Dermatology

Blauvelt, A., K. Reich, S. Mehlis, F. Vanaclocha, H. Sofen, W. Abramovits, Y. Zhao, I. Gilloteau, E. Davenport, N. Williams, A. Guana and S. Tyring (2017). “Secukinumab demonstrates greater sustained improvements in daily activities and personal relationships than ustekinumab in patients with moderate-to-severe plaque psoriasis: 52-week results from the clear study.” J Eur Acad Dermatol Venereol: 2017 Jun [Epub ahead of print].

Full text of this article.

BACKGROUND: Psoriasis can greatly impact patients’ lives by influencing clothing worn as well as by impairing sexual functioning. Secukinumab, a human monoclonal antibody selectively neutralizing interleukin-17A, has demonstrated good efficacy and safety in the treatment of moderate-to-severe psoriasis and psoriatic arthritis with a rapid onset of action and sustained response. OBJECTIVE: This analysis using the CLEAR study, a phase 3b double-blind study comparing the efficacy and safety of secukinumab versus ustekinumab in adults with moderate-to-severe plaque psoriasis, evaluated the treatment effects on patient’s daily activities and personal relationships. METHODS: Impact on daily activities (interference with home/shopping/garden, and influence on clothes worn) and impact on personal relationships (problems with partner/others, and sexual difficulties) as well as their corresponding subscales were selected from the Dermatology Life Quality Index scale and evaluated for patients treated with secukinumab vs. ustekinumab from the CLEAR study. Treatment differences in mean scores and proportions of responders (score = 0, indicating no impact) were evaluated through 52 weeks. Time to response was evaluated through week 16. RESULTS: Significant differences between secukinumab and ustekinumab were observed for daily activities and personal relationship at week 16 and sustained through Week 52 (Week 52 response rates for daily activities: 82.9% vs. 73.5%, including interference with home/shopping/garden: 88.5% vs. 78.2%, and influence on clothes worn: 85.6% vs. 74.4%; personal relationship: 86.1% vs. 73.7%, including problems with partner/others: 86.6% vs. 74.8%, and sexual difficulties: 88.5% vs. 74.3%; all P < 0.01). The median time to response was 4 weeks for secukinumab versus 8 weeks for ustekinumab for daily activities and personal relationships (both P < 0.05). CONCLUSION: Secukinumab treatment helps patients with moderate-to-severe plaque psoriasis have a more normal life faster when compared to ustekinumab, by providing greater and sustained improvement in clothing choice and sexual functioning.

Frieder, J., D. Kivelevitch and A. Menter (2017). “Calcipotriene betamethasone dipropionate aerosol foam in the treatment of plaque psoriasis: A review of the literature.” Ther Deliv: 2017 Jun [Epub ahead of print].

Full text of this article.

Psoriasis is a common chronic immune-mediated skin disease which has a significant impact on patients’ quality of life, and is associated with numerous comorbidities (i.e., psoriatic arthritis, Crohn’s disease and cardiovascular disease). A greater understanding of its immunopathogenesis has guided the development of novel, more targeted therapies. Nonetheless, traditional treatment with topical agents, phototherapy and systemic medications is used in the management of the majority of psoriasis patients. Mainstay topical treatments include corticosteroids and vitamin D derivatives. Calcipotriene/betamethasone dipropionate aerosol foam is a novel single product combination, which seeks to provide superior therapeutic efficacy in addition to enhanced cosmetic properties. This article reviews the literature on the pharmacology and clinical data in terms of safety, efficacy and patient satisfaction of this topical medication.

Shear, N. H., R. Alhusayen, A. Fernandez-Obregon, A. B. Kimball, A. Menter, J. J. Wu, K. Goyal, H. Patel, R. Lin and A. W. Armstrong (2017). “Observations from our evaluation of body weight changes after initiation of a biologic therapy in psolar.” J Eur Acad Dermatol Venereol: 2017 Jun [Epub ahead of print].

Full text of this article.

PSOLAR is a global, prospective, observational study designed to evaluate long-term safety and clinical outcomes for over 12,000 psoriasis patients who are receiving, or are eligible to receive, biologic and/or conventional systemic agents. Data from the registry may also be used to test hypotheses for topics of interest to dermatologists.1 While PSOLAR has produced many viable analyses of safety and efficacy outcomes, including overall safety, serious infections, comparative effectiveness, and persistence of treatment,2-5 a recently tested hypothesis related to treatment effect on body weight did not generate interpretable results. Our observations may be relevant for future research in this area.

Agarwal, A., A. Gopinath, M. T. Tetzlaff and V. G. Prieto (2017). “Phosphohistone-h3 and ki67: Useful markers in differentiating dermatofibroma from dermatofibrosarcoma protuberans and atypical fibrohistiocytic lesions.” Am J Dermatopathol 39(7): 504-507.

Full text of this article.

Dermatofibromas (DF) are common, benign, skin tumors, usually easily differentiated from dermatofibrosarcoma protuberans (DFSP) by the presence of a relative low cellularity, lesser degree of infiltration of subcutaneous tissue, and immunohistochemical pattern (eg, FXIIIa in DF and CD34 in DFSP). Atypical fibrohistiocytic lesions (AFL) have features intermediate to DF and DFSP (trunk location, storiform pattern, infiltration of the subcutaneous tissue, and focal expression of both CD34 and Factor XIIIa). It is unclear if mitotic counts/degree of proliferation is helpful to distinguish DF from DFSP. To study the mitotic rate and proliferation index in DF, AFL/DFSP, anti-ki67, and anti-PHH3 were performed on 10 cases of DF (including 4 cellular DF), 10 standard DFSP, and 2 AFL. The proliferation index and mitotic figures were counted per square millimeter in a “hotspot” (in a fashion similar to mitotic counts in melanoma). All cases of DF showed much higher Ki67 proliferation index (P = 0.0001) along with increased mitotic figures both on H&E and with anti-PHH3 (P = 0.0001) when compared to AFL/DFSP. Our data indicate that DF has a higher proliferation index and mitotic counts when compared to superficial/peripheral portion of AFL and DFSP. This finding may be helpful in the differential diagnosis among these fibrohistiocytic lesions.

Paul, C., C. Leonardi, A. Menter, K. Reich, L. S. Gold, R. B. Warren, A. Moller and M. Lebwohl (2017). “Calcipotriol plus betamethasone dipropionate aerosol foam in patients with moderate-to-severe psoriasis: Sub-group analysis of the pso-able study.” Am J Clin Dermatol 18(3): 405-411.

Full text of this article.

BACKGROUND: Fixed-combination calcipotriol 50 mug/g plus betamethasone 0.5 mg/g (Cal/BD) aerosol foam is a new topical treatment for psoriasis. Although moderate-to-severe psoriasis is typically treated with systemic/biologic therapies, a topical treatment that is efficacious in these patients may be a significant cost-saving alternative to systemic therapy. OBJECTIVE: The objective of this study was to assess the response to Cal/BD foam and gel in patients with moderate-to-severe psoriasis enrolled in the phase III, 12-week PSO-ABLE study. METHODS: Patients eligible for this analysis had moderate-to-severe psoriasis, defined by the ‘Rule of Tens’: body surface area >/=10% or Psoriasis Area and Severity Index (PASI) [excluding head; modified PASI (mPASI)] >10 or Dermatology Life-Quality Index >10. Endpoints included: proportion of patients achieving mPASI75 or mPASI90; change in body surface area; proportion of patients clear/almost clear with a >/=2 grade improvement (i.e., treatment success); change in Dermatology Life-Quality Index. RESULTS: Seventy-seven Cal/BD foam patients and 82 gel patients had moderate-to-severe psoriasis. A greater proportion achieved mPASI75 and mPASI90 with Cal/BD foam than gel at weeks 4, 8, and 12 (57.1 vs. 35.4%; p = 0.006 and 15.6 vs. 12.2% at week 12, respectively); overall reduction in mPASI from baseline to week 12 was 64% with the foam vs. 51% with the gel. Overall reduction in body surface area at week 12 was 50% with the foam and 39% with the gel. Treatment success rates were higher with the Cal/BD foam than the gel at weeks 1, 2, 4, 8 (p = 0.0089), and 12, and a greater proportion of foam patients achieved a Dermatology Life-Quality Index score of 0/1 at weeks 4 (p = 0.004), 8, and 12 (p = 0.001). CONCLUSION: Cal/BD foam can be considered as a treatment option in some patients with moderate-to-severe psoriasis who are potential candidates for systemic therapy.