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1.
J Med Econ ; 25(1): 741-749, 2022.
Article in English | MEDLINE | ID: covidwho-1864882

ABSTRACT

AIMS: To compare long-term healthcare resource utilization (HCRU) and costs among patients who initiated ixekizumab (IXE) or adalimumab (ADA) for treatment of psoriasis in the United States. METHODS: Adult patients with psoriasis who had ≥1 claim for IXE or ADA were identified from IBM MarketScan claims databases prior to the COVID-19 pandemic (1 March 2016-31 October 2019). The index date was the date of first claim for the index drug of interest. Inverse probability of treatment weighting was employed to balance treatment cohorts. All-cause and psoriasis-related HCRU and costs were examined for 24 months of follow-up. Costs were reported as per patient per month. Costs of psoriasis-related biologics were adjusted using published Institute for Clinical and Economic Review (ICER) discount factors. Index drug costs were adjusted for adherence and ICER discount rates. RESULTS: The analyses included 407 IXE and 2,702 ADA users. IXE users had significantly higher inpatient admission rate (all-cause HCRU: 14.9% vs. 11.0%; p =0.012) and greater mean length of stay per admission (days, 6.6 vs. 4.1; p =0.004) than ADA users. ICER-adjusted costs were significantly higher in IXE than ADA users (all-cause costs: $4,132 vs. $3,610; p <0.001; psoriasis-related costs $3,077 vs. $2,700; p <0.001). After adjusting for ICER and adherence, IXE and ADA drug costs were comparable ($3,636 vs. $3,677; p =0.714). LIMITATIONS: Study relied on administrative claims data, subjected to data coding limitations and data entry errors. Rebates, patient assistance programs, and commission to wholesalers are not always captured in claims. Adjustment made by ICER discount factors may lead to double-discounting if the discounts have been applied in claim payments. CONCLUSIONS: All-cause HCRU was higher in IXE than ADA users. Healthcare costs were also higher in IXE than ADA users after ICER adjustment, over 24 months. Cost differences were largely driven by higher treatment adherence associated with IXE. Index drug costs were comparable after ICER and adherence adjustments.


Subject(s)
Antirheumatic Agents , COVID-19 , Psoriasis , Adalimumab/therapeutic use , Adult , Antibodies, Monoclonal, Humanized , Antirheumatic Agents/therapeutic use , Drug Costs , Follow-Up Studies , Health Care Costs , Humans , Pandemics , Psoriasis/drug therapy , Retrospective Studies , United States
2.
Int J Mol Sci ; 23(9)2022 Apr 30.
Article in English | MEDLINE | ID: covidwho-1847342

ABSTRACT

Elucidating transcriptome in the peripheral edge of the lesional (PE) skin could provide a better understanding of the molecules or signalings that intensify inflammation in the PE skin. Full-thickness biopsies of PE skin and uninvolved (UN) skin were obtained from psoriasis patients for RNA-seq. Several potential differentially expressed genes (DEGs) in the PE skin compared to those in the UN skin were identified. These DEGs enhanced functions such as angiogenesis, growth of epithelial tissue, chemotaxis and homing of cells, growth of connective tissues, and degranulation of myeloid cells beneath the PE skin. Moreover, the canonical pathways of IL-17A, IL-6, and IL-22 signaling were enriched by the DEGs. Finally, we proposed that inflammation in the PE skin might be driven by the IL-36/TLR9 axis or IL-6/Th17 axis and potentiated by IL-36α, IL-36γ, IL-17C, IL-8, S100A7, S100A8, S100A9, S100A15, SERPINB4, and hBD-2. Along with IL-36α, IL-17C, and IκBζ, ROCK2 could be an equally important factor in the pathogenesis of psoriasis, which may involve self-sustaining circuits between innate and adaptive immune responses via regulation of IL-36α and IL-36γ expression. Our finding provides new insight into signaling pathways in PE skin, which could lead to the discovery of new psoriasis targets.


Subject(s)
Gene Expression Profiling , Psoriasis , Humans , Inflammation/pathology , Interleukin-17/metabolism , Interleukin-6/metabolism , Keratinocytes/metabolism , Psoriasis/genetics , Psoriasis/metabolism , Skin/metabolism , Transcriptome
3.
Clin Exp Dermatol ; 47(5): 949-952, 2022 May.
Article in English | MEDLINE | ID: covidwho-1816539

ABSTRACT

Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis, rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects both on the public perception of psoriasis and on patients' knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a formal literature review via PubMed and a thematic review via Google. Key themes of misinformation included 'victim-blaming' (hygiene), 'vector' (contagion), 'vaccination', 'vilification' of conventional therapy, 'validation' of natural treatment and diet, 'veneration' of cures and 'vocalization' from celebrities. Misinformation related to psoriasis is pervasive on social media and other websites. Dermatologists, as patient advocates, should be aware of the content of misinformation available online and combat misleading health information to optimize health outcomes for patients with psoriasis.


Subject(s)
COVID-19 , Psoriasis , Social Media , Communication , Humans , Vaccination
5.
Dermatol Ther ; 35(4): e15339, 2022 04.
Article in English | MEDLINE | ID: covidwho-1794709

ABSTRACT

Psoriasis is a skin disorder characterized by chronic inflammation driven by different immunologic pathways, among which the IL-23/Th17 axis plays a pivotal role. For this reason, the use of IL23p19 inhibitors in psoriasis treatment has been evaluated over the years. Guselkumab, a totally human IgG1 lambda monoclonal antibody, that selectively blocks the p 19 subunit of IL- 23 has demonstrated high efficacy and safety throughout several, randomized, double-blind phase III trials (VOYAGE 1 and 2, NAVIGATE and ECLIPSE). We designed a single-center retrospective cohort study in a population consisting of 46 patients followed from December 2018 to April 2021. After a diagnosis of moderate to severe psoriasis, all the patients were considered suitable to receive treatment with Guselkumab. In our population, among those who achieved clinical improvement in terms of Psoriasis Area Severity Index (PASI), PASI 75, 90, and 100 were achieved on average on weeks 14, 19, 21 respectively. We then analyzed a subgroup of our population, consisting of 35 patients, who had an identical follow-up time of 28 weeks, thus observing the trend in mean PASI at subsequent assessments and the number of patients who had reached PASI 75, PASI 90, and PASI 100 at week 4 (10; 3; 1), week 12 (12; 13; 11), week 20 (7; 6; 2), and week 28 (1; 4; 6), respectively. The results obtained are in line with those obtained from previous studies, thus confirming that Guselkumab is an excellent choice in terms of security, long-term efficacy, and overall tolerance.


Subject(s)
Psoriasis , Antibodies, Monoclonal, Humanized , Clinical Trials, Phase III as Topic , Double-Blind Method , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Randomized Controlled Trials as Topic , Retrospective Studies , Severity of Illness Index , Treatment Outcome
6.
Indian J Dermatol Venereol Leprol ; 88(3): 286-290, 2022.
Article in English | MEDLINE | ID: covidwho-1791403

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic has affected every sphere of life including management of psoriasis. The availability of COVID-19 vaccines has given rise to hope and at the same time some apprehensions as well. With the general population becoming eligible for vaccination, there is some confusion, on the eligibility of patients with different medical conditions and patients on immunosuppressive or immunomodulating medications for COVID-19 vaccination. Dermatologists treating psoriasis patients frequently face questions from them, whether they can undergo coronavirus disease 2019 vaccination. A PUBMED search was performed using the following strategy: 'COVID-19' AND 'Vaccine' AND 'Psoriasis'. We also performed a PUBMED search using the following strategy: 'SARS-CoV-2' AND 'Vaccine' AND 'Psoriasis'. All articles irrespective of language and publication date were included to arrive at this position statement. This position statement deals with the safety, eligibility and modifications of treatment, if needed among psoriasis patients with regards to the coronavirus disease 2019 vaccines currently available in India.


Subject(s)
COVID-19 , Psoriasis , Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Humans , India/epidemiology , Psoriasis/diagnosis , Psoriasis/drug therapy , Psoriasis/epidemiology , SARS-CoV-2 , Vaccination
7.
Ital J Dermatol Venerol ; 157(2): 132-136, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1786558

ABSTRACT

Acrodermatitis continua of Hallopeau is a sterile pustular dermatosis primarily of the digits. Often considered a type of pustular psoriasis, it may be difficult to diagnose and even more difficult to treat. Initial involvement of a distal finger or toe may appear as erythema which should not be confused with the chilblains-like findings potentially associated with COVID-19 infection. We review the clinical manifestations of and explore potential therapeutic options for this uncommon, clinically striking dermatosis.


Subject(s)
Acrodermatitis , COVID-19 , Psoriasis , Skin Diseases, Vesiculobullous , Acrodermatitis/diagnosis , Extremities , Humans , Psoriasis/diagnosis
9.
Dermatol Ther ; 35(6): e15464, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1752532

ABSTRACT

Generalized erythrodermic psoriasis (GEP) is a rare and potentially life-threatening variant of psoriasis. Possible triggers that have been identified to date include poorly controlled psoriasis, medications, abrupt discontinuation of anti-psoriatic treatment, and underlying systemic illnesses. However, vaccines have rarely been reported to exacerbate GEP. Herein, we report two unique cases with GEP exacerbated following a dose of the BNT162b2 mRNA vaccine for COVID-19 (as their second dose, the first being the mRNA-1273 vaccine). Based on our observations and a literature review, vaccination was considered the most likely trigger of GEP due to the close temporal relationship between the second vaccination and the onset of GEP.


Subject(s)
COVID-19 , Psoriasis , /adverse effects , COVID-19/prevention & control , Humans , Psoriasis/chemically induced , SARS-CoV-2 , Vaccination/adverse effects
10.
J Dermatol ; 49(6): 624-628, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1752454

ABSTRACT

The impact of the COVID-19 pandemic on biologic treatment for psoriasis in Japan remains to be elucidated. This study aimed to investigate changes in biologic treatment and patients' behavior of visiting our department, especially in psoriasis patients treated with biologics before and during the pandemic. Data were collected from medical records retrospectively. The numbers of new psoriasis patients before (2019) and during (2020) the pandemic were compared. Patients' behavior of visiting our department was evaluated. The number of new psoriasis patients who visited our department in 2020 decreased by 35.7% compared with that in 2019. The reduction rate of new patients with psoriasis vulgaris was 49.3%, whereas the numbers of new patients with psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP) were almost the same in 2019 and 2020. The number of patients who newly initiated biologics did not decrease in 2020 compared with that in 2019. As of January 1, 2020, 215 psoriasis patients were treated with biologics. Six patients (2.8%) discontinued biologics treatment possibly due to COVID-19 in 2020. Among 212 patients with good adherence to visiting our department in the previous year, 24 patients (11.3%) refrained from their visits for at least 1 month. In most cases, refrainment was observed in April and May when the first state of emergency was in effect in Japan. In conclusion, the COVID-19 pandemic hindered patients from visiting our department. However, its impact on patients who needed intensive care, such as patients with PsA and GPP, and psoriasis patients treated with biologics, was limited.


Subject(s)
Arthritis, Psoriatic , Biological Products , COVID-19 , Psoriasis , Skin Diseases, Vesiculobullous , Acute Disease , Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/epidemiology , Biological Products/therapeutic use , COVID-19/epidemiology , Humans , Japan/epidemiology , Pandemics , Psoriasis/drug therapy , Psoriasis/epidemiology , Retrospective Studies
12.
Ital J Dermatol Venerol ; 157(Suppl. 1 to No. 1): 1-78, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1737523

ABSTRACT

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by moderate to severe plaque psoriasis. The content of the guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline, suggestions for disease severity grading and treatment goals. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs including acitretin, cyclosporine, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab. Moreover, the guideline provides guidance for specific clinical situations such as patient with concomitant psoriatic arthritis, inflammatory bowel disease, a history of malignancies, a history of depression, diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or those with childbearing potential. Information on vaccination, immunogenicity and systemic treatment during the COVID-19 pandemic is also provided.


Subject(s)
COVID-19 , Psoriasis , Female , Humans , Pandemics , Pregnancy , Psoriasis/drug therapy , SARS-CoV-2 , Ustekinumab/therapeutic use
13.
J Dermatol ; 49(3): 341-348, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1735829

ABSTRACT

Patients suffering from chronic inflammatory diseases such as psoriasis are prone to develop depressive symptoms. However, within the time constraints of dermatological clinics, depressive symptoms in psoriasis patients are often overlooked and thus underdiagnosed. The Two Questions Test may serve as a quick screening tool for an initial assessment of depressive burden in these patients. We evaluated its usefulness in the clinical context analyzing the records of patients starting systemic treatment for psoriasis with a selective interleukin (IL)23- or IL17A-inhibitor. In a total sample of N = 139 patients, baseline Two Questions Test scores were analyzed together with measures of psoriatic and psychiatric symptoms. In addition, the development of the Two Questions Test scores over the course of the first 28 weeks of treatment was assessed. No association was found between the Two Questions Test scores and skin symptoms measured by the Psoriasis Area and Severity Index and the visibility of skin lesions. However, skin related quality of life analyzed with the Dermatology Life Quality Index was associated with the Two Questions Test scores. In addition, the longitudinal analysis revealed improvement in Two Questions Test outcomes over the course of patients' treatment. These results indicate the Two Questions Test's usefulness both as an initial screening tool of depressive symptoms, as well as in its use as a sensitive tool for the repeated assessment of depressive symptoms in psoriasis patients.


Subject(s)
Psoriasis , Quality of Life , Chronic Disease , Depression/diagnosis , Depression/etiology , Depression/psychology , Humans , Psoriasis/complications , Psoriasis/diagnosis , Psoriasis/drug therapy , Severity of Illness Index
14.
Dermatol Ther ; 35(5): e15430, 2022 May.
Article in English | MEDLINE | ID: covidwho-1731140

ABSTRACT

SARS-CoV2 vaccines were approved without long-term monitoring due to emergent situations. This has raised some issues about timing and protocol of receiving vaccines in specific situations including patients with chronic inflammatory disorders such as psoriasis. Here, we present different aspects of SARS-CoV-2 infection and vaccination in psoriasis patients and aim to provide solutions to overcome the potential challenges. In brief, the benefits of vaccination outweigh the potential risk; vaccine-triggered de novo or flares of psoriasis is uncommon. As such, all psoriasis patients, especially those receiving systemic treatments including anti tumor necrosis factor agents, are strongly recommended to get SARS-CoV-2 vaccines. It is recommended that new immunosuppressive/immunomodulatory therapies be initiated at least 1 week after the second SARS-CoV-2 vaccine dose, if possible. In addition, in severe and active forms of psoriasis, it is better to delay vaccination until stabilization of the disease.


Subject(s)
COVID-19 , Psoriasis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Psoriasis/drug therapy , RNA, Viral/therapeutic use , SARS-CoV-2 , Vaccination
15.
J Rheumatol ; 49(6 Suppl 1): 10-12, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1726137

ABSTRACT

The efficacy and safety of coronavirus disease 2019 (COVID-19) vaccination in patients with autoimmune inflammatory diseases (AIRDs) who are treated with immunomodulatory therapies was the focus of a symposium at the 2021 virtual annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The keynote address was delivered by Dr. Jeffrey Curtis, chair of the American College of Rheumatology COVID-19 Vaccine Clinical Guidance task force, detailing what we do and do not know about vaccine efficacy and safety in patients with AIRDs and providing guidance about the need for modification of dosing in some immunomodulatory medications for optimal vaccine response. A consensus of the task force was that all patients with AIRDs should be vaccinated as soon as it is allowed in their respective locations, since the benefits of increased protection against COVID-19 infection outweigh the potential for vaccination reactions, including flares of underlying disease, or for reduced efficacy of vaccination because of disease state or medications. Key issues among patient research partners with psoriatic disease expressed in the premeeting survey and panel discussion/question-and-answer period included: vaccine efficacy and safety, the need to continue safe social habits and masking, how to assess efficacy of vaccination, how to deal with vaccine hesitancy among social contacts, medication management relative to vaccination, and concerns about the adequacy of ongoing telehealth visits vs the convenience of that technology.


Subject(s)
COVID-19 Vaccines , COVID-19 , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Humans , Psoriasis/diagnosis , Psoriasis/therapy , Research , Vaccination
17.
Cutis ; 109(2): 101-102, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1716155

ABSTRACT

Guttate psoriasis is a subgroup of psoriasis that most commonly presents as raindroplike, erythematous, silvery, scaly papules. Guttate psoriatic flares may follow rhinovirus or COVID-19 infection due to dysregulation of the innate immune response. We describe the case of a patient who experienced a moderate psoriatic flare 3 weeks after diagnosis of SARS-CoV-2 infection. We discuss the dysregulation of proinflammatory cytokines that we believe triggered this flare and the treatment regimen for our patient.


Subject(s)
COVID-19 , Psoriasis , COVID-19/complications , COVID-19/diagnosis , Humans , Psoriasis/therapy , SARS-CoV-2 , Skin
19.
J Rheumatol ; 49(6 Suppl 1): 1-3, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1690115

ABSTRACT

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held its annual meeting in 2021 in an online format due to travel restrictions during the ongoing COVID-19 (coronavirus disease 2019) pandemic. The virtual meeting was attended by rheumatologists, dermatologists, representatives of biopharmaceutical companies, and patient research partners. Similar to previous years, GRAPPA's annual meeting focused on the 3 overlapping missions of education, research, and clinical care of psoriatic disease (PsD). The virtual meeting allowed a variety of different types of sessions to be held, including the trainee symposium, keynote lectures, interactive sessions (5 Meet the Experts sessions, a debate on first-line therapy, and 5 guided poster sessions), 4 workshops (trainee workshop focusing on the diagnosis of PsD, ultrasound, magnetic resonance imaging, and the International Dermatology Outcome Measures group), updates on a variety of research topics (research findings from the 2020 GRAPPA research grant awardees, 3 basic science talks, Outcome Measures in Rheumatology [OMERACT] Working Group efforts, and Collaborative Research Network progress), current "hot topics" (use of Janus kinase inhibitors, promoting diversity and inclusion in PsD, progress on the updated GRAPPA treatment recommendations, and the introduction of the Young GRAPPA member group), and the presentation of four 2021 GRAPPA grant awardees and election results. In this prologue, we introduce the papers that summarize this meeting.


Subject(s)
Arthritis, Psoriatic , Psoriasis , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , COVID-19 , Humans , Psoriasis/diagnosis , Psoriasis/therapy , Research
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