Psoriasis: Elmets CA

Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R, Anonymous00035. · Baylor University Medical Center, Dallas, Texas, USA. · J Am Acad Dermatol. · Pubmed #19217694 No free full text.

Abstract: Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.

Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, Van Voorhees AS, Elmets CA, Leonardi CL, Beutner KR, Bhushan R, Menter A. · Department of Dermatology, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. · J Am Acad Dermatol. · Pubmed #18423261 No free full text.

Abstract: Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this second of 5 sections of the guidelines of care for psoriasis, we give an overview of psoriatic arthritis including its cardinal clinical features, pathogenesis, prognosis, classification, assessment tools used to evaluate psoriatic arthritis, and the approach to treatment. Although patients with mild to moderate psoriatic arthritis may be treated with nonsteroidal anti-inflammatory drugs and/or intra-articular steroid injections, the use of disease-modifying antirheumatic drugs, particularly methotrexate, along with the biologic agents, are considered the standard of care in patients with more significant psoriatic arthritis. We will discuss the use of disease-modifying antirheumatic drugs and the biologic therapies in the treatment of patients with moderate to severe psoriatic arthritis.

Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JY, Elmets CA, Korman NJ, Beutner KR, Bhushan R. · Baylor University Medical Center, Dallas, Texas, USA. · J Am Acad Dermatol. · Pubmed #18423260 No free full text.

Abstract: Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this first of 5 sections of the guidelines of care for psoriasis, we discuss the classification of psoriasis; associated comorbidities including autoimmune diseases, cardiovascular risk, psychiatric/psychologic issues, and cancer risk; along with assessment tools for skin disease and quality-of-life issues. Finally, we will discuss the safety and efficacy of the biologic treatments used to treat patients with psoriasis.

Kircik L, Bagel J, Korman N, Menter A, Elmets CA, Koo J, Yang YC, Chiou CF, Dann F, Stevens SR, Anonymous00125. · Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA. · J Drugs Dermatol. · Pubmed #18380206 No free full text.

Abstract: BACKGROUND: Moderate to severe psoriasis is a significant inflammatory disease that frequently requires systemic therapies to effectively treat the underlying disorder. Etanercept and narrow-band ultraviolet light B (NB-UVB) are widely used to treat this disease. OBJECTIVE: To evaluate the effectiveness, tolerability, and patient-reported outcomes of combination etanercept plus NB-UVB phototherapy in moderate to severe plaque psoriasis. METHODS: This 12-week, single-arm, open-label study evaluated the combination of etanercept 50 mg twice weekly and NB-UVB thrice weekly in 86 patients. The primary outcome measure was > or =75% improvement from baseline in the Psoriasis Area and Severity Index (PASI 75). Other measures included PASI 90, PASI 100, and the Dermatology Life Quality Index (DLQI). RESULTS: At week 12, 26.0% achieved PASI 100, 58.1% achieved PASI 90, and 84.9% of patients achieved PASI 75. Mean improvement from baseline in DLQI was 84.4%. No unexpected, untoward adverse events were noted. CONCLUSIONS: A 12-week course of etanercept plus NB-UVB phototherapy was well tolerated and produced clinically meaningful improvements in signs and symptoms of moderate to severe plaque psoriasis and in patient-reported outcomes. Further investigation of the safety and efficacy of the use of such combination for this indication in controlled clinical trials would be of interest.

Cafardi JA, Cantrell W, Wang W, Elmets CA, Elewski BE. · Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA. · Skinmed. · Pubmed #18327010 No free full text.

Abstract: OBJECTIVES: Alefacept is a biologic response modifier indicated for moderate to severe psoriasis; it has been available since 2003. It is typically administered in a dosing regimen of 15 mg intramuscularly (IM) weekly for 12 weeks. The purpose of this study was to determine whether a higher dose may be more beneficial in achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75). A secondary objective of this study was to examine whether increasing the dose during the initial course of alefacept would reduce the time to onset of efficacy and overall response rate. Two separate dosing regimens are evaluated in this study: 30 mg IM for 6 weeks followed by 15 mg IM for 6 weeks (group 1) and alefacept 30 mg IM weekly for 12 weeks (group 2). METHODS: Efficacy was assessed using the PASI, Physician Global Assessment, body surface area, and photographic evaluation of a target lesion. A total of 20 patients enrolled and were randomized, 16 of whom completed the study. Data analyses were performed on a per-protocol basis. RESULTS: Overall, the mean PASI scores progressively decreased, with 43.8% reaching a 50% reduction in the PASI (PASI 50) at week 14 evaluation. Of these participants, 37.5% were in group 1 and 50% were treated with alefacept 30 mg IM for 12 weeks (group 2). Although our sample size was small, 12.5% of patients (one patient in each treatment arm) reached PASI 75. The most common adverse events encountered in this trial were mild infection, headache, pruritus, and erythroderma. There were no infections associated with a CD4(+) cell count <250 cells/mm(3). CONCLUSIONS: There was no difference between the treatment groups in achieving PASI 50 or PASI 75. In addition, in our small population, the higher doses of alefacept were associated with increased adverse effects, including erythroderma.

Elmets CA. · Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294-0009, USA. · Arch Dermatol. · Pubmed #17116843 No free full text.

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