Sr Feldman

Better medication adherence results in greater improvement in severity of psoriasis

Background  Patients are commonly nonadherent to medication regimens. In dermatology, there has been little study of the effect of nonadherence on outcomes.

The genetics of pyoderma gangrenosum and implications for treatment: a systematic review

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful skin ulcerations for which treatment can be challenging. The genetic basis of PG may provide a better understanding of the disease and new targets for treatment. We systematically reviewed the published literature regarding the syndromes and genetic mutations associated with PG. A literature search was performed through the clinical queries PubMed (National Library of Medicine) database and the Cochrane database. The studies were assessed and then categorized as relating to syndromes or specific gene mutations. Two hundred and eight articles were identified, describing 823 cases of PG. A total of 537 (65·2%) cases were associated with inflammatory bowel disease, 133 (16·1%) with polyarthritis and 103 (12·5%) with haematological disorders. Thirty‐one cases of pyogenic arthritis, pyoderma gangrenosum and acne, and its variants, were identified. Two patients had mutations in MTHFR and two had mutations in JAK2. Fourteen (1·7%) cases were familial. PG responded to different treatments depending on the setting. For example, treatment with B vitamins improved PG in cases of mutations in MTHFR, whereas patients with myelodysplastic syndrome improved with thalidomide treatment. PG can occur in isolation, associated with systemic disease or as part of various syndromes. Different genetic causes may be best treated with particular treatments. Understanding its genetic basis can help elucidate new potential targets for drug development.

Economic evaluation of biologic therapies for the treatment of moderate to severe psoriasis in the United States

Abstract Background: New biologic therapies are available for moderate to severe psoriasis. Objective: To determine the most cost-effective sequence of biologic treatments. Methods: Through modeling of the clinical pathway of biologic agents, adalimumab, alefacept, efalizumab, etanercept, and infliximab, the costs and benefits (quality-adjusted life-years [QALYs]) were determined. A decision rule determined the optimal treatment sequence comparing costs and QALYs. Results: While infliximab was found to provide the most incremental QALY and etanercept was found to be the least costly, on balance, the incremental cost-effectiveness ratio of adalimumab was the most favorable (ICER =

Validation and Reliability of 2 Specialty Care Satisfaction Scales

544/QALY). Consequently, the optimal sequence would begin with adalimumab and be followed by etanercept, infliximab, efalizumab, and alefacept, respectively. The limitations of this study are that evidence was based on indirect comparisons of biologic effectiveness, and toxicities were not included in the model. Conclusions: In consideration of cost-effectiveness in prescribing biologics for moderate to severe psoriasis, the optimal sequence would begin with adalimumab.

Using ‘number needed to treat’ to help conceptualize the magnitude of benefit and risk of tumour necrosis factor‐α inhibitors for patients with severe psoriasis

DrScore.com an online patient satisfaction survey, uses 2 patient satisfaction scales, namely, satisfaction with physician care and satisfaction with office policy and procedures, including accessibility to care, convenience of office and practice location, and staff friendliness. This study assesses the validity and reliability of the scales. The sample includes 11212 specialty care visits, comprised of 64% women, 82% established patients, and 24% routine visits. A confirmatory factor analysis is used to test factor structure. Convergent validity also is examined. The goodness-of-fit index is 0.99, and standardized factor loadings are uniformly high, exceeding 0.90 for all but 2 items. Cronbach α is 0.99 for the physician scale and 0.94 for the office scale. Both scales discriminate other satisfaction indicators. Correlation between scales is high at 0.90. Both scales possess excellent psychometric properties but are not clearly differentiated. Results agree with the unidimensional view of patient satisfaction and confirm that online surveys can be reliable and valid. (Am J Med Qual 2009;24:12-18)

Utilization pattern of etanercept and its cost implications in moderate to severe psoriasis in a managed care population

Background  Risks and benefits of tumour necrosis factor (TNF) α inhibitors are often presented using statistical descriptions that are difficult to translate directly for patients into a clinically meaningful context.

Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring

ABSTRACT Objective: To describe the utilization patterns, particularly dosage-escalation patterns, and economic implications of etanercept in the treatment of moderate to severe psoriasis in a real-world setting. Methods: Patients with psoriasis receiving etanercept were identified from the Integrated Health Care Information Services database and were observed for 12 months or until etanercept discontinuation (defined as gap of >60 days between prescriptions). Patients were excluded if they had other autoimmune conditions or received TNF antagonists within 6 months of the index date. Ratios of patients with dosage increase to total sample were calculated. Among patients continuing treatment for 1 year, etanercept dosage and drug costs (measured by average wholesale price) were compared for patients with and without dosage increase using the Wilcoxon signed rank test. Results: 55.2% of patients discontinued during the study year; 51.6% of patients initiated at 100 mg/week; and 34.8% who initiated at 50 mg/week required dosage increases. Among patients continuously treated for 1 year, dosage increase resulted in incremental annual drug costs of

Emerging drugs for the treatment of acne

8 440 and

Prevalence of Rosacea in Community Settings

9 313 for 100 and 50 mg/week, respectively (both p < 0.0001). The annual dosage of etanercept in excess of the labeled amount translated into

Toward Continuous Primary Care in the United States Differences in Patient Satisfaction Between First and Return Visits to Primary Care Physicians/Analysis of DrScore—The National e-Survey Data

2 040 and