Robert Strohal

Efficacy and safety of continuous versus paused etanercept treatment in patients with moderate-to-severe psoriasis over 54 weeks: the CRYSTEL study

Objective: To evaluate the efficacy and safety of continuous and paused etanercept regimens in psoriasis patients. Methods: Patients with moderate-to-severe plaque psoriasis were randomized to receive continuous etanercept 25 mg twice weekly or paused etanercept for 54 weeks. The paused group received etanercept 50 mg twice weekly for no more than 12 weeks until reaching a Physician Global Assessment (PGA) of 2 or less (mild or better), when treatment was paused; upon relapse (PGA ≥ 3), etanercept was resumed at 25 mg twice weekly until a PGA of 2 or less was regained. The primary efficacy end point was mean PGA over 54 weeks, which was compared between the continuous and paused groups. Secondary efficacy end points included changes from baseline in mean PGA score, Psoriasis Area and Severity Index (PASI) and patient satisfaction with current psoriasis treatment. Results: Among 711 patients evaluable for efficacy, the mean PGA score averaged over 54 weeks (primary end point) was significantly lower in the...

Juvenile psoriasis and its clinical management: a European expert group consensus

Background: Psoriasis, an inflammatory disorder of the skin, can significantly impact on a patients quality of life, affecting their daily activities and families. The onset of psoriasis in childhood is quite common; however, the treatment of moderate‐to‐severe disease in this population is challenging, with a paucity of data reported and few licensed agents available.

Recommendations for the use of etanercept in psoriasis: a European dermatology expert group consensus

Background  Psoriasis is a chronic, inflammatory skin disorder that has a significant impact on quality of life and, particularly in moderate to severe cases, adversely affects the patients overall health and well‐being. Biological treatments, such as etanercept, are being widely adopted across Europe for treatment of moderate to severe psoriasis due to favourable safety and efficacy profiles. The increase in usage, combined with a growing body of clinical evidence, has identified a need to clarify the best use of etanercept within its current treatment label.

Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis.

Psoriatic arthritis (PsA) and co‐morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate‐to‐severe psoriasis. Often these co‐morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co‐morbidities is lacking.

The role of IL-23 and the IL-23/TH17 immune axis in the pathogenesis and treatment of psoriasis

Psoriasis is a chronic, immune‐mediated disease affecting more than 100 million people worldwide and up to 2.2% of the UK population. The aetiology of psoriasis is thought to originate from an interplay of genetic, environmental, infectious and lifestyle factors. The manner in which genetic and environmental factors interact to contribute to the molecular disease mechanisms has remained elusive. However, the interleukin 23 (IL‐23)/T‐helper 17 (TH17) immune axis has been identified as a major immune pathway in psoriasis disease pathogenesis. Central to this pathway is the cytokine IL‐23, a heterodimer composed of a p40 subunit also found in IL‐12 and a p19 subunit exclusive to IL‐23. IL‐23 is important for maintaining TH17 responses, and levels of IL‐23 are elevated in psoriatic skin compared with non‐lesional skin. A number of agents that specifically inhibit IL‐23p19 are currently in development for the treatment of moderate‐to‐severe plaque psoriasis, with recent clinical trials demonstrating efficacy with a good safety and tolerability profile. These data support the role of this cytokine in the pathogenesis of psoriasis. A better understanding of the IL‐23/TH17 immune axis is vital and will promote the development of additional targets for psoriasis and other inflammatory diseases that share similar genetic aetiology and pathogenetic pathways.

Kompressionstherapie bei Patienten mit Ulcus cruris venosum

Wund‐D.A.CH. ist der Dachverband deutschsprachiger Fachgesellschaften, die sich mit den Thematiken der Wundbehandlung beschäftigen. Experten verschiedener Fachgesellschaften aus Deutschland, Österreich und der Schweiz haben nun einen aktuellen Konsens der Kompressionstherapie für Patienten mit Ulcus cruris venosum erstellt.

Compression therapy in patients with venous leg ulcers

Wund‐D.A.CH. is the umbrella organization of the various wound care societies in German‐speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland.

Psoriasis beyond the skin: a review of the literature on cardiometabolic and psychological co-morbidities of psoriasis.

Psoriasis is increasingly associated with a range of co-morbid diseases and risk factors. Patients with co-morbidities are more likely to need hospitalisation for non-dermatological conditions, and incur greater total costs than those without co-morbidities. A literature review was conducted on two of the most common co-morbidities of psoriasis (cardiovascular (CV) and psychological co-morbidities), to establish their incidence and impact and to raise awareness of unanswered questions and highlight knowledge gaps. A large number of small controlled or cross-sectional studies report increased prevalence of cardiometabolic and psychological co-morbidities in psoriasis patients.Anumber of large cohort studies documented the incidence of various cardiometabolic comorbidities. Severe psoriasis is associated with increased mortality, and the most common cause of death is CV disease. Studies on the management of co-morbidities and their impact on psoriasis treatment are scarce. Many questions on the co-morbidities of psoriasis remain to be answered.

M.O.I.S.T. – ein Konzept für die Lokaltherapie chronischer Wunden

Wunden werden als chronisch bezeichnet, wenn diese nach acht Wochen nicht abgeheilt sind [ 1 ] . Unabhängig von dieser zeitlich orientierten Defi nition werden Wunden von Beginn an als chronisch eingestuft, wenn ihre Behandlung eine Therapie der weiterhin bestehenden Ursache erfordert. Hierzu gehören beispielsweise das diabetische Fußulkus, Wunden bei pAVK, Ulcus cruris venosum oder Dekubitus. Die Grundlage der erfolgreichen Therapie chronischer Wunden basiert auf der Diagnostik [ 2 ] und der kausal ansetzenden Behandlung der zugrundeliegenden, pathophysiologisch relevanten Erkrankungen [ 3 ] unter Einbezug relevanter psychosozialer Faktoren [ 4 ] . Begleitend hierzu sollte bei den meisten Patienten auch eine an den Phasen der Wundheilung orientierte, feuchte Wundtherapie durchgeführt werden [ 5 ] . Metaanalysen belegen, dass der Einsatz einer solchen modernen Wundtherapie die Abheilungsraten chronischer Wunden unterstützt [ 6 ] . Die aktuell hierfür zur Verfügung stehenden Therapieoptionen sind sehr vielfältig, so dass es vielen Therapeuten schwer fällt, einen Überblick zu bewahren. In den letzten Jahren wurden bereits verschiedene Akronyme vorgestellt, die eine Hilfe bei der Strukturierung der Lokaltherapie chronischer Wunden darstellen sollten. International hat sicher das 2003 erstmalig publizierte T.I.M.E.-Konzept die weiteste Verbreitung gefunden. In den letzten mehr als zehn Jahren haben sich allerdings viele neue Aspekte und Therapieoptionen ergeben. Es war daher das Ziel einer interdisziplinären und interprofessionellen Expertengruppe für Wund-D.A.CH., dem Dachverband der deutschsprachigen Fachgesellschaften im Wundheilungssektor, das bewährte T.I.M.E.-Konzept für die Systematik der Lokaltherapie chronischer Wunden weiterzuentwickeln, um auch aktuelle Optionen hierbei einbeziehen zu können. Die mit „T“, „I“ und „M“ beschriebenen Faktoren des T.I.M.E.-Konzepts sind weiterhin zeitgemäß und wichtig. Sie wurden daher leicht modifi ziert für das neu entwickelte M.O.I.S.T.-Konzept übernommen (Tabelle 1 ). Mit dem Buchstaben „E“ wurde bei T.I.M.E. ursprünglich epidermis [ 7 ] Clinical Letter

Identifying the biologic closest to the ideal to treat chronic plaque psoriasis in different clinical scenarios: using a pilot multi-attribute decision model as a decision-support aid

Abstract Objective: Multi-attribute decision-making (MADM) models evaluate competing solutions for complex problems to identify the closest fit to the ideal solution. MADM models may assist dermatologists when selecting between biologics for plaque psoriasis. Here, is described the development of a pilot model to identify the preferred biologic from the dermatologists perspective. Research design and methods: A group of European dermatologists were surveyed to identify treatment attributes they consider when prescribing a biologic. The relative importance of each was determined by allocation of 100 importance points in the context of seven case vignettes, reflecting the breadth of disease encountered in dermatological practice. Biologic performance was rated anonymously on a scale of 1–10, scores entered into a MADM matrix, and TOPSIS (Technique for Ordered Preference by Similarity to the Ideal Solution) analysis applied to identify the biologic closest to the hypothetical ideal. Results: Long-term efficacy and safety were the most important attributes considered by dermatologists when selecting a biologic. For one case vignette (chronic stable psoriasis), TOPSIS scores showed that etanercept was closest to the ideal for 63% of respondents, with adalimumab closest to the ideal for 32% of respondents. Differences among the biologics were highly significant (p < 0.0001). For severe unstable psoriasis, infliximab and adalimumab were preferred. Limitation: This study was conducted with a group of dermatologists attending a Wyeth-sponsored advisory board meeting. Conclusions: Based on responses from this expert group, etanercept was the preferred choice for stable chronic plaque psoriasis for the majority, with infliximab preferred for more severe disease. However, there are several limitations to this pilot model, most notably the non-random selection of the expert group. Further development of the model encompassing a random survey of dermatologists and inclusion of other treatment alternatives and the latest clinical data, will add to the clinical utility of the tool.