi Score ◽  
Total Body

Treatment of moderate-to-severe psoriasis in patients with HIV infection is a clinical challenge. We present the case of a patient with a longstanding history of well-controlled HIV. He had failed topical management, and his hypertriglyceridemia made use of acitretin potentially unsafe. He was unable to regularly attend a phototherapy unit. Physical examination revealed 12% total body surface area involvement with a Psoriasis Area Severity Index (PASI) of 10.2. His Dermatology Quality of Life Index (DLQI) was 20. After 3 months of apremilast treatment, his PASI decreased to 4.1. After 7 months, his PASI decreased to 2.7 and his DLQI to 1. Two years later, his PASI score was 2.4, with a stable CD4 count of 1200 cells/mm3 and an undetectable viral load. There were no serious opportunistic infections or laboratory abnormalities. To our knowledge, this represents the second reported case of psoriasis treatment with apremilast in a patient with HIV.

scholarly journals Safety and Impact of Anti-COVID-19 Vaccines in Psoriatic Patients Treated with Biologics: A Real Life Experience

2021 ◽  
Vol 10 (15) ◽  
pp. 3355
Author(s):  
Nevena Skroza ◽  
Nicoletta Bernardini ◽  
Ersilia Tolino ◽  
Ilaria Proietti ◽  
Alessandra Mambrin ◽  
...  
Keyword(s):  
Life Experience ◽  
Real Life ◽  
Severity Index ◽  
Primary Objective ◽  
Severe Psoriasis ◽  
Psoriasis Area Severity Index ◽  
Immunomodulating Therapy ◽  
Prophylactic Vaccination ◽  
Secondary Objective ◽  
Biotechnological Drugs

Since all clinical trials conducted during the development of anti-COVID-19 vaccines have adopted among the exclusion criteria the presence of immunodepression or immunomodulating therapy, to date, the effects of vaccination against the new coronavirus 2 in people under such conditions have yet to be clearly defined. The primary objective of the study is to assess the safety of treatment with biotechnological drugs in patients suffering from moderate–severe psoriasis and subjected to the prophylactic vaccination against SARS-Cov-2. Additionally, the secondary objective of the research is to investigate the existence of a possible impact of anti-COVID-19 vaccination on the natural chronic-relapsing course and the severity of the psoriatic disease. The study included 436 patients with moderate–severe psoriasis, both male and female, in treatment with biologics. The data were collected using the direct interview method. A reduction of 74.13% of average Psoriasis Area Severity Index (PASI )compared to baseline (T0) was found in all subjects; this does not differ significantly from the group that underwent vaccination (73.4%). Moreover; at the end of the study, neither mild nor severe adverse events (ADR) were observed among them. In conclusion, biotechnological drugs used in the management of patients with moderate–severe psoriasis demonstrate a high safety profile also in subjects immunized against SARS-Cov-2.

scholarly journals Cost-Effectiveness Analysis of Psoriasis Treatment Modalities in Malaysia

2019 ◽  
Vol 8 (7) ◽  
pp. 394-402
Author(s):  
Nor Azmaniza Azizam ◽  
Aniza Ismail ◽  
Saperi Sulong ◽  
Norazirah Md Nor
Keyword(s):  
Cost Effectiveness ◽  
Treatment Options ◽  
Life Quality ◽  
Severity Index ◽  
Severe Psoriasis ◽  
Public Hospitals ◽  
Treatment Modalities ◽  
Psoriasis Area Severity Index ◽  
Cost Effective Treatment ◽  
The Cost

Background: There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. Methods: This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015’s recorded Malaysian Ringgit (RM) currency. Results: Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter. Conclusion: Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options.

scholarly journals Secukinumab efficacy in the treatment of various types of psoriasis: A case series

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
K. Geetha ◽  
N. Sudhakar
Keyword(s):  
Tertiary Care ◽  
Life Quality ◽  
Case Series ◽  
Severity Index ◽  
Rapid Onset ◽  
Onset Of Action ◽  
Psoriasis Area Severity Index ◽  
College Hospital ◽  
Medical College

The aim of this article is to describe our experience in a tertiary care medical college hospital with secukinumab in the treatment of various types of psoriasis as a case series of 10 patients. All the patients showed significant improvement in psoriasis area severity index and dermatology life quality index scores with no major adverse event reported during the period of study for 6 months duration. Secukinumab may be effective and safe for the treatment of all types of psoriasis with rapid onset of action and improvement in the quality of life.

Preliminary Validation of the Severity of Nail Psoriasis Score (SNAPS) for the Assessment of Nail Psoriasis in Patients With Psoriatic Arthritis

2021 ◽  
pp. 247553032110114
Author(s):  
Anna Antony ◽  
Sadaf Saeed ◽  
Darren Hart ◽  
Preeti Nair ◽  
Charlotte Cavill ◽  
...  
Keyword(s):  
Severity Index ◽  
Routine Care ◽  
Measurement Properties ◽  
Strong Correlations ◽  
Nail Dystrophy ◽  
Psoriasis Area Severity Index ◽  
Nail Psoriasis ◽  
Outcome Instrument ◽  
Preliminary Validation

Background: Psoriatic nail dystrophy is infrequently assessed in routine care and observational cohorts due to the lack of a feasible validated outcome measure. Objective: To assess the measurement properties of the “Severity of NAil Psoriasis Score” (SNAPS) in PsA. Methods: Nail photography was performed on prospectively recruited patients at baseline and 6 months. The modified Nail Psoriasis Severity Index (mNAPSI) and Physician Nail Visual Acuity Scale (PhNVAS) were comparator instruments for construct validity. Reliability and feasibility were assessed using intra-class correlations (ICCs) and timed scoring. Responsiveness was assessed by correlating the changes in SNAPS, mNAPSI and PhNVAS. Retrospective data from the Bath PsA database was further utilized to assess responsiveness. Results: 21 patients participated in the prospective validation at baseline. Inter- and intra-rater reliability of SNAPS were 0.94 and 0.93-0.96 (p ≤ 0.005). Mean times required to score SNAPS and mNAPSI were 59 and 136 seconds. There were strong correlations between SNAPS and mNAPSI (r = 0.95, p < 0.001) and PhNVAS (r = 0.77, p < 0.001) at baseline. There was a significant reduction in the mNAPSI and SNAPS (p < 0.005) at 6 months and a strong correlation between the change in SNAPS and mNAPSI (rho = 0.838, p < 0.001). Historical data from 57 patients commenced on Etanercept were evaluated. Mean SNAPS reduced from 3.6 to 2.0 at 3 months and 1.2 at 6 months (p < 0.05). Change in SNAPS correlated with changes in Psoriasis Area Severity Index and Dermatology Quality of Life at 3 and 6 months (r≥0.510; p ≤ 0.003). Conclusion: SNAPS is a feasible, reliable and responsive outcome instrument for psoriatic nail dystrophy.

Identifying Top Predictors of Change in Noncalcified Coronary Burden in Psoriasis by Machine Learning Over 1-Year

2021 ◽  
pp. 247553032110007
Author(s):  
Eric Munger ◽  
Amit K. Dey ◽  
Justin Rodante ◽  
Martin P. Playford ◽  
Alexander V. Sorokin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Blood Pressure ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Severity Index ◽  
Blood Cell Count ◽  
Psoriasis Area Severity Index ◽  
Severity Index Score

Background: Psoriasis is associated with accelerated non-calcified coronary plaque burden (NCB) by coronary computed tomography angiography (CCTA). Machine learning (ML) algorithms have been shown to effectively identify cardiometabolic variables with NCB in cross-sectional analysis. Objective: To use ML methods to characterize important predictors of change in NCB by CCTA in psoriasis over 1-year of observation. Methods: The analysis included 182 consecutive patients with 80 available variables from the Psoriasis Atherosclerosis Cardiometabolic Initiative, a prospective, observational cohort study at baseline and 1-year using the random forest regression algorithm. NCB was assessed at baseline and 1-year from CCTA. Results: Using ML, we identified variables of high importance in the context of predicting changes in NCB. For the cohort that worsened NCB (n = 102), top baseline variables were cholesterol (total and HDL), white blood cell count, psoriasis area severity index score, and diastolic blood pressure. Top predictors of 1-year change were change in visceral adiposity, white blood cell count, total cholesterol, c-reactive protein, and absolute lymphocyte count. For the cohort that improved NCB (n = 80), the top baseline variables were HDL cholesterol related including apolipoprotein A1, basophil count, and psoriasis area severity index score, and top predictors of 1-year change were change in apoA, apoB, and systolic blood pressure. Conclusion: ML methods ranked predictors of progression and regression of NCB in psoriasis over 1 year providing strong evidence to focus on treating LDL, blood pressure, and obesity; as well as the importance of controlling cutaneous disease in psoriasis.

scholarly journals Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

2021 ◽  
Vol 10 (6) ◽  
pp. 1288
Author(s):  
Riccardo Senter ◽  
Federico Capone ◽  
Stefano Pasqualin ◽  
Lorenzo Cerruti ◽  
Leonardo Molinari ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Imaging Modality ◽  
Case Series ◽  
Severity Index ◽  
Disease Stage ◽  
Retrospective Case ◽  
North East ◽  
High Flow Oxygen ◽  
B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

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