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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.
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
3.
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
5.
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
6.
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
7.
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
8.
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.
Br J Dermatol ; 186(1): 59-68, 2022 01.
Article in English | MEDLINE | ID: covidwho-1607164

ABSTRACT

BACKGROUND: Data on treatment exposures for psoriasis and poor COVID-19 outcomes are limited. OBJECTIVES: To assess the risk of hospitalization or in-hospital mortality due to COVID-19 by treatment exposure in patients with psoriasis. METHODS: All adults with psoriasis registered in the French national health-insurance (Système National des Données de Santé, SNDS) database between 2008 and 2019 were eligible. Two study periods were considered: 15 February to 30 June 2020 and 1 October 2020 to 31 January 2021, the first and second waves of the COVID-19 pandemic in France, respectively. Patients were classified according to their baseline treatment: biologics, nonbiologics, topicals or no treatment. The primary endpoint was hospitalization for COVID-19 using Cox models with inverse probability of treatment weighting. The secondary endpoint was in-hospital mortality due to COVID-19. RESULTS: We identified 1 326 312 patients with psoriasis (mean age 59 years; males, 48%). During the first study period, 3871 patients were hospitalized for COVID-19 and 759 (20%) died; during the second period 3603 were hospitalized for COVID-19 and 686 (19%) died. In the propensity score-weighted Cox models, risk of hospitalization for COVID-19 was associated with exposure to topicals or nonbiologics [hazard ratio (95% confidence interval): 1·11 (1·04-1·20) and 1·27 (1·09-1·48), respectively] during the first period, and with all exposure types, during the second period. None of the exposure types was associated with in-hospital mortality due to COVID-19. CONCLUSIONS: Systemic treatments for psoriasis (including biologics) were not associated with increased risk of in-hospital mortality due to COVID-19. These results support maintaining systemic treatment for psoriasis during the pandemic.


Subject(s)
COVID-19 , Psoriasis , Adult , Cohort Studies , France/epidemiology , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Pandemics , Psoriasis/drug therapy , Psoriasis/epidemiology , SARS-CoV-2
18.
Hautarzt ; 73(2): 156-159, 2022 Feb.
Article in German | MEDLINE | ID: covidwho-1568342

ABSTRACT

We present a clinical case of a patient with acutely exacerbated erythrodermic psoriasis vulgaris after symptomatic infection with SARS-CoV­2 (severe acute respiratory syndrome coronavirus 2). Various factors are already known that can lead to an exacerbation of psoriasis, such as drugs or infections with, for example, streptococcus. An association between psoriasis and an infection with SARS-CoV­2 has been described so far in individual case reports, in which, however, drug treatment with for example hydroxychloroquine, a known trigger of psoriasis, often took place. Later cases of exacerbation of psoriasis, partly as pustular psoriasis have been published also without drug induction. However we present for the first time a case of erythrodermic psoriasis triggered by COVID-19 (coronavirus disease 2019) without an obvious drug trigger.


Subject(s)
COVID-19 , Psoriasis , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , SARS-CoV-2
19.
N Engl J Med ; 385(24): 2295-2296, 2021 12 09.
Article in English | MEDLINE | ID: covidwho-1562119
20.
J Dermatol ; 49(4): 454-458, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1550775

ABSTRACT

Generalized pustular psoriasis (GPP) is characterized by acute flare-ups induced by various factors, but few reports have described GPP onset or flare-up induced by vaccination. To our knowledge, only three such cases following coronavirus disease 2019 (COVID-19) vaccination have been reported. We herein report a case of GPP flare-up after COVID-19 mRNA vaccination. A 65-year-old man with GPP controlled by infliximab presented with widespread pustular erythema, fever, and malaise following his second COVID-19 mRNA vaccination. A skin eruption was apparent at the injection site. He also exhibited systemic capillary leak syndrome (SCLS), which responded rapidly to secukinumab and systemic corticosteroids. Two biopsies, one of which was of the injection site, revealed not only findings typical of GPP, but also a dermal mixed-cell infiltration with eosinophils, and microthrombi in the small dermal vessels. The latter findings have been observed in cutaneous lesions induced by both COVID-19 infection and vaccination. This is the first case of a GPP flare-up accompanied by SCLS induced by a COVID-19 mRNA vaccine. Also, this is the first flare-up induced by the second vaccine dose, and the first such report including detailed histological data, including for the injection site.


Subject(s)
COVID-19 , Capillary Leak Syndrome , Psoriasis , Aged , COVID-19/diagnosis , COVID-19 Vaccines/adverse effects , Capillary Leak Syndrome/diagnosis , Capillary Leak Syndrome/etiology , Humans , Male , Psoriasis/drug therapy , Psoriasis/pathology , RNA, Messenger , Vaccination , Vaccines, Synthetic
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