Michael Ziv

Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study

Background: Secukinumab demonstrated superior efficacy to ustekinumab at week 4 and week 16 of the CLEAR study, with comparable safety, in subjects with moderate‐to‐severe plaque psoriasis. Objective: To compare the efficacy and safety of secukinumab and ustekinumab use over 52 weeks. Methods: Analysis of 52‐week data from CLEAR, a randomized, double‐blind, phase 3b study. Results: Among 676 randomized subjects, secukinumab demonstrated superiority to ustekinumab at week 52 in the proportion of subjects with ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) (76% vs 61% [P < .0001]); PASI 100 responses were 46% versus 36% (P = .0103) and Investigators Global Assessment responses of clear/almost clear skin were 80% versus 65% (P < .0001). Subjects on secukinumab reported greater reductions in psoriasis‐related pain, itching, and scaling, and greater improvement across all quality‐of‐life measures evaluated (Dermatology Life Quality Index [DLQI], EuroQoL 5‐Dimension Health Questionnaire, Work Productivity and Activity Impairment Questionnaire‐Psoriasis, and Health Assessment Questionnaire‐Disability Index). At week 52, 72% of subjects on secukinumab versus 59% on ustekinumab (P = .0008) reported no impact of skin disease on their lives (DLQI 0/1 response). Safety and tolerability was comparable. Limitations: There was no placebo arm. Conclusion: In this head‐to‐head, double‐blind study, secukinumab demonstrated sustained superior efficacy in comparison with ustekinumab in clearing skin through week 52, greater improvement in quality of life, and a favorable and comparable safety profile.

Nail disorders in patients with chronic renal failure and undergoing haemodialysis treatment: a case-control study

Background  Few controlled studies have compared nail disorders in patients with chronic renal failure (CRF) and haemodialysis (HD)‐dependent individuals with a healthy population.

Pregnancy outcomes in women with moderate-to-severe psoriasis.

Background  The association between psoriasis and pregnancy outcomes has not been adequately examined, although psoriasis onset is common in the reproductive period.

Cutaneous nocardiosis: report of two cases and review of the literature.

Background  Cutaneous nocardiosis is an uncommon infectious disease that presents as a primary cutaneous infection or as a disseminated disease. It is often misdiagnosed because of its rarity and nonspecific clinical picture.

Epidemiological and clinical manifestations of patients hospitalized with brown recluse spider bite

Background  Necrotic arachnidism represents a common health problem and standard treatments are usually safe and effective.

Opportunistic infections in patients with pemphigus

BACKGROUND Opportunistic infections (OIs) can be defined as infections in immunosuppressed patients that are more frequent or severe because of immunosuppression. The literature on OIs in pemphigus is sparse. OBJECTIVE We assessed the incidence, risk factors, and characteristics of OIs in patients with pemphigus. METHODS This was a historical prospective study following a cohort of 172 patients with newly diagnosed pemphigus for the development of OIs. RESULTS Fourteen patients developed OIs at a mean of 4 months from the time of diagnosis while taking a mean dose of 0.8 mg/kg/day of prednisone, 5 in conjunction with azathioprine. The risk of developing an OI in the first year after the diagnosis of pemphigus was 9.3%, subsequently dropping to 0. Advanced age and possibly diabetes were found to be risk factors for OI development. Infectious agents included Nocardia, cytomegalovirus, Legionella, and Listeria. Two patients died within 2 months of OI diagnosis, and 2 more had neurologic impairment. LIMITATIONS Limitations include the extraction of historical data and the cohort originating from a single geographic region. CONCLUSION OIs present in a significant number of patients with pemphigus during the first year after the diagnosis of pemphigus, with potential deleterious effects. Older and possibly diabetic patients are at increased risk. Physician vigilance and patient education on limiting pathogen exposure is recommended.

Biologic drug survival in Israeli psoriasis patients

Background Drug survival is defined as the time period of treatment with a certain drug until its cessation. The role of previous exposure to traditional systemic treatments in biologic survival is still unknown. Objective To investigate the drug survival rates of biologic treatments in patients with psoriasis and to identify predictor factors. Methods Survival analysis was performed on patients with severe psoriasis who received adalimumab, infliximab, etanercept, and ustekinumab for treatment of psoriasis, drawn from the Clalit Health Services database. Multivariate analysis was performed adjusting for demographic variables; metabolic syndrome and its components; psoriatic arthritis; biologic naivety; coadministration of methotrexate, acitretin, or cyclosporine; and previous standard systemic treatment exposure. Results Among 907 patients treated with 1575 biologic treatments, ustekinumab had a significantly higher survival rate than tumor necrosis factor inhibitors. Biologic naivety and concomitant methotrexate intake were positive predictors for drug survival, whereas the female sex and the duration of previous systemic treatments were negative predictors. Limitations Data regarding disease severity or duration could not be drawn from the Clalit Health Services database. Conclusion Ustekinumab had better retention rates in comparison with other investigated biologics in patients with severe psoriasis, most of whom used it as a third line therapy.

Combination therapy of cyclosporine and anti-tumor necrosis factor α in psoriasis: a case series of 10 patients.

Combination therapy has become important in treating psoriasis, using synergism between different mechanisms to maximize efficacy and minimize toxicity. Little has been published on the combination of cyclosporine and anti‐tumor necrosis factor (TNF) α agents. In this study, a retrospective chart review was made of the effects of this combination therapy in 10 patients with recalcitrant psoriasis. Treatment included a conditioning phase with cyclosporine, 3.14 ± 0.37 mg/kg for 4.6 ± 2 weeks, and a combination phase during which etanercept/adalimumab were initiated and cyclosporine was tapered over 10.2 ± 3.7 weeks. Treatment success, evaluated after each phase, was classified as complete recovery (CR, more than 75% improvement), partial response (PR, 25–75% improvement), and no response (NR, less than 25% improvement). All patients reached CR at the end of the combination therapy. Two were still on combination therapy after 12 and 20 weeks. Adverse event occurred in three cases, all in the conditioning phase. We conclude that combination therapy with cyclosporine and anti‐TNF α appears to offer an effective and safe approach to treatment of psoriasis.

Bacteriological aspects of Darier’s disease

Background  There are no established data on the prevalence of bacterial colonization of lesional skin, nares and perineum in Darier’s disease (DD), or its contribution to the clinical manifestations of the disease.

Health-related quality of life among Darier's disease patients.

Background  Darier’s disease (DD) is an autosomal dominant skin disorder characterized by persistent eruption of hyperkeratotic papules. The effect of DD on quality of life (QOL) has been assessed in only one study, which found no correlation between the Dermatology Life Quality Index (DLQI) score and clinical severity of the disease. The correlation between health‐related quality of life (HRQL) and other diseases and patient characteristics has not been studied.