ABSTRACT
INTRODUCTION: Apremilast is approved for the treatment of psoriasis and psoriatic arthritis. However, data on the efficacy and safety of apremilast in clinical practice are limited. We assessed the real-world use and effectiveness of apremilast in patients with moderate to severe plaque psoriasis visiting dermatologist practices in Belgium, from the perspectives of the patient and the physician. METHODS: This prospective observational study enrolled adults aged 18 years or more initiating apremilast between 6 April 2017 and 30 June 2018, per Belgian reimbursement criteria. Primary outcome was the Patient Benefit Index for Skin Diseases (PBI-S). Secondary outcomes included the Patient Global Assessment (PtGA), Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), and body surface area (BSA). Patients were followed up for up to 18 months. RESULTS: Overall, 122 enrolled patients received at least one dose of apremilast, of which 89 received treatment for more than 150 days and were included in the reference population. Treatment goals most frequently identified (at least 70% of patients) as "very important" in the PBI-S were related to physical impairments. After 6 months of apremilast treatment, 61-78% of patients reported they had achieved these goals; only 12.5% assessed their disease as severe (PtGA, 53.6% at apremilast initiation) and over half reported a DLQI score of 5 or less, indicating improved quality of life. As assessed by the physician, 68.4% and 35.1% of patients achieved at least a 50% and 75% reduction in PASI, respectively, at month 6. Apremilast was well tolerated with no new safety signals identified. CONCLUSIONS: Our real-world data indicate that apremilast fulfils the expectations of Belgian patients with moderate to severe psoriasis, and from the perspectives of both the patient and physician, apremilast has a positive impact on their disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03097003.
Subject(s)
Psoriasis , Quality of Life , Adolescent , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Belgium , Humans , Psoriasis/drug therapy , Severity of Illness Index , Thalidomide/analogs & derivatives , Treatment OutcomeABSTRACT
BACKGROUND: The incidence of melanoma has been increasing for 50 years. Exposure to ultraviolet (UV) radiation constitutes the main risk factor. The aim of this study was to analyze the impact on hospital staff behaviour with regard to UV of screening campaigns initiated in Belgium 11 years ago. PATIENTS AND METHODS: We performed a multicentre, before-after study by sending an anonymous survey to the staff of four hospital in Brussels, from March 2010 to April 2010 (group 2: n=895). Demographic, clinical and behavioural data were collected and compared to those collected 23 years ago in the same hospitals (group 1: n=2410). RESULTS: Phototypes in both groups were similar. In group 2, the distribution of naevi tended to be spread over the whole body and the severity of sunburn had decreased. Group 2 participants reported a reduction in active sun exposure, especially in the past 10 years, with less leisure-time tanning. There was a significant increase in holidays in sunny locations, although vacation time was shorter, with prolonged daily and annual exposure. Sunscreens were more frequently used and there was an increase in sun-bed use, especially in beauty parlours. CONCLUSION: Our study comprises a double snapshot of a population of hospital workers at an interval of 23 years. The information and screening campaigns do not seem to have had the desired effect on the hospital staff surveyed. Sunscreen use has in fact resulted in extended UV exposure and the observed exposure pattern is that most frequently involved in melanoma development.