Bing Thio

Long-term safety and effectiveness of high-dose dimethylfumarate in the treatment of moderate to severe psoriasis: a prospective single-blinded follow-up study

Abstract Background: Mixtures of fumaric acid esters (FAE) are used as an oral systemic treatment for moderate to severe psoriasis. Large clinical studies with dimethylfumarate (DMF) monotherapy are scarce. Objectives: The objective of this study is to assess the effectiveness and long-term safety of high-dose DMF monotherapy in moderate to severe psoriasis. Methods: A prospective single-blinded follow-up study was performed in a cohort of patients treated with DMF. Patients were followed-up at fixed intervals. Assessment of consecutive photographs was performed by two observers. Primary outcome was a change in static physician global assessment (PGA) score. Safety outcome was defined as incidences of (serious) adverse events. Results: A total of 176 patients with moderate to severe psoriasis were treated with DMF for a median duration of 28 months. The median daily maintenance dosage of 480 mg was reached after a median of 8 months. Psoriasis activity decreased significantly by 1.7 out of five points. A total of 152 patients reported one or more adverse events, such as gastrointestinal complaints and flushing. Conclusions: High-dose DMF monotherapy is an effective and safe treatment option in moderate to severe psoriasis. It can be suggested that 50% of all patients may benefit from high-dose DMF monotherapy.

Lower lifetime prevalence of atopy in rheumatoid arthritis.

There is evidence that the prevalence of atopic disorders may be lower in patients with autoimmune conditions [1]. In the past, five studies have looked into the associations between atopy and rheumatoid arthritis (RA). All have found evidence of a lower prevalence of atopy in RA patients. However, they were either only questionnaire based, without serological confirmation of atopy [2–4], or they did not account for all manifestations of atopy [4–6]. We have set out to assess the lifetime prevalence of clinical and serological manifestations of atopy in RA patients in a case control study. The subjects were recruited between July 2010 and July 2011, from outpatient clinic for rheumatology at the Maxima Medical Center, Eindhoven, and the controls were patients with varicosities from our phlebology outpatient clinic. All subjects provided informed consent, and the study protocol was reviewed by the local Medical Ethical Committee. The diagnosis of RA was made according to the criteria of the American Rheumatism Association. The disease activity and course severity in RA patients were assessed with disease activity score 28 (DAS) and Health Assessment Questionnaire Disability Index, respectively (HAQDI) [7, 8]. Manifestations of atopy were assessed using a questionnaire based on the European Community Respiratory Health Survey [9]. Blood samples were taken from all subjects and levels of total serum IgE, and IgE directed against common aeroallergens were measured using Phadiatop; Phadia AB, Uppsala Sweden, according to the manufacturers protocol. One hundred and thirty-three RA patients and 124 controls were included. Eighty-nine (66 %) of the RA patients were anti-CCP positive and 90 (67 %) were currently treated with methotrexate. The average age at onset of RA was 50 years, standard deviation 13. The average age was higher in RA patients than in controls (62 vs. 54 years, p \ 0.001). There were 48 (36 %) and 53 (42 %) males in RA and control group, respectively (p = 0.278). RA patients reported previous symptoms of dermatitis, itching and flexural rash less often (20 vs. 33 %, p = 0.020) and (9 vs. 19 %, p = 0.037) (Table 1). However, dry skin during last year, a measure of current symptomatology of atopic dermatitis, was reported equally in both groups (44 vs. 44 %, p = 0.896). RA patients also reported having had hay fever less often (11 vs. 20 %, p = 0.032). The percentage of patients diagnosed with asthma was lower in the RA group although the difference did not reach statistical significance (8 vs. 14 %, p = 0.086). Current asthma symptomatology expressed as asthma attacks in the last year and inhalator use were equally distributed across both groups (Table 1). Finally, serological evidence of atopy was less often found in RA patients. Twelve per cent of the RA group had a serum IgE level of more than 100 kU/L, and in controls, this was 21 %, p = 0.053. A smaller percentage of the RA group were sensitized to common aeroallergens than controls (22 vs. 33 %, p = 0.043). Having any atopic feature lowered the odds of having RA by roughly 60 % with OR 0.43; 95 % CI [0.25–0.75]. Adjusted for age and sex this was OR 0.51; 95 % CI [0.28–0.92]. The median HAQDI in sensitized RA patients did not differ from the median in non-sensitized patients (1.0; IQR [0.3–1.6] vs. 1.0; IQR [0.4–1.5], p = 0.375). The DAS28 score was equally distributed in sensitized and non-sensitized RA patients as well (2.6; IQR [2.1–3.9] vs. 3.2; IQR [2.2–4.0], p = 0.343). In conclusion, RA patients had a lower prevalence of clinical and serological atopic features. Atopy had no effect E. Hajdarbegovic (&) B. Thio T. Nijsten Rotterdam, The Netherlands e-mail: e.hajdarbegovic@erasmusmc.nl

Enteric-coated mycophenolate sodium in psoriasis vulgaris: an open pilot study

Background: Mycophenolate mofetil is a well-known immunosuppressive agent in transplantation medicine. The efficacy of enteric-coated mycophenolate sodium (EC-MPS) was confirmed in other inflammatory skin diseases, including atopic dermatitis and SCLE. Objective: To investigate the efficacy and the tolerability/short-term safety of EC-MPS in patients with moderate to severe chronic plaque psoriasis. Patients and methods: An open-label pilot study in which 20 patients with a PASI >10 received EC-MPS 720 mg twice daily for 6 weeks followed by 360 mg twice daily for another 6 weeks. Patients who completed 12 weeks of treatment were followed-up for an additional 12 weeks. Treatment outcomes were assessed with PASI50% and PASI75%. Results: Eighteen men and two women (mean age 46 years) entered the study. Sixty-five percent (13/20) finished the treatment period. By week 6, no patient achieved PASI 75% and 8/20 patients achieved a PASI 50%. Compared to week 6, 4/13 showed a deterioration of their psoriasis at week 12. Twenty-five percent (2/8) achieved a PASI 75% in week 24. The most-reported adverse events were itching (30%), diarrhea (10%), and a reversible elevation of the triglycerides level. Conclusion: EC-MPS does not seem effective as monotherapy for moderate to severe psoriasis, but might be used at a dosage of 1440 mg daily in well-selected patients with treatment-resistant psoriasis.

Prevalence of atopic diseases in patients with sarcoidosis.

It remains unclear whether atopy is associated with the occurrence of sarcoidosis or affects its severity. The purpose of this study was to compare the lifetime prevalence of atopic eczema, asthma, and hay fever in sarcoidosis patients with controls and to assess whether atopy influences the severity of sarcoidosis. The prevalence of atopic disorders assessed with a validated postal questionnaire in sarcoidosis patients with pulmonary, uveitis, and cutaneous sarcoidosis was compared with that of their domestic partners in a case-control study. The serological parameters, the pulmonary function tests, and the high-resolution computed tomography (HRCT) scans of atopic and nonatopic sarcoidosis patients were compared in a nested cohort. Multivariate logistic regression models were used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs). Two hundred twenty-five sarcoidosis patients and 177 controls were included. The prevalences of atopic eczema, asthma, and hay fever were comparable between patients and controls (12.4% versus 12.4%, 5.3% versus 5.6%, and 16.9% versus 15.8%, respectively). After adjusting for gender and ethnicity, those with sarcoidosis and a history of atopic eczema were significantly less likely to have uveitis (OR, 0.30; 95% CI, 0.13-0.71). Within the sarcoidosis cohort, the distributions of serological markers, the lung function tests, and the HRCT scans were similar between atopic and nonatopic patients. Atopy is not associated with the occurrence of sarcoidosis, but atopic eczema may decrease the likelihood of eye involvement.

The association between atopic disorders and keloids: A case-control study

Background: Keloids and atopic disorders share common inducing and maintaining inflammatory pathways that are characterized by T-helper cell 2 cytokines. Aims and Objectives: The objective of this study was to test for associations between keloids and atopic eczema, asthma and hay fever. Materials and Methods: This was a case-control study with 131 patients diagnosed with keloids at our dermatology outpatient clinic between 2000 and 2012. Controls were 258 partners of keloid or sarcoidosis patients. Patient who reported life time prevalences of atopic eczema, asthma and hay fever were assessed using a questionnaire based on The European Community Respiratory Health Survey (ECRHS) and The International Study of Asthma and Allergies in Children (ISAAC). Results: The prevalence of asthma was lower in keloid patients (19/131 vs. 20/258, P = 0.035), as was being diagnosed with asthma by a physician (18/131 vs. 19/258, P = 0.039) and using inhalators for asthma (13/131 vs. 7/258, P = 0.02). After adjusting for age and non-European descent the odds ratio for having a keloid was (adjusted OR = 4.44; 95% CI 1.59–12.40) in asthmatics using inhalators. There were no clear and consistent associations found for keloids with atopic eczema or with hay fever. Conclusion: In conclusion, our study shows that keloids may be strongly associated with atopic asthma. Atopic eczema and hay fever do not seem to be correlated with keloid. Further studies are warranted to assess the validity of atopic asthma as a risk factor for the development of keloid scars.