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    <recommendedItem id="20100101_19_404"
                     title="Tailor Etanercept to Symptoms in Psoriasis and Psoriatic Arthritis (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18309?impressionId=1265782376949"
                     
      &lt;p&gt;The decision to use once-weekly or twice-weekly etanercept (Enbrel) in patients with both psoriasis and psoriatic arthritis should be determined by the cutaneous and joint symptoms of the patient, researchers said.&lt;/p&gt;
&lt;p&gt;In a blinded, multicenter study, 46% of patients who received the drug twice a week had cleared or almost cleared their skin manifestations of psoriasis at week 12, compared with 32% of those who received the drug only once each week (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Wolfram Sterry, MD, of Charite University Medicine in Berlin, and colleagues.&lt;/p&gt;
&lt;p&gt;In contrast, there were no differences in response for arthritis symptoms, with 77% of those in the twice-weekly group and 76% of those in the once-weekly group meeting predetermined psoriatic arthritis response criteria at week 12, the researchers reported online in the &lt;em&gt;BMJ&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;An estimated 30% of patients with psoriasis have an arthritic component to their disease, manifesting as chronic inflammation of the joints and entheses.&lt;/p&gt;
&lt;p&gt;&quot;The challenge of treating patients with both active psoriasis and active psoriatic arthritis is to optimize the treatment of both disease manifestations to give the best overall outcome,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;Etanercept, a fully human tumor necrosis factor (TNF) inhibitor, is approved for use in both conditions based on findings showing that TNF and other cytokines are upregulated in both inflamed joint and skin tissues.&lt;/p&gt;
&lt;p&gt;To determine the efficacy of two different treatment regimens in patients who had not previously received a TNF inhibitor but had moderate-to-severe skin symptoms and active arthritis, Sterry and colleagues recruited 752 patients from 98 centers for PRESTA (Psoriasis Randomized Etanercept STudy in subjects with psoriatic Arthritis).&lt;/p&gt;
&lt;p&gt;They paired rheumatologists and dermatologists to cooperatively assess effects of the drug.&lt;/p&gt;
&lt;p&gt;Patients were randomized to receive subcutaneous etanercept, 50 mg once or twice weekly for 12 weeks, and for an additional 12 weeks both groups received 50 mg once weekly.&lt;/p&gt;
&lt;p&gt;To maintain blinding, the once-weekly group also received a placebo injection during the first 12 weeks.&lt;/p&gt;
&lt;p&gt;Participants&apos; mean age was 46.5 years. Mean duration of psoriasis was 18.9 years, and mean duration of arthritis was seven years. Most were white men.&lt;/p&gt;
&lt;p&gt;For the joint symptoms, the proportions of patients who achieved American College of Rheumatology (ACR) responses were similar at weeks 12 and 24 in the two groups.&lt;/p&gt;
&lt;p&gt;At week 12, 66.4% and 60.8% of patients in the twice- and once-weekly groups, respectively, had achieved ACR20 responses (representing a 20% improvement). At week 24, the corresponding proportions were 69% and 71.7%.&lt;/p&gt;
&lt;p&gt;At week 12, the percentage reductions in physician&apos;s global assessment of arthritis were 60% and 62% for the twice- and once-weekly groups (&lt;em&gt;P&lt;/em&gt;=0.823), and at week 24 the corresponding percentages were 73% and 74% (&lt;em&gt;P&lt;/em&gt;=0.760).&lt;/p&gt;
&lt;p&gt;At baseline, enthesitis was found in 287 patients and dactylitis in 318. These two symptoms decreased comparatively in both groups at weeks 12 and 24.&lt;/p&gt;
&lt;p&gt;Skin findings included the following for the twice-weekly and once-weekly groups, respectively: &lt;ul&gt; &lt;li&gt;Improvement in physician&apos;s global assessment at week 12, 52% versus 45%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001&lt;/li&gt; &lt;li&gt;At week 24, 57% versus 55%, &lt;em&gt;P&lt;/em&gt;=0.420&lt;/li&gt; &lt;li&gt;Improvement in psoriasis area and severity index at week 12, 71% versus 62%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001&lt;/li&gt; &lt;li&gt;At week 24, 78% versus 74%, &lt;em&gt;P&lt;/em&gt;=0.110&lt;/li&gt; &lt;li&gt;75% improvement in psoriasis area and severity index at week 12, 55% versus 36%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001&lt;/li&gt; &lt;li&gt;At week 24, 70% versus 62%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.026&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Clearly there were differences in the optimal dosages for the skin lesions at week 12, but when the dosage was decreased to once weekly for the two groups, improvements in both joint and skin symptoms continued to improve, and at week 24 the responses were similar in the two groups, the investigators observed.&lt;/p&gt;
&lt;p&gt;&quot;We found that initial treatment of the psoriasis with etanercept 50 mg twice weekly may allow for more rapid clearance of skin lesions than a 50 mg weekly regimen,&quot; they wrote, noting that the higher dose therefore may be preferable for patients with more severe cutaneous involvement.&lt;/p&gt;
&lt;p&gt;In contrast, at no time was the twice-weekly regimen more effective in treating the articular symptoms, so 50 mg once weekly is a sufficient dose for the treatment of joint symptoms alone, they concluded.&lt;/p&gt;
&lt;p&gt;There were no differences in safety between the regimens.&lt;/p&gt;
&lt;p&gt;It is not clear why the higher dose cleared the skin symptoms more rapidly than the low dose but did not have an additional benefit for the joint symptoms.&lt;/p&gt;
&lt;p&gt;&quot;These two different organ systems may have dissimilar autoimmune inflammatory environments, allowing for differences in local concentrations of tumor necrosis factor or in disease burdens or a subtle difference in tissue penetration of drug, although little information is available to support any particular mechanism,&quot; the researchers noted.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Wyeth Research, which was acquired by Pfizer in October 2009, sponsored the trial.&lt;/p&gt;&lt;p&gt;Authors and sponsor were involved in study design, interpretation of data, manuscript preparation, and decision to publish.&lt;/p&gt;&lt;p&gt;Statistical analyses were done by the biostatistics department of Wyeth Research.&lt;/p&gt;&lt;p&gt;Several co-authors are employees of Pfizer, and others have received fees from multiple pharmaceutical companies including Wyeth.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1439"
                     title="SID: Risk of Psoriatic Arthritis Increases with Obesity"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14121?impressionId=1265782376949"
                     
       MONTREAL, May 8 -- Patients with psoriasis face an increased risk of developing psoriatic arthritis if they are overweight, according to data from the Utah Psoriasis Initiative. 
              &lt;p&gt;A one-unit increase in BMI increases the hazard of psoriatic arthritis by 5.4%, Kristina Callis Duffin, M.D., of the University of Utah, reported at the Society for Investigative Dermatology meeting here. 
              &lt;p&gt;&quot;The probability of remaining psoriatic arthritis free is considerably lower in [psoriasis] patients who have a body mass index of 30 or greater,&quot; she said. 
              &lt;p&gt;Dr. Duffin and her colleagues have prospectively recruited more than a thousand psoriasis patients into the Utah Psoriasis Initiative since 2002, and have previously reported a higher prevalence of obesity among subjects compared with the general population. 
              &lt;p&gt;The mean BMI in this population is 29, compared with 26 in the general population, and 34% of study participants have a BMI of 30 or more, compared with 18% in the general population. 
              &lt;p&gt;At study entry, participants -- who are a mean of 48 years old -- are asked to recall their age of onset of psoriasis as well as their weight at the age of 18. 
              &lt;p&gt;&quot;This data suggests that psoriasis comes first and obesity comes second,&quot; said Dr. Duffin, noting that other research, namely the Nurses&apos; Health Initiative, has suggested the reverse. 
              &lt;p&gt;Participants in the current study reported a mean age of psoriasis onset of 27, and those who developed psoriatic arthritis had a mean age of onset of 37, she said. 
              &lt;p&gt;A new analysis of the data shows that at study entry BMIs were higher in the patients with psoriatic arthritis than in those with psoriasis only (30.5 vs 27), and that BMI at age 18 was predictive of developing arthritis later on, she said. 
              &lt;p&gt;Among patients with a BMI at 18 of less than 25, 26.5% went on to develop psoriatic arthritis, compared to 35.4% of those with a BMI between 25 and 30, and 40% of those with a BMI over 40. 
              &lt;p&gt;We need to spread this awareness to primary care physicians and dermatologists and rheumatologists that certainly weight gain is a part of this disease,&quot; said Dr. Duffin in an interview. 
              &lt;p&gt;&quot;If you have a patient with psoriasis who is morbidly obese, they could be increasing their risk of developing psoriatic arthritis. Similarly, if you have someone with psoriatic arthritis, they are perhaps going to have an increased problem with their weight somewhere down the road.&quot;  
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Duffin reported being a consultant investigator, advisor, and speaker for Amgen, a speaker and investigator for Abbott and Centocor, and a consultant investigator for Pfizer, Genzyme, Bristol Myers Squibb, and Novonordisk.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1467"
                     title="SID: Beer Consumption Increases Risk of Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14161?impressionId=1265782376949"
                     
      MONTREAL, May 12 -- Women who drink beer -- but not other types of alcohol -- are more likely to develop psoriasis than other women, researchers found. 
              &lt;p&gt;
              &lt;p&gt;An analysis of data from the Nurses&apos; Health Study found that beer drinking was a significant independent predictor (relative risk 1.83, 95% CI 1.16 to 2.86) for the development of psoriasis, according to Patrick Dominguez, M.D., of Harvard and Brigham and Women&apos;s Hospital in Boston. 
              &lt;p&gt;
              &lt;p&gt;&quot;These findings have implications for psoriasis prevention and management,&quot; said Dr. Dominguez, who presented his findings at the Society for Investigative Dermatology meeting. 
              &lt;p&gt;
              &lt;p&gt;At study entry in 1989, women were asked about their level of alcohol consumption in grams per week. 
              &lt;p&gt;
              &lt;p&gt;According to the CDC, a standard drink -- defined as 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of distilled spirits -- contains 13.7 grams of alcohol. 
              &lt;p&gt;
              &lt;p&gt;Over a 14-year period, biennial questionnaires were used to monitor both the amount and type of alcohol they consumed -- regular beer, light beer, red wine, white wine, or liquor -- said Dr. Dominguez. 
              &lt;p&gt;
              &lt;p&gt;In 2005, he and his colleagues asked participants if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis, with 1,162 of these being prevalent cases, and the remaining 1,007 being new onset, or incident cases, said Dr. Dominguez. 
              &lt;p&gt;
              &lt;p&gt;After excluding incident cases for which there was incomplete information on alcohol consumption, a total of 955 participants with new-onset psoriasis were included for analysis. 
              &lt;p&gt;
              &lt;p&gt;Compared with abstainers, women who drank alcohol (defined as consumption of 30 grams, or roughly two drinks, or more per week) had a significantly increased risk of developing psoriasis, with a relative risk of 1.59 (95% CI 1.02 to 2.49), Dr. Dominguez said. 
              &lt;p&gt;
              &lt;p&gt;However, when the researchers examined the data by type of alcohol, only consumption of regular beer -- and five or more cans a week -- was a significant independent predictor. 
              &lt;p&gt;
              &lt;p&gt;&quot;For any amount of light beer, wine, or liquor consumed, the relative risks were not significant,&quot; he explained. 
              &lt;p&gt;
              &lt;p&gt;There was no difference in age between abstainers and women who drank alcohol. Abstainers had a slightly higher BMI, and drinkers were more physically active -- with a higher percentage of drinkers also reporting current or past smoking. 
              &lt;p&gt;
              &lt;p&gt;&quot;We also measured dietary folate, which may be a modifier for alcohol&apos;s effect in psoriasis, and folate intake was higher in the drinkers, but not significantly so,&quot; said Dr. Dominguez. 
              &lt;p&gt;
              &lt;p&gt;One possible explanation for the study&apos;s findings might be that gluten, a nonalcoholic ingredient found in beer, might trigger the onset of psoriasis, he said.
              &lt;p&gt;
              &lt;p&gt;&quot;There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet and their psoriasis clears up,&quot; he said in an interview. 
              &lt;p&gt;
              &lt;p&gt;&quot;Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.&quot; 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The Nurses&apos; Health Study is funded by the National Institutes of Health.
              &lt;p&gt;
              &lt;p&gt;Dr. Dominguez made no financial disclosures. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20090101_19_1446"
                     title="SID: Actinic Keratoses Have Cyclic Nature"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14130?impressionId=1265782376949"
                     
       MONTREAL, May 8 -- Actinic keratoses are dynamic lesions with intermittent expression in subjects with even extensive damage, according to an 11-month study of their natural course. 
              &lt;p&gt;&quot;At any one time, less than half of the lesions are present clinically,&quot; said Craig Elmets, M.D., who reported his findings here at the Society for Investigative Dermatology meeting. 
              &lt;p&gt;The frequent regression and recurrence of lesions has implications for the treatment of actinic keratoses (AK), which are precursors to squamous cell carcinomas, said Dr. Elmets, of the University of Alabama in Birmingham. 
              &lt;p&gt;&quot;In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions,&quot; Dr. Elmets said. &quot;If one is going to treat individual lesions, then they need to be treated very aggressively because at any one time only a minority of the AK are present.&quot; 
              &lt;p&gt;Dr. Elmets and colleagues followed AK lesions in 26 individuals with extensive actinic damage. At baseline, the study participants had between 10 and 40 actinic lesions and at least one prior histological diagnosis of an AK or nonmelanoma skin cancer. 
              &lt;p&gt;Mapping of the lesions was done at baseline and again at three, six, nine, and 11 months. The lesions were also biopsied at both baseline and the end of the study. 
              &lt;p&gt;&quot;If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,&quot; Dr. Elmets explained. 
              &lt;p&gt;At baseline, there was a total number of 610 AKs in the study group (mean 23.5 per individual), and this number was not significantly different at the end of the study, despite the development of 973 new lesions over the 11-month period. 
              &lt;p&gt;About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, Dr. Elmets said. &quot;A total of 51 of the lesions regressed twice.&quot; 
              &lt;p&gt;Using a histologic grading scheme that was based on a cervical dysplasia model, he noted little progression in severity of lesions in terms of proliferation, atypia, or both. 
              &lt;p&gt;&quot;The histologic appearance seems to accurately correlate with the clinical appearance, and over the course of 11 months there was little evidence of histologic progression,&quot; he said. 
              &lt;p&gt;AK lesions have strong predictive value for individuals who will eventually develop basal cell or squamous cell carcinomas,&quot; Dr. Elmets said, &quot;but until now their natural history has not been well understood.&quot;   
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Elmets did not disclose any conflicts of interest or funding for the study.  &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1453"
                     title="SID: Melanoma in U.S. Shows Rapid Increase"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14141?impressionId=1265782376949"
                     
      MONTREAL, May 11 -- The incidence of melanoma in the U.S. increased rapidly over a 12-year period -- across socioeconomic lines and for all tumor thicknesses -- according to a study reported here. 
              &lt;p&gt;
              &lt;p&gt;During the study period from 1992 to 2004, the incidence of all thicknesses of melanoma increased from 18.2 per 100,000 to 26.3 per 100,000 (95% CI 25.7 to 27.0) -- an annual increase of 3.1% (&lt;em&gt;P&lt;/em&gt;&lt;0.001), the report said. 
              &lt;p&gt;
              &lt;p&gt;A total of 70,596 new cases was reported over the period.
              &lt;p&gt;
              &lt;p&gt;&quot;This has implications for preventive screening and primary care,&quot; Eleni Linos, M.D., Ph.D., of Stanford University Medical Center, told colleagues at the Society for Investigative Dermatology meeting here. 
              &lt;p&gt;
              &lt;p&gt;&quot;We believe this represents a genuine increase in melanoma cases, not just a sign of better screening,&quot; she said in an interview. 
              &lt;p&gt;
              &lt;p&gt;Her study, published in the &lt;em&gt;Journal of&lt;/em&gt; &lt;em&gt;Investigative Dermatology&lt;/em&gt;, examined data from the Surveillance Epidemiology and End Results (SEER) registry between 1992 and 2004. (See: &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/SkinCancer/12377&quot; target=&quot;blank&quot;&gt;Reports of Increases in Melanoma Incidence Are Real&lt;/a&gt;). 
              &lt;p&gt;
              &lt;p&gt;The research focused only on non-Hispanic white subjects, in whom 90% of melanomas occur, said Dr. Linos. 
              &lt;p&gt;
              &lt;p&gt;Melanoma affects both sexes, but during the period of the study, cases involving women outnumbered those in men by a 3:2 margin. 
              &lt;p&gt;
              &lt;p&gt;The steepest increase and highest overall incidence occurred in men ages 65 years and older, with the rate rising from 73 to 126 new cases per 100,000 (CI 120.2 to 132.4). Among women the rate was 51 per 100,000 (CI 50.8 (47.5 to 54.2).
              &lt;p&gt; 
              &lt;p&gt;Among those younger than 65 years, incidence rates were 18.8 cases per 100,000 in men (CI 18.0 to 19.6) and 17.9 cases among women (CI 17.1 to 18.7). 
              &lt;p&gt;
              &lt;p&gt;Fortunately, the increase in overall incidence was not matched by an increase in mortality, which rose by 0.4% annually, with a 2% annual rise in older men. 
              &lt;p&gt;
              &lt;p&gt;&quot;The vast majority of melanomas that are diagnosed are thin, and that is why we have not seen such a dramatic increase in mortality rates,&quot; Dr. Linos explained. 
              &lt;p&gt;
              &lt;p&gt;Researchers examined melanoma trends according to socioeconomic status to determine whether the findings could be explained by better screening in those with higher brackets, and by higher mortality rates in those with lower socioeconomic status. 
              &lt;p&gt;
              &lt;p&gt;Similarly, tumor thickness was examined to determine whether the increased incidence could be explained by more diagnoses of thin, clinically insignificant tumors. 
              &lt;p&gt;
              &lt;p&gt;&quot;We found parallel increases across all socioeconomic groups and thicknesses, representing a true increase in clinically significant tumors,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Linos reported no conflicts of interest. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
</recommendedContent>