Eva Vilarrasa

Efficacy of biologics in the treatment of moderate-to-severe plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials with different time points

Differences in response rates of biologics for the treatment of moderate‐to‐severe plaque psoriasis have been reported in several meta‐analyses published to date. However, the usefulness of these meta‐analyses is limited as they do not reflect currently approved recommendations in the Summaries of Product Characteristics (SmPCs) and clinical practice.

Safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and chronic viral hepatitis B or C: a retrospective, multicentre study in a clinical setting

Background  Both the safety and efficacy of biologic therapy may be affected in the presence of highly prevalent chronic viral hepatitis.

Adalimumab for the treatment of psoriasis in real life: a retrospective cohort of 119 patients at a single Spanish centre.

Patients with moderate‐to‐severe psoriasis treated with adalimumab in daily clinical practice are different from those in clinical trials, and outcomes may differ in different geographical settings.

Efficacy of ustekinumab in refractory palmoplantar pustular psoriasis.

Summary Background Palmoplantar pustulosis (PPP) is characterized by sterile pustules with hyperkeratosis, erythema, scaling and fissuring on the palms and soles. PPP can present alone, or in association with palmoplantar pustular psoriasis (PPPP).

Treatment of Acrodermatitis Continua of Hallopeau with TNF-Blocking Agents: Case Report and Review

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular eruption, characterized by sterile pustules, paronychia and atrophic skin changes, onychodystrophy and osteolysis of the distal phalanges of the fingers and toes. It is considered to be a variant of pustular psoriasis with a chronic relapsing course and frequent refractoriness to many therapeutic modalities, which can be amenable to successful treatment by tumor necrosis factor α antagonists. We report 1 patient with pustular psoriasis and ACH whom we have treated successfully with etanercept (for 30 months) and then adalimumab (for 13 months and ongoing). Blanching was initially achieved with etanercept 50 mg twice a week, but suppression of periungual inflammation then required combination therapy with etanercept 50 mg twice a week and methotrexate 10 mg weekly; lower doses of both drugs did not allow complete control of the disease. Eventually, adalimumab 40 mg every 2 weeks has provided the most cost-effective response in this patient, allowing maintenance of response with partial nail regrowth under monotherapy.

Long-term study of infliximab for psoriasis in daily practice: drug survival depends on combined treatment, obesity and infusion reactions.

Infiximab has been shown to be highly effective in phase III clinical trials, but limited information is available regarding drug survival and maintenance of efficacy beyond 1 year in real‐life clinical setting.

Histologic persistence of a congenital melanocytic nevus of the scalp despite clinical involution

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Secukinumab (AIN457) for the treatment of psoriasis

Psoriasis is a chronic inflammatory disease with a multifactorial origin that appears in patients with genetic predisposition and is induced by environmental factors, and characterized by alterations in the innate and adaptive immunity. IL-17A is one of the specific cytokines involved in the pathogenesis of psoriasis and its inhibition is highly effective in the treatment of patients with moderate and severe psoriasis. Secukinumab is a monoclonal antibody that specifically binds to IL-17A and inhibits the interaction to its receptor, and it has demonstrated its efficacy and safety in the treatment of psoriasis. Phase II and III clinical trials indicate that > 80% of the patients receiving secukinumab achieve Psoriasis Area Severity Index (PASI) 75 at week 12. In the Phase III efficacy of response and safety of two fixed secukinumab regimens in psoriasis trial, PASI 75 rates were 81.6% with 300 mg secukinumab, 71.6% with 150 mg secukinumab and 4.5% with placebo, and responses were maintained up to 52 weeks in the majority of patients. In the Phase III Full Year Investigative Examination Of Secukinumab versus Etanercept Using Two Dosing Regimens To Determine Efficacy in Psoriasis study, the efficacy of secukinumab was compared to etanercept. The results indicate that both doses of secukinumab (150 and 300 mg) showed superior efficacy compared with etanercept throughout the study; PASI 75 rates at week 12 were 77.1% with 300 mg secukinumab, 67% with 150 mg of secukinumab, 44% with etanercept and 4.9% with placebo. PASI 90 and PASI 100 were 54 and 24% with secukinumab 300 mg and 21 and 4% with etanercept at week 12. At week 52, PASI 90 continued to be higher in the secukinumab group (65%) compared with the etanercept group (33%). Regarding safety, the most common side effects were nasopharyngitis and headache. The rate of infections was higher with secukinumab than placebo. This was especially the case for Candida infections, which were more common in the secukinumab group (4.7% with secukinumab 300 mg and 2.3% with secukinumab 150 mg), but all cases were resolved with conventional treatment. Secukinumab is a well-tolerated treatment that has demonstrated efficacy in treating moderate-to-severe plaque psoriasis. Nevertheless, long-term studies are necessary to confirm Phase II and Phase III data.

Acute Severe Methotrexate Toxicity in Patients with Psoriasis: A Case Series and Discussion

Background: Methotrexate (MTX) is considered a relatively safe drug when prescribed at low-dose regimens not exceeding 25 mg/week. Severe acute toxicity is rare and presents with mucositis, cutaneous ulceration and pancytopenia. Most cases occur as the result of inadvertent overdosing due to erroneously taking the drug daily. However, concomitant factors such as older age, co-medication and renal failure may increase the drugs toxicity. Case Reports: We report four consecutive cases of acute MTX toxicity in patients with psoriasis vulgaris. In three patients, MTX was erroneously taken daily for 2-4 weeks. All three patients recovered following MTX withdrawal and intensive treatment. The fourth patient was taking 7.5 mg weekly MTX as prescribed, but had concomitant factors and died. Conclusion: Although low-dose MTX appears to be a safe medication, acute MTX toxicity can be a life-threatening emergency. Greater awareness of possible MTX toxicity is still needed for its prevention, early diagnosis and management.

Análisis de coste-eficacia incremental de los tratamientos biológicos para la psoriasis en los momentos de valoración significativos para la práctica clínica

The Spanish guidelines for the treatment of psoriasis recommend that drug choice should be guided by the criteria established in the Summary of Product Characteristics (SPC) for each agent and that decisions should be made on a case-by-case basis and take into account economic considerations. Since the introduction of biologic agents, several authors have studied their cost-efficacy. However, none of these studies present an overall view of the results at clinically significant evaluation time points. The equation used for cost-effectiveness analysis, which can support therapeutic decisions, is the incremental cost effectiveness ratio (ICER): ICER = (C1--C2)/(E1--E2), where C1 and E1 are the cost and effect in the treatment group and C2 and E2 are the cost and effect in the control group. The present analysis is intended to provide useful information to guide clinical practice based on the results of a recent meta-analysis, evaluating the most important variables at each time point. The outcomes and time points used were as follows: a 50% reduction in PASI score (PASI 50) at the time point the SPC recommends assessment of response in order to identify primary treatment failure, and PASI 50 and PASI 75 responses at week 24 (the end of the induction phase). The cost of each treatment was calculated on the basis of the pharmaceutical company’s sale price as of January 2014 less the mandatory deduction under Spanish law (Real Decreto 08/2010) plus VAT. In the case of infliximab,