Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis / Custo-efetividade do tratamento biológico para psoríase moderada a grave no sistema brasileiro de saúde suplementar: resultados de custo por resposta obtidos por meio de uma metanálise em rede

Objective: To assess the cost-per-responder (CpR) of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) from the private healthcare system's perspective. Methods: Number needed to treat (NNT) and (CpR) analyses were performed to evaluate biologic therapies' cost-effectiveness for moderate-to-severe PsO available in Brazil. The effectiveness of biologic treatments for moderate-to-severe PsO was assessed based on a previously published metanalysis, which included studies considering PsO patients and outcomes of interest (PASI 75, 90, and 100). The clinical efficacy data in terms of estimated NNT based on the network metanalysis (NMA) results were combined with drug treatment costs to determine the CpR for each treatment arm in 3-time horizons: the primary response period, 1-year, and 2-years. Results: Risankizumab was the most cost-effective option when NMA base case scenario data was used to calculate NNT in all PASI response for both the primary response period and 1- and 2-years follow-up durations. Differences in CpR between risankizumab and other biologic drugs increased with more significant PASI improvements. CpR sensitivity analysis also confirmed these findings, indicating that risankizumab has a better performance for PASI 100, and both risankizumab and guselkumab are very similar in terms of cost per additional PASI 75 and PASI 90 responder. Conclusions: Risankizumab was estimated to have a lower cost per PASI 75, 90, and 100 responders in most simulated scenarios (primary response period [12-16 weeks], 1-year and 2-years), among the evaluated biologic therapies.

Objetivo: Avaliar o custo por respondedor (CpR) das terapias biológicas disponíveis no Brasil para tratamento da psoríase em placas (PsO) moderada a grave, na perspectiva do sistema brasileiro de saúde suplementar. Métodos: Foram realizadas análises de número necessário para tratar (NNT) e CpR para avaliar o custo-efetividade das terapias biológicas para PsO moderada a grave disponíveis no Brasil. A eficácia foi avaliada por meio de dados de uma metanálise em rede (NMA), que incluiu estudos considerando pacientes com PsO moderada a grave e os desfechos de interesse (PASI 75, 90 e 100). Dados de eficácia em termos de NNT foram combinados com custos do tratamento medicamentoso para determinar o CpR para cada braço de tratamento em três horizontes temporais: período de resposta primária, 1 ano e 2 anos. Resultados: Risanquizumabe foi mais econômico quando utilizados os dados do caso-base para calcular o NNT, considerando todos os escores PASI para o período de resposta primária e em 1 e 2 anos. As diferenças no CpR entre o risanquizumabe e os outros medicamentos biológicos aumentaram com maiores ganhos de PASI. O CpR calculado pela análise de sensibilidade confirmou esses achados, indicando que risanquizumabe tem um melhor desempenho para PASI 100, e risanquizumabe e guselcumabe são muito semelhantes em termos de CpR por PASI 75 e PASI 90 adicionais. Conclusões: Risanquizumabe apresentou um custo mais baixo por respondedor PASI 75, 90 e 100 na maioria dos cenários analisados (período de resposta primária [12-16 semanas], 1 ano e 2 anos), entre as terapias biológicas avaliadas.

Moderate to severe plaque psoriasis - treatment with drugs of the classic scheme

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Psoriasis in moderate grave plaque - immunobiological treatment

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

The association between psoriasis and health-related quality of life, work productivity, and healthcare resource use in Brazil

Abstract: Background: Psoriasis is a chronic, immune mediated inflammatory condition that affects a significant amount of the global population. Yet geographic variability in the consequences of psoriasis warrants region-level analyses. Objective: The current study contributes to the psoriasis outcomes literature by offering a comprehensive assessment of the humanistic and economic burden in Brazil. Methods: The 2012 Brazil National Health and Wellness Survey (N=12,000) was used to assess health-related quality of life (Short Form-12, version 2), work productivity, and healthcare resource use associated with experiencing psoriasis vs. no psoriasis, along with varying levels of psoriasis severity. Results: A total of 210 respondents reported diagnosis of psoriasis (N=157, 42, and 11 reporting mild, moderate, and severe psoriasis, respectively). Compared with controls, respondents with psoriasis reported diminished mental component summary scores and health utilities, as well as increased presenteeism, activity impairment, and physician visits over the past six months, adjusting for covariates. Among those with psoriasis, physical health decreased as psoriasis severity increased. Although work productivity and healthcare resource utilization did not differ with psoriasis severity, the high rates of productivity loss (e.g. 45.5% presenteeism in the severe psoriasis group) suggest an economic burden. Study limitations: Cost analyses were not performed, and cross-sectional patient-reported data limit causal conclusions and may reflect reporting biases. Conclusions: Nevertheless, these results suggest a significant burden to patients with psoriasis across both humanistic and economic outcomes. The association between psoriasis and mental health aspects and health utilities were particularly strong and exceeded what would be considered clinically meaningful.

Psoriasis comorbidities: complications and benefits of immunobiological treatment

Abstract During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients.

The use of ustekinumab in a patient with severe psoriasis and positive HBV serology

Psoriasis is a chronic inflammatory, immune-mediated disease that affects 1% to 2% of the world's population. Immunobiological medications are prescribed for certain patients with severe forms of psoriasis, however, these drugs increase the risk of reactivation of viral diseases such as hepatitis B. We report the case of a patient with severe psoriasis with positive serology for the Hepatitis B virus, who received ustekinumab (a human monoclonal antibody against interleukin 12 and 23). In this patient, the use of ustekinumab did not reactivate the Hepatitis B virus. Given the high prevalence of chronic viral infections in patients who are candidates for biologic therapy, as well as the potential for reactivate chronic viral illness, randomized controlled studies are needed to assess the risks and benefits of such therapy in these populations.

Intervenções educacionais e psicológicas para psoríase: uma revisão sistemática / Educational and psychological interventions on psoriasis: a systematic review

INTRODUÇÃO: Psoríase em placas é uma dermatose crônica que tem um impacto importante nas dimensões social e psicológica nos pacientes. Estudos anteriores sugeriram que intervenções educacionais e psicológicas podem ser efetivas no gerenciamento da psoríase. OBJETIVOS: Examinar as intervenções educativas e psicológicas para psoríase em período de 20 anos (1992 a 2012). MÉTODO: revisão sistemática de literatura nas bases de dados: PubMed/Medline, PsycInfo (APA), ProQuest e Pepsic. RESULTADOS: 1359 artigos foram primeiramente selecionados por busca computadorizada, dos quais 36 foram analisados por dois revisores. Sete (n=7) estudos foram posteriormente selecionados para análise detalhada, sendo um artigo (n=1) de intervenção educativa individual, dois (n=2) envolvendo intervenções psicológicas e quatro (n=4) programas de gerenciamento de sintomas. CONCLUSÃO: Embora a literatura aponte para um crescente número de estudos de intervenção para psoríase e variáveis psicológicas, são necessários estudos de maior rigor para ajudar os pacientes a lidar com a doença.(AU)

BACKGROUND: Plaque psoriasis is a chronic skin disorder that has a major impact on patient´s social and psychological abilities. Preliminary studies have suggested that educative and psychological interventions may be effective in the management of psoriasis. OBJECTIVES: To examine the educative and psychological interventions for psoriasis in the last 20 years (1992-2012). METHODS: A systematic review of literature was conducted in medical and psychological databases: PubMed / Medline, PsycInfo (APA), ProQuest and Pepsic. RESULTS: 1359 articles were first selected by computerized search, from which 36 were examined by two revisers. Seven studies (n=7) were selected to a more in depth analysis, one (n=1) was a single educative intervention, two (n=2) involved psychological interventions and four (n=4) were symptom management programmes. CONCLUSION: Although the recent literature shows an increase number of interventions targeting psoriasis and psychosocial variables, stronger studies are necessary to help patients deal with the disease.(AU)

Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma / Pistas dermatoscópicas no diagnóstico de melanoma maligno amelanótico e hipomelanótico

The clinical identification of amelanotic malignant melanoma (AMM) and hypomelanotic malignant melanoma (HMM) becomes difficult due to the lack of pigmentation and to the diverse clinical presentations. Dermoscopy is very useful in these cases, increasing the level of suspicion of malignancy. We report 4 cases of amelanotic malignant melanoma and hypomelanotic malignant melanoma with characteristic dermoscopic findings. Dermoscopy under polarized light demonstrates vascular polymorphism, globules and milky-red areas, in addition to chrysalis and multiple blue-gray dots.

A identificação clínica de melanoma maligno amelanótico e hipomelanótico torna-se difícil devido à falta de pigmentação e às diversas apresentações desse tipo de tumor. A dermatoscopia é muito útil nestes casos, aumentando o grau de suspeição de malignidade. Relatamos 4 casos de melanoma maligno amelanótico e melanoma maligno hipomelanótico com achados dermatoscópicos característicos. A dermatoscopia com luz polarizada demonstra polimorfismo vascular, glóbulos e áreas vermelholeitosas, assim como crisálides e múltiplos pontos azul-acinzentados.

HLA and skin cancer / HLA e câncer de pele

Skin cancer - melanoma and non melanoma - are common neoplasm with rising incidence over the last decades. It is an important public health problem. Its pathogenesis is not completely understood and the same happens with the genetic factors involved. The genes that encode the HLA are associated with some tumors and they may be responsible for one of the mechanisms that take part in the development of the before mentioned cancers. We have reviewed the literature on the subject of HLA antigens, melanoma and non melanoma skin cancer.

Os cânceres da pele - melanoma e não-melanoma - são neoplasias comuns e com incidência crescente ao longo de décadas. Representam um importante problema de saúde pública. A patogênese destas neoplasias não é completamente compreendida, assim como não o são os fatores genéticos envolvidos. Os genes HLA estão associados a alguns tumores e podem representar um dos mecanismos implicados no desenvolvimento do câncer de pele. Apresenta-se uma revisão atualizada sobre a relação entre antígenos HLA, câncer da pele não-melanoma e melanoma.

Ceratose pilar e ulerythema ophryogenes em mulher com monossomia do braço curto do cromosomo 18 / Keratosis pilaris and ulerythema ophryogenes in a woman with monosomy of the short arm of chromosome 18

A monossomia parcial do braço curto do cromosomo 18 (síndrome do 18p) caracteriza-se, principalmente, por atraso na aquisição da fala, retardo mental leve a moderado e baixa estatura. Relatamos o caso de uma paciente com esta síndrome associada à ceratose pilar extensa e ulerythema ophryogenes. Este é o quarto relato de caso que descreve tal associação, que desperta considerável interesse porque pode revelar uma região candidata a sede de genes responsáveis pela queratinização folicular.

Partial monosomy of the short arm of chromosome 18 (18p- syndrome) is characterized mainly by speech delay, mild to moderate mental retardation and short stature. We describe a patient with the 18psyndrome and widespread severe keratosis pilaris and ulerythema ophryogenes. This is the fourth case in which such an association has been reported. This association is of considerable interest because it may uncover a candidate genomic region and help to identify the gene responsible for follicular keratinization.

Frequência de dermatoses infecciosas em 208 pacientes transplantados renais / Frequency of infectious dermatosis in 208 renal transplant recipients

Nos pacientes transplantados renais, a imunossupressão crônica acarreta maior suscetibilidade às dermatoses infecciosas. Avaliar a freqüência de dermatoses infecciosas em 208 pacientes transplantados renais no período de 12 meses e verificar a relação entre sua ocorrência e o período de tempo transcorrido desde o transplante, 208 transplantados renais de uma população de 720 pacientes foram submetidos a exame dermatológico no período de um ano, tendo sido realizados exames anatomopatológico micológico, bacteriológico e/ou cultural das lesões suspeitas. A freqüência de dermatoses infecciosas nessa população foi de 89,4 por cento. As infecções fúngicas, virais, bacterianas e parasitárias mais freqüentes foram pitiríase versicolor (17,8 por cento), verruga vulgar (32,2 por cento), foliculite (4,3 por cento) e escabiose (3,8 por cento).As dermatoses infecciosas são freqüentes nos pacientes transplantados renais, e sua ocorrência aumenta progressivamente conforme o tempo transcorrido a partir do transplante, sendo importante o acompanhamento dermatológico desses pacientes

Sarcoma de Kaposi em paciente transplantada renal em uso de Fk-506 / Kaposi's Sarcoma in a renal transplant patient receiving Fk-506

O Sarcoma de Kaposi (SK) é neoplasia maligna multicêntrica, cutânea e extracutânea, que tem sido descrita em pacientes transplantados renais que recebem terapia imunossupressora clássica. Este estudo descreve um caso de sarcoma de Kaposi em paciente transplantada renal recebendo FK-506, que surgiu 10 meses após o transplante