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The Journal of Dermatological Treatment Dec 2024Understanding the economic value of deucravacitinib and apremilast could assist treatment decision-making for patients with moderate to severe plaque psoriasis. (Comparative Study)
Comparative Study
BACKGROUND
Understanding the economic value of deucravacitinib and apremilast could assist treatment decision-making for patients with moderate to severe plaque psoriasis.
OBJECTIVE
This study compared the cost per response (CPR) for US patients initiating deucravacitinib versus apremilast for moderate to severe plaque psoriasis.
METHODS
A CPR model using pharmacy and administration costs was developed from a US payer perspective. Response was defined as a 75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at weeks 16 and 24. Long-term response was defined as the cumulative benefit over 52 weeks, measured as area under the curve; subsequent treatment was included. Scenario analyses explored varying the efficacy measure or choices of subsequent treatments and limiting discontinuation.
RESULTS
The CPR for deucravacitinib versus apremilast was lower at 16 weeks (difference: -$3796 [95% confidence interval (CI): -$6140 to -$1659]) and 24 weeks (difference: -$12,784 [95% CI: -$16,674 to -$9369]). At 52 weeks, the cost per cumulative benefit was lower for patients who initiated deucravacitinib, regardless of initial treatment period duration (16 or 24 weeks).
CONCLUSIONS
Scenario analyses found mainly consistent results. This study showed that the CPR is lower when initiating deucravacitinib versus apremilast in moderate to severe plaque psoriasis.
Topics: Humans; Psoriasis; United States; Thalidomide; Severity of Illness Index; Cost-Benefit Analysis; Biological Products; Treatment Outcome; Drug Costs; Male; Female
PubMed: 38914425
DOI: 10.1080/09546634.2024.2366503 -
The Journal of Dermatological Treatment Dec 2024This noninterventional, cross-sectional survey estimated the prevalence and consequences of residual disease in apremilast-treated US adults with moderate to severe...
This noninterventional, cross-sectional survey estimated the prevalence and consequences of residual disease in apremilast-treated US adults with moderate to severe psoriasis. Residual disease was defined as experiencing moderate, severe, or very severe psoriasis over the past week or having ≥3% body surface area affected, despite treatment. Factors associated with residual disease and its effects on flare-ups, humanistic burden, and health care resource utilization (HCRU) were evaluated. Of the 344 apremilast users (mean age, 44.9 years; female, 65.4%), 174 (50.6%) had residual disease. It was more prevalent in Black versus White participants (OR, 4.5; 95% CI, 1.6-12.2), those receiving apremilast for ≥1 versus <1 year (OR, 16.5; 95% CI, 7.9-34.4), those reporting ≥2 versus 0 to 1 flare-ups during the past 3 months (OR, 10.0; 95% CI, 5.0-20.1), and those with ≥4 versus 1 to 3 body regions affected at time of survey (OR, 8.6; 95% CI, 3.8-19.8). Participants with versus without residual disease self-reported more psoriasis flare-ups over the past 3 months (mean, 4.7 vs 0.9; < .001) and more anxiety (89.7% vs 50.0%; < .001) and depression (69.0% vs 23.6%; < .001) over the past 30 days. Generally, participants with versus without residual disease also had significantly more comorbidities and greater HCRU.
Topics: Humans; Psoriasis; Thalidomide; Female; Male; Cross-Sectional Studies; Adult; Middle Aged; United States; Prevalence; Severity of Illness Index; Anti-Inflammatory Agents, Non-Steroidal; Surveys and Questionnaires; Symptom Flare Up
PubMed: 38914422
DOI: 10.1080/09546634.2024.2366532 -
The Journal of Dermatological Treatment Dec 2024Providers who treat patients with psoriasis are unevenly distributed across the United States, with more in urban than rural areas. This retrospective claims analysis...
PURPOSE
Providers who treat patients with psoriasis are unevenly distributed across the United States, with more in urban than rural areas. This retrospective claims analysis characterized disparities in access to care for US patients with psoriasis using data from the STATinMED database.
MATERIALS AND METHODS
Patients (≥18 years) had ≥1 claim with a psoriasis diagnosis and ≥1 claim for advanced psoriasis therapy (apremilast or biologics) between January 2015 and December 2019. Access to psoriasis care was determined using the proportion of patients with 0, 1-2, 3-4, or ≥5 providers in their local area.
RESULTS
Overall, 179,688 patients were included in the analysis, 80.0% in urban areas. The access ratio was highest for internal medicine physicians (97.1 per 1000 patients) and lowest for dermatologists (4.4 per 1000 patients) and family practice physicians (3.9 per 1000 patients). In urban areas, 41% of patients had access to ≥5 dermatologists versus 7% in rural areas. Whereas 2% of patients in urban areas sought care outside of their local area, 75% in rural areas did so. Use of advanced therapies was low in all states (<17%).
CONCLUSION
Access to psoriasis-treating providers varied widely. Regardless of access, utilization of advanced treatments was low, suggesting the need for effective, easy-to-administer therapy.
Topics: Humans; Psoriasis; United States; Health Services Accessibility; Retrospective Studies; Female; Male; Middle Aged; Healthcare Disparities; Adult; Rural Population; Aged; Urban Population; Young Adult
PubMed: 38914420
DOI: 10.1080/09546634.2024.2365820 -
Rheumatology Advances in Practice 2024This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA),...
OBJECTIVES
This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise.
METHODS
An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints.
RESULTS
About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action.
CONCLUSION
The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.
PubMed: 38912423
DOI: 10.1093/rap/rkae074 -
Psoriasis (Auckland, N.Z.) 2024Psoriasis is a chronic skin condition that can significantly impact the quality of life of those affected. As an autoimmune disease, it can lead to itchy, painful, and... (Review)
Review
Psoriasis is a chronic skin condition that can significantly impact the quality of life of those affected. As an autoimmune disease, it can lead to itchy, painful, and scaly patches on the skin. Although various treatments, including topical creams, phototherapy, and systemic medications, are currently available, they may not always offer effective relief and can have side effects. Researchers have thus been exploring the potential benefits of non-psychoactive compounds such as CBD, found in Cannabis sativa plants, for treating psoriasis. CBD treatment may reduce inflammation, oxidative stress, itching, abnormal proliferation of keratinocytes, and may increase hydration. This review aims to provide an overview of the existing literature on the potential uses of CBD for psoriasis treatment.
PubMed: 38911997
DOI: 10.2147/PTT.S469698 -
Frontiers in Immunology 2024Programmed cell death protein-1 (PD-1) maintains peripheral immune tolerance by preventing T cell continuous activation. Aiming to understand the extent of PD-1...
OBJECTIVES
Programmed cell death protein-1 (PD-1) maintains peripheral immune tolerance by preventing T cell continuous activation. Aiming to understand the extent of PD-1 expression in inflammatory arthritis beyond its involvement with T cells, we assess its presence on various circulating single cells.
METHODS
Mass cytometry analysis of patients with active seropositive/seronegative rheumatoid (RA; n=9/8) and psoriatic (PsA; n=9) arthritis versus healthy controls (HC; n=13), re-evaluating patients after 3 months of anti-rheumatic treatment.
RESULTS
PD-1 was expressed in all leukocyte subpopulations, with the highest PD-1 cell frequencies in eosinophils (59-73%) and T cells (50-60%), and the lowest in natural-killer cells (1-3%). PD-1 cell frequencies and PD-1 median expression were comparable between patient subgroups and HC, in the majority of cell subsets. Exceptions included increases in certain T cell/B cell subsets of seropositive RA and specific monocyte subsets and dendritic cells of PsA; an expanded PD-1CD4CD45RACD27CD28 T subset, denoting exhausted T cells, was common across patient subgroups. Strikingly, significant inverse correlations between individual biomarkers of systemic inflammation (ESR and/or serum CRP) and PD-1 cell frequencies and/or median expression were evident in several innate and adaptive immunity cell subsets of RA and PsA patients. Furthermore, all inverse correlations noted in individuals with active arthritis were no longer discernible in those who attained remission/low disease activity post-treatment.
CONCLUSION
PD-1 expression may be insufficient, relative to the magnitude of the concomitant systemic inflammatory response on distinct leukocyte subsets, varying between RA and PsA. Our results point to the potential therapeutic benefits of pharmacological PD-1 activation, to rebalance the autoimmune response and reduce inflammation.
Topics: Humans; Programmed Cell Death 1 Receptor; Male; Female; Middle Aged; Single-Cell Analysis; Arthritis, Rheumatoid; Arthritis, Psoriatic; Proteomics; Aged; Adult; Autoimmunity; Biomarkers
PubMed: 38911848
DOI: 10.3389/fimmu.2024.1403680 -
Patient Preference and Adherence 2024Medication adherence is crucial for achieving clinical goals. Medication adherence drivers and behaviors were explored across multiple conditions, countries, and...
PURPOSE
Medication adherence is crucial for achieving clinical goals. Medication adherence drivers and behaviors were explored across multiple conditions, countries, and medication schedules/modalities to develop a conceptual model of medication adherence, which could later be used to support development of a patient-reported outcome (PRO) measure of adherence.
PATIENTS AND METHODS
Targeted review of qualitative literature identified important medication adherence concepts. Fifty-seven qualitative concept elicitation interviews were conducted (USA n=21, Spain n=18, Germany n=18). Participants were prescribed medication for: hypertension (n=9), asthma (n=8), multiple myeloma (n=8), psoriasis (n=8), diabetes (n=7), depression (n=7), multiple sclerosis (n=7), and/or schizophrenia (n=6). Thematic analysis of verbatim transcripts was performed. Expert clinicians (n=3) provided input throughout.
RESULTS
Nine qualitative articles were selected for review from 2168 screened abstracts. Forty-two medication adherence concepts were reported and grouped into 10 domains. Eight forms of medication adherence were reported during interviews, along with 27 drivers of non-adherence, all of which were incorporated into a conceptual model. Participants reported skipping medication doses (n=36/57; 63.2%) or taking medication later in the day than prescribed (n=29/57; 50.9%). Common drivers of non-adherence included forgetfulness (n=35/57; 61.4%), being out of the usual routine (n=31/57; 54.4%) and being busy (n=22/57; 38.6%). US participants were more likely to report non-adherence due to low perceived efficacy (n=6/21, 28.6%) and cost (n=5/21, 23.8%) than German (n=1/18, 5.6%; n=0/18, 0.0%) or Spanish (n=2/18, 11.1%; n=1/18, 5.6%) participants.
CONCLUSION
Findings highlight the diverse forms and drivers of medication non-adherence, informing the development of a comprehensive conceptual model of medication adherence. The conceptual model builds on and advances previous models of medication adherence and can be used by healthcare professionals to understand and interpret barriers to medication adherence and how best to support patients in taking their medication as intended.
PubMed: 38911591
DOI: 10.2147/PPA.S433662 -
Severe Hypertriglyceridemia in a Patient With Metabolic Syndrome and Psoriasis on Risankizumab-Rzaa.JCEM Case Reports Jun 2024We report a case of severe hypertriglyceridemia (HTG) complicated by hyperviscosity syndrome as a possible adverse reaction to risankizumab-rzaa in a 49-year-old male...
We report a case of severe hypertriglyceridemia (HTG) complicated by hyperviscosity syndrome as a possible adverse reaction to risankizumab-rzaa in a 49-year-old male with a history of longstanding uncontrolled type 2 diabetes, obesity, and coronary artery disease with prior ST-elevation myocardial infarction. On admission, the patient presented with xanthomatous plaques, chest and epigastric discomfort, and headache. Subsequent blood testing revealed severely elevated triglyceride (TG) levels at 7670 mg/dL (86.59 mmol/L) [reference range: <150 mg/dL; 1.69 mmol/L] and total cholesterol at 934 mg/dL (24.14 mmol/L) [reference range: <200 mg/dL; 5.17 mmol/L]. Triglyceride levels decreased and symptoms resolved with dietary restrictions and plasmapheresis. At follow-up, his TG remained elevated but improved, and he was advised to continue lipid-lowering medications as well as cessation of risankizumab. While the patient presented with high risk factors, we posit that the subacute presentation of severe HTG is a possible result of his recent course of risankizumab-rzaa therapy for management of psoriasis. This is noteworthy as pharmaceutical surveys and clinical trials do not list severe HTG as an adverse effect. Postmarketing surveillance studies are essential to confirm this potential association and monitor drug safety. In summary, this case highlights a possible link between risankizumab and severe HTG, emphasizing the importance of ongoing pharmacovigilance to identify and manage unexpected adverse effects associated with new medications.
PubMed: 38911361
DOI: 10.1210/jcemcr/luae087 -
Clinical, Cosmetic and Investigational... 2024Psoriasis is a common chronic inflammatory disease. However, trace elements are essential to biochemical processes of the skin, it is suspected that the trace elements...
OBJECTIVE
Psoriasis is a common chronic inflammatory disease. However, trace elements are essential to biochemical processes of the skin, it is suspected that the trace elements are vital in the pathogenesis of psoriasis. Our research is aimed to investigate the association between serum levels and dietary intake levels of selenium, zinc, and copper with psoriasis.
METHODS
In this cross-sectional study, we utilized the National Health and Nutrition Examination Survey data from 2011 to 2014 to examine the association between psoriasis and serum concentration and dietary intake of trace elements including copper, zinc, and selenium in the US individuals. Our research combined two cycles and weighted the data. Student's t-tests and χ2 test were used. Subgroup analyses and interaction tests were conducted by IBM SPSS Statistics 22 and EmpowerStats.
RESULTS
This study indicates that the population with psoriasis has a lower dose of dietary intake selenium than the controls, and risk analysis showed that the men with selenium daily intake >150 mcg/day have a decreasing risk for psoriasis compared to those with daily intaking selenium <75 mcg/day. However, there are no differences on daily intake of selenium, zinc, and copper and serum levels of Zinc and Copper between psoriasis and healthy controls. The current study showed that the psoriasis group was significantly older with a bigger waist circumference, a higher education level, a higher ratio of people with smoke every day, and a higher ratio of people in USA and being non-Hispanic White.
CONCLUSION
This cross-section study showed that a high selenium intake may benefit USA adults from psoriasis, especially for males. The social and cultural background and ethnic differences between the two groups influence the eating and living models, including the trace element intake. The national recommended dietary allowances (RDAs) might be considered to be modified with more reliable investigative clinical data and certain considering the social and cultural models.
PubMed: 38911341
DOI: 10.2147/CCID.S450407 -
Clinical, Cosmetic and Investigational... 2024[This corrects the article DOI: 10.2147/CCID.S447123.].
[This corrects the article DOI: 10.2147/CCID.S447123.].
PubMed: 38911339
DOI: 10.2147/CCID.S482737