Dermatology

Noe, M. H., M. T. Wan, D. B. Shin, A. W. Armstrong, K. C. Duffin, Z. C. Chiesa Fuxench, R. E. Kalb, A. Menter, E. L. Simpson, J. Takeshita, S. K. Tyring, A. S. Van Voorhees, N. N. Mehta and J. M. Gelfand (2019). “Patient-Reported Outcomes of Adalimumab, Phototherapy, and Placebo in the Vascular Inflammation in Psoriasis Trial: A Randomized Controlled Study.” J Am Acad Dermatol Jun 1. [Epub ahead of print].

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BACKGROUND: There is limited data about the impact of narrowband ultraviolet B phototherapy on patient-reported measures of health-related quality of life (HRQoL). OBJECTIVE: To evaluate the impact of adalimumab and phototherapy on HRQoL. METHODS: We examined patient-reported outcomes (PROs) from a multicenter, randomized placebo-controlled trial (NCT01553058). Dermatology Life Quality Index (DLQI) and EQ-5D-3L were evaluated every 4 weeks. RESULTS: We enrolled 97 patients: 30.9% female, mean (SD) age 43.5(14.0) years, median (interquartile range) PASI 16.7(13.9-21.6). At week 12, patients being treated with adalimumab (OR: 2.88, 95% CI:1.02, 8.17) and phototherapy (OR: 8.83, 95% CI:2.47, 31.57) were more likely to achieve the minimal clinically important difference (MCID) in DLQI compared to placebo. There were higher odds of achieving the MCID for the EQ-5D-3L Index score when comparing phototherapy versus placebo (OR: 9.78, 95% CI:2.99, 31.95) and phototherapy versus adalimumab (OR: 4.07, 95% CI:1.42, 11.70). LIMITATIONS: small sample size, secondary analysis, generalizability CONCLUSION: Phototherapy and adalimumab both improve skin-related quality of life and overall health related quality of life compared to placebo in patients with psoriasis, however, phototherapy treated patients achieved more improvement in overall health quality of life compared to patients treated with adalimumab.

Matza, L. S., J. E. Brazier, K. D. Stewart, L. Pinto, R. H. Bender, L. Kircik, J. Jordan, K. J. Kim, A. Mutebi, H. N. Viswanathan and A. Menter (2019). “Developing a preference-based utility scoring algorithm for the Psoriasis Area Severity Index (PASI).” J Med Econ Jun 4:1-20. [Epub ahead of print].

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Introduction. It is challenging to identify health state utilities associated with psoriasis because generic preference-based measures may not capture the impact of dermatological symptoms. The Psoriasis Area Severity Index (PASI) is one of the most commonly used psoriasis rating scales in clinical trials. The purpose of this study was to develop a utility scoring algorithm for the PASI. Methods. Forty health states were developed based on PASI scores of 40 clinical trial patients. Health states were valued in time trade-off interviews with UK general population participants. Regression models were conducted to crosswalk from PASI scores to utilities (e.g., OLS linear, random effects, mean, robust, spline, quadratic). Results A total of 245 participants completed utility interviews (51.4% female; mean age = 45.3y). Models predicting utility based on the four PASI location scores (head, upper limbs, trunk, lower limbs) had better fit/accuracy (e.g., R(2), mean absolute error [MAE]) than models using the PASI total score. Head/upper limb scores were more strongly associated with utility than trunk/lower limb. The recommended model is the OLS linear model based on the four PASI location scores (R(2) = 0.13; MAE =0.03). An alternative is recommended for situations when it is necessary to estimate utility based on the PASI total score. Conclusions. The recommended scoring algorithm may be used to estimate utilities based on PASI scores of any treatment group with psoriasis. Because the PASI is commonly used in psoriasis clinical trials, this scoring algorithm greatly expands options for quantifying treatment outcomes in cost-effectiveness analyses of psoriasis therapies. Results indicate that psoriasis of the head/upper limbs could be more important than trunk/lower limbs, suggesting reconsideration of the standard PASI scoring approach.

Gupta, A. K., R. P. Love, W. Abramovits and K. D. Vincent (2019). “Dupixent(R) (Dupilumab): A Newly Approved Interleukin-4 Receptor Antagonist for the Treatment of Atopic Dermatitis in Pediatric Patients.” Skinmed 17(2): 107-109.

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Silfvast-Kaiser, A., R. Youssef and S. Y. Paek (2019). “Diet in hidradenitis suppurativa: a review of published and lay literature.” Int J Dermatol Apr 21. [Epub ahead of print].

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Hidradenitis suppurativa (HS) is a chronic, recurring, inflammatory skin disorder resulting in skin abscesses and sinus tracts of the skin folds. Hidradenitis suppurativa remains a disease with limited treatment options. Management of disease activity with dietary modification has been of considerable interest to the HS patient community. Limited evidence exists to support dietary changes for treatment of HS. Strategies such as eliminating dairy products, limiting simple carbohydrate and sugar intake, and avoiding nightshades (Solanaceae) and foods containing brewer’s yeast have been reported to be helpful in some patients. Several supplements have also been touted as beneficial. Herein, we review the existing dietary recommendations in both peer-reviewed and lay literature in an attempt to consolidate and evaluate existing information, while stimulating further inquiry into the role of diet in HS. Although dietary modifications are often of considerable interest to HS patients, there is a paucity of data regarding diet as it relates to HS. It is unclear whether diet may prove to be of value in limiting the severity of HS. Further research is needed to determine the potential benefits of these dietary changes.

Menter, A., B. E. Strober, D. H. Kaplan, D. Kivelevitch, E. F. Prater, B. Stoff, A. W. Armstrong, C. Connor, K. M. Cordoro, D. M. R. Davis, B. E. Elewski, J. M. Gelfand, K. B. Gordon, A. B. Gottlieb, A. Kavanaugh, M. Kiselica, N. J. Korman, D. Kroshinsky, M. Lebwohl, C. L. Leonardi, J. Lichten, H. W. Lim, N. N. Mehta, A. S. Paller, S. L. Parra, A. L. Pathy, R. N. Rupani, M. Siegel, E. B. Wong, J. J. Wu, V. Hariharan and C. A. Elmets (2019). “Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.” J Am Acad Dermatol 80(4): 1029-1072.

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Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.