Abstract/Text
INTRODUCTION: Medication nonadherence is common throughout medicine, and research into this area is increasing; however, knowledge about topical medication adherence is limited.
METHODS: A total of 30 patients were enrolled in a clinical trial for psoriasis and followed up for 8 weeks using 3 methods of adherence monitoring: electronic monitoring caps; medication logs; and medication usage by weight.
RESULTS: Adherence rates calculated from the medication logs and medication weights were consistently higher than those of the electronic monitors (P <.05). Electronically measured adherence rates declined from 84.6% to 51% during the 8-week study (P <.0001). Female sex and increasing age by 1 year predicted improved adherence of 5% and 0.8%, respectively (P <.0001). The number of treatment gaps increased from the first half to the last half of the study, and weekend days were overrepresented in treatment gaps.
CONCLUSION: Medication logs and weights do not ensure medication adherence to topical therapy. Electronic monitoring allows a more precise method of adherence measurement.
Abstract/Text
The armamentarium of therapies for psoriasis continues to expand with drugs such as tazarotene, calcipotriene, and acitretin approved in recent years. New forms of old treatments such as cyclosporine and anthralin have also been introduced. Frequently, inadequate attention is devoted to duration of remission. The purpose of this article is to examine the duration of remission reported with many therapies currently used for psoriasis. Studies examining duration of remission are included. Among our conclusions were the following: the definitions of remission/relapse used in various studies differ, duration of remission is influenced by the natural history of each patient's disease, among topical monotherapies anthralin and tazarotene appear to induce longer remissions than calcipotriene and corticosteroids, among systemic agents longer remissions occur with etretinate than cyclosporine or methotrexate but compared with the remission rate of phototherapeutic modalities, especially Goeckerman and PUVA therapy, the remission rates are much less.
Abstract/Text
BACKGROUND: Topical corticosteroids, commonly used for psoriasis, show diminished response on continuous use.
OBJECTIVE: We tested efficacy of topical corticosteroid and calcipotriene used on alternate weeks versus daily corticosteroid in patients with psoriasis.
METHODS: In a randomized, observer-blind design, the experimental group of 25 patients with stable plaque psoriasis received augmented betamethasone dipropionate 0.05% cream once daily in the first and third weeks and calcipotriene 0.005% ointment twice daily in the second and fourth weeks. The control group of 27 patients received augmented betamethasone once daily for 4 weeks.
RESULTS: The experimental regimen was more effective than the control regimen as evidenced by (1) more patients with at least a 90% reduction in Psoriasis Area and Severity Index (PASI) score (difference 49.5%, 95% confidence interval [CI], 26.1%-72.9%, P <. 001), (2) lower PASI after 2 weeks (P < or =.04), and (3) greater percentage reduction in PASI after 2 and 4 weeks (difference 23.1% [CI, 11.1%-35.1%] and 46.4% [28.9%-63.8%], respectively; P <.001). The study had power of 93.7%. No patient had skin irritation.
CONCLUSION: Use of augmented betamethasone and calcipotriene on alternate weeks is more effective than daily corticosteroid and represents a novel strategy for treating psoriasis.
R Kaufmann, A J Bibby, R Bissonnette, F Cambazard, A C Chu, J Decroix, W S Douglas, D Lowson, J M Mascaro, G M Murphy, B Stymne
A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris.
Dermatology. 2002;205(4):389-93. doi: 66440.
Abstract/Text
BACKGROUND: Topical corticosteroids and calcipotriol have been used separately for many years to treat psoriasis. A new combination ointment has been formulated, which contains both calcipotriol and the corticosteroid betamethasone dipropionate.
OBJECTIVE: To compare the combination ointment with betamethasone dipropionate ointment, calcipotriol ointment and ointment vehicle in patients with psoriasis vulgaris.
METHODS: 1,603 patients were randomised to one of the 4 double-blind treatments used once daily for 4 weeks.
RESULTS: The mean percentage change in the PASI at the end of treatment was -71.3 (combination), -57.2 (betamethasone), -46.1 (calcipotriol) and -22.7 (vehicle). The mean difference of combination minus betamethasone was -14.2 (95% CI: -17.6 to -10.8, p < 0.001), of combination minus calcipotriol -25.3 (95% CI: -28.7 to -21.9, p < 0.001) and of combination minus vehicle -48.3 (95% CI: -53.2 to -43.4, p < 0.001). 6.0% of patients (combination) reported local adverse reactions compared to 4.9% (betamethasone), 11.4% (calcipotriol) and 13.6% (vehicle).
CONCLUSION: Calcipotriol/betamethasone dipropionate combination ointment used once daily is well tolerated and more effective than either active constituent used alone.
Copyright 2002 S. Karger AG, Basel
Mamitaro Ohtsuki, Hidemi Nakagawa, Junichi Sugai, Akira Ozawa, Muneo Ohkido, Juichiro Nakayama, Jiro Hanada, Yosuke Morimoto, Kowichi Jimbow, Takashi Horikoshi, Hiroto Kitahara, Kunihiko Tamaki, Kazunori Urabe, Yoshiaki Hori
Long-term continuous versus intermittent cyclosporin: therapy for psoriasis.
J Dermatol. 2003 Apr;30(4):290-8.
Abstract/Text
A multicenter randomized controlled study was conducted to assess the long-term efficacy and safety of cyclosporin A therapy for psoriasis using either a continuous or an intermittent regimen. Initially, both regimens consisted of 3-5 mg/kg/day administration of CyA. Once remission was obtained, CyA dose was maintained between 0.5 and 3 mg/kg/day under the continuous regimen, while under the intermittent regimen, CyA dose was tapered off and, when necessary, topical corticosteroids were used until relapse occurred. Thirty-one patients were followed for at least 48 months (mean follow-up period: 55.9+/-4.6 months): 15 received continuous therapy, and 16 received intermittent therapy. With both regimens, the PASI (Psoriasis Area and Severity Index) score was maintained at 5-12 points throughout the follow-up period. The score was decreased by more than 70% from baseline with both regimens: the responses between them were not significantly different. However, overall control of psoriasis, as assessed from the averaged PASI score, was better in the patients receiving continuous therapy. Although the overall frequency of adverse reactions was similar for the two regimens, cancer occurred in two patients on continuous therapy (gastric cancer and hepatocellular carcinoma in one patient each). We could not, however, definitely attribute the cancers in the two patients to continuous therapy itself. There was a significantly higher incidence of renal impairment in elderly patients receiving either regimen when compared with younger patients. In conclusion, CyA administered to psoriasis patients under both regimens exhibited long-term efficacy and tolerability. Despite a lower overall efficacy, it seems proper to conclude that intermittent therapy is more useful than continuous therapy due to the occurrence of malignancies with continuous therapy. Further investigation is required to determine whether intermittent therapy is really safer than continuous therapy, and, if so, how it should be designed to minimize long-term adverse reactions and achieve overall control comparable to that of continuous CyA therapy.
Abstract/Text
OBJECTIVE: To assess the severity of psoriasis over time.
DESIGN: We analyzed the results of structured dermatologic examinations administered over a 20-year period beginning 10 years after study enrollment.
SETTING: The PUVA [psoralen-UV-A] Follow-up Study, which is a prospective cohort study.
PATIENTS: The analyses were restricted to 815 patients (83.2% of those eligible) who underwent at least 2 of 4 possible examinations between 1985 and 2005.
MAIN OUTCOME MEASURE: A 4-point physician global assessment (PGA).
RESULTS: The distribution of the PGA levels in the study group did not change significantly over time, except that in 2005 more patients had no psoriasis compared with patients who underwent examinations in the previous study years (9.6% vs < 5.1%, P < .03). The PGA level changed more than 1 level between examinations in only 14% of patients. Multistate Markov models estimated that patients had a likelihood of about 80% to remain at the same PGA level 1 year later. After 10 years, this likelihood varied between 19% and 53%, depending on the PGA level. Except for patients who were clear of disease at baseline, on average patients had about 1 year without psoriasis over 20 years. On average, individuals with moderate to severe disease remained at these levels for 11 or more years. Conclusion Three decades after a large and diverse group of patients sought a cure for their psoriasis, consistent control of their psoriasis often had not been achieved.
Emiko Akasaka, Tomotaka Mabuchi, Yasuaki Manabe, Eiichiro Yahagi, Azusa Yamada-Hiruma, Hanako Yamaoka, Tomoko Kojima, Masayuki Kato, Norihiro Ikoma, Akira Ozawa, Yasuo Haruki
Long-term efficacy of psoriasis vulgaris treatments: analysis of treatment with topical corticosteroid and/or vitamin D3 analog, oral cyclosporin, etretinate and phototherapy over a 35-year period, 1975-2010.
J Dermatol. 2013 Apr;40(4):238-43. doi: 10.1111/1346-8138.12069. Epub 2013 Jan 21.
Abstract/Text
Various therapies have been tried for psoriasis. In Japan, biologics began to be used for psoriasis treatment in January 2010. Their clinical efficacy is well known, but biologics cannot be used in all psoriasis patients for reasons such as side-effects and cost. It is necessary to evaluate the effect of long-term psoriasis treatment, but there have been no reports evaluating long-term treatment. Therefore, the outcomes of patients who had been treated at the Tokai University Hospital for more than 5 years, before biological agents were released, were examined. Three categories, classified by initial severity, changes in severity by method of treatment and background characteristics, were investigated. In conclusion, cases of long-term treatment with a combination of topical corticosteroid and topical vitamin D3 analog or oral cyclosporin were found to be effective therapies. Patients with a history of diabetes mellitus or cardiovascular disease of psoriasis were likely to be treatment resistant.
© 2013 Japanese Dermatological Association.
Abstract/Text
BACKGROUND: Psoriasis therapy has evolved during the past 25 years as newer and more effective medications become available. Furthermore, various combination regimens and approaches have been advocated.
OBJECTIVE: We sought to describe patterns of psoriasis treatment from 1986 to 2005.
METHODS: Visits to dermatologists for treatment of psoriasis were identified using National Ambulatory Medical Care Survey data, a representative survey of visits to physician offices in the United States. We focused on medications listed at these visits during the 1986-to-2005 interval to determine how treatment for psoriasis has changed.
RESULTS: There were an estimated 23.9 million visits for psoriasis during the 20-year study period. As a category, the most common medications used for psoriasis were topical steroids. Dermatologists are prescribing more potent topical steroids compared with nondermatologists. The use of these potent drugs has increased from 1986 to 2005. There has been growing use of systemic treatments, with biologic therapies introduced in the 2001-to-2005 time period.
LIMITATIONS: National Ambulatory Medical Care Survey data represent national trends in psoriasis treatment and cannot be used to evaluate smaller subpopulations of patients with psoriasis. These data are used to speculate why certain trends in treatment are seen.
CONCLUSION: The primary treatment for psoriasis in the late 1980s and early 1990s was mid-potency corticosteroids. Since then, the primary therapies for psoriasis have evolved to include class I ultrapotent topical corticosteroids, vitamin-D analogs, and systemic medications such as methotrexate and biologic agents. These changes in psoriasis management are consistent with patient desire for better disease control.
Abstract/Text
BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with an HLA-Cw6 allele. Higher waist-hip ratio (WHR) and body mass index (BMI) may increase the risk of psoriasis vulgaris, but, to our knowledge, no evidence of the combined effects of HLA-Cw6 and BMI, WHR are available.
OBJECTIVES: To evaluate the combined effect of HLA-Cw6, BMI and WHR on psoriasis vaulgaris.
METHODS: The data of 466 patients and 177 controls were investigated and analyzed by a hospital-based case-control study and non-condition logistic regress model.
RESULTS: There was a graded positive association of WHR and BMI with psoriasis vulgaris. Compared with a WHR of 0.80 or less than 0.80, the odds ratio (OR) was 2.36 (p < 0.01) for WHR 0.80-0.85, and 2.74 (p < 0.01) for WHR greater than 0.85. Compared with subjects with a BMI of 20 or less than 20, the multivariate OR of psoriasis were 1.20 (p > 0.05) for a BMI of 20-25, 1.84 (p < 0.05) for a BMI of more than 25 corresponding overweight (p for trend, <0.01). We found not only the risk of psoriasis for the individual with HLA-Cw6+ was 8.33 times greater than that for individual with HLA-Cw6(-) but also the risk increased approximately 35 times in individuals with HLA-Cw6+ and a overweight as compared with one with HLA-Cw6(-) and a non-overweight, and 17-fold when the individuals with HLA-Cw6+ and a WHR of more than 0.80 were compared with individuals with HLA-Cw6(-) and a WHR of 0.80 or less than 0.80, displaying the combined effect of HLA-Cw6, BMI and WHR (all p < 001).
CONCLUSION: This study suggested that HLA-Cw6, overweight and higher waist-hip ratio are material risk factors of psoriasis vulgaris, specially the combined effects of HLA-Cw6 and BMI, WHR on psoriasis vulgaris in Chinese population.
K Kragballe, J Austad, L Barnes, A Bibby, M de la Brassinne, F Cambazard, C Fleming, H Heikkilä, Z Williams, J Peyri Rey, A Svensson, J Toole, G Wozel
Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris.
Dermatology. 2006;213(4):319-26. doi: 10.1159/000096069.
Abstract/Text
BACKGROUND: The calcipotriol/betamethasone dipropionate two-compound product is safe and effective in the short-term treatment of psoriasis.
OBJECTIVE: The primary objective was to investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks. The efficacy results are presented here.
METHODS: Six hundred and thirty-four patients were randomised double-blind to treatment (once daily, when required) with either: 52 weeks of two-compound product (two-compound group), 52 weeks of alternating 4-week periods of two-compound product and calcipotriol (alternating group), or 4 weeks of two-compound product followed by 48 weeks of calcipotriol (calcipotriol group).
RESULTS: There was a trend towards a difference between treatments from the overall treatment effect for the percentage of satisfactory responses for each patient during the study (p = 0.071). This appeared to be due to the comparison of the two-compound and calcipotriol groups (p = 0.025).
CONCLUSION: There was a trend towards the efficacy of the two-compound product used for up to 52 weeks being better than that of 4 weeks of the two-compound product followed by 48 weeks of calcipotriol.
Copyright (c) 2006 S. Karger AG, Basel.
D Thaçi, J-P Ortonne, S Chimenti, P-D Ghislain, P Arenberger, K Kragballe, J-H Saurat, A Khemis, P Sprøgel, H-U Esslinger, K Unnebrink, H Kupper
A phase IIIb, multicentre, randomized, double-blind, vehicle-controlled study of the efficacy and safety of adalimumab with and without calcipotriol/betamethasone topical treatment in patients with moderate to severe psoriasis: the BELIEVE study.
Br J Dermatol. 2010 Aug;163(2):402-11. doi: 10.1111/j.1365-2133.2010.09791.x. Epub 2010 Apr 2.
Abstract/Text
BACKGROUND: Data are lacking on the use of topical therapies in combination with tumour necrosis factor blockers for the treatment of psoriasis.
OBJECTIVES: To assess the efficacy and safety of adalimumab (ADA) with topical calcipotriol/betamethasone (C/B) in patients with psoriasis resembling those treated in routine clinical practice.
METHODS: A 16-week, randomized, vehicle-controlled trial was conducted in patients with moderate to severe psoriasis and previous failure, intolerance or contraindications to two or more systemic treatments. All patients received ADA (80 mg, week 0; 40 mg every other week, weeks 1-15) in addition to either topical C/B or drug-free vehicle applied once daily for 4 weeks, and as needed thereafter. The primary endpoint was 75% improvement from baseline in Psoriasis Area and Severity Index (PASI 75) at week 16.
RESULTS: A total of 730 patients received either ADA + C/B (n = 366) or ADA + vehicle (n = 364). PASI 75 response was initially higher with the combination therapy [14.8% for ADA + C/B vs. 5.8% for ADA + vehicle at week 2 (P < 0.001); and 40.7% vs. 32.4%, respectively, at week 4 (P = 0.021)]. After week 4, the trend was towards a higher response with ADA monotherapy, with no statistical difference in the PASI 75 response at week 16 (64.8% for ADA + C/B vs. 70.9% for ADA monotherapy, P = 0.086). Safety findings were consistent with previous ADA trials.
CONCLUSIONS: ADA + C/B resulted in more rapid and higher efficacy within the first 4 weeks; thereafter, the trend was towards a higher response with ADA monotherapy. There was no statistical difference in the PASI 75 response at week 16. Both treatment regimens were well tolerated.
Abstract/Text
Psoriasis treatment responses are affected by patient characteristics. However, the literature does not contain reviews of factors that affect the response to biologic therapies. We therefore performed a comprehensive literature search to identify papers describing demographic, lifestyle, and clinical factors associated with response to biologic drug therapy in psoriatic patients. We found that age, gender, ethnicity, alcohol consumption, smoking, geographic location, age at diagnosis, duration and severity of psoriasis, and baseline C-reactive protein levels did not consistently affect response to biologic psoriasis therapy. However, increased body mass index (BMI) appears to adversely affect responses. It might therefore be valuable to include BMI as a stratification variable in future studies of psoriasis therapies and to consider a patient's weight or BMI when selecting a systemic psoriasis treatment.
