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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_404"
                     title="Tailor Etanercept to Symptoms in Psoriasis and Psoriatic Arthritis (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18309?impressionId=1265725056139"
                     
      &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="20100101_19_190"
                     title="Rising Costs -- the Real Heartbreak of Psoriasis (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Dermatology/Psoriasis/tb/18028?impressionId=1265725056139"
                     
      &lt;p&gt;The heartbreak of psoriasis used to be the disease itself. Now it&apos;s the skyrocketing cost of treatment.&lt;/p&gt;
&lt;p&gt;From 2000 through 2008, the cost of brand-name drugs increased 66% on average, according to Vivianne Beyer, MD, and Stephen Wolverton, MD, of the Indiana University School of Medicine in Indianapolis (Beyer is currently at St. Vincent Hospital in Indianapolis).&lt;/p&gt;
&lt;p&gt;The cost of several of the drugs &quot;greatly outpaced&quot; both general inflation and the overall increase in cost of prescription medicines, the researchers reported in the January issue of &lt;em&gt;Archives of Dermatology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The disease, a chronic autoimmune illness, affects between 4.5 million and 7.5 million people in the U.S., the researchers noted.&lt;/p&gt;
&lt;p&gt;Up to a third of those do not respond to topical therapy. However, more effective systemic treatments appear to be underused, they said  --  perhaps in part because of cost, a major issue with newer biologic drugs.&lt;/p&gt;
&lt;p&gt;Analysis showed that current annual costs ranged from $1,197 for methotrexate (Rheumatrex, Trexall), at 7.5 milligrams a week, to $27,577 for two 12-week courses of alefacept (Amevive).&lt;/p&gt;
&lt;p&gt;Phototherapy costs ranged from $3,083 for a year of UV-B therapy to $7,288 annually for psoralen-UV-A treatment, including induction and maintenance.&lt;/p&gt;
&lt;p&gt;Acitretin (Soriatane) at 25 milligrams a day cost $9,163, comparable to the $9,999 for 400 milligrams daily of cyclosporine. But some patients need twice the dose of acitretin, which increases the annual cost to $17,613, the researchers said.&lt;/p&gt;
&lt;p&gt;The annual costs of the biologics used to treat psoriasis ranged from $18,384 to $27,577, but those requiring a loading dose  --  such as adalimumab (Humira) and infliximab (Remicade)  --  were more costly during the first year of treatment than in following years, they said.&lt;/p&gt;
&lt;p&gt;To obtain information about trends, the researchers compared year-over-year average wholesale prices for the various treatments.&lt;/p&gt;
&lt;p&gt;They found that percentage changes in drug prices between 2000 and 2008 ranged from a drop of 24.1% for methotrexate to an increase of 316% for the brand-name version of methoxsalen  --  Oxsoralen-Ultra.&lt;/p&gt;
&lt;p&gt;The second-largest increase was 157.5% for acitretin, they said.&lt;/p&gt;
&lt;p&gt;The biologics also increased in price, but not all were available for the entire period. For example, the cost of efalizumab (Raptiva) increased by 35.1% over a four-year period, while adalimumab&apos;s cost increased by 27.2% during a five-year interval, the researchers said.&lt;/p&gt;
&lt;p&gt;On average the increase was 66%, they said, which is markedly higher than inflation. Over the same period, the consumer price index-urban for all items rose 25.8%, and 30.1% for prescription drugs.&lt;/p&gt;
&lt;p&gt;The researchers did not include indirect costs, such as time away from work, direct costs such as inpatient care, or costs that arose because of adverse effects.&lt;/p&gt;
&lt;p&gt;One clinical implication of the findings is that physicians should consider cost as well as efficacy and tolerability when prescribing drugs for psoriasis, the researchers concluded.&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;The researchers did not report external support for the study. Wolverton reported financial links with Eli Lilly and Amgen.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1652"
                     title="ICD: Coal Tar Still Viable for Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14402?impressionId=1265725056139"
                     
       PRAGUE, May 27 -- For psoriasis patients who can handle the smell and mess, coal tar remains an effective, inexpensive treatment option for stable disease, investigators concluded. 
              &lt;p&gt;&lt;p&gt;Coal tar proved just as effective as topical tazarotene (Tazorac, Avage) in a small study of patients with stable plaque psoriasis who served as their own controls, Uma Kumar, M.D., of All India Institute of Medical Sciences in New Delhi, reported at the International Congress of Dermatology. 
              &lt;p&gt;All patients in both groups had either marked or moderate improvement after 12 weeks of treatment. 
              &lt;p&gt;&quot;Our results indicate that tazarotene 0.1% gel and coal tar 5% ointment appear to have comparable efficacy in stable plaque psoriasis,&quot; Dr. Kumar said. 
              &lt;p&gt;&quot;Considering the overall cost/benefit ratio in a chronic disease like psoriasis, coal tar ointment is still an effective treatment modality for patients with stable plaque psoriasis, especially in developing countries where the treatment/healthcare costs are borne by patients themselves.&quot; 
              &lt;p&gt;The findings came from a comparison of tazarotene gel and crude coal tar in 30 patients with stable plaque psoriasis. The patients had limited disease, defined as involvement of &amp;lt;20% of body surface area. Disease duration averaged about nine years. 
              &lt;p&gt;Before the initiation of study treatment, patients completed a four-week washout of systemic therapy, two weeks for existing topical therapy. 
              &lt;p&gt;Each patient was treated simultaneously with both agents in an unblinded manner: tazarotene on the right side of the body and coal tar on the left. 
              &lt;p&gt;Treatment continued for 12 weeks, and patients were assessed at two-week intervals. Response was determined by change in the erythema, scaling, and induration (ESI) score, which averaged about 28 at baseline. 
              &lt;p&gt;The ESI scores did not differ significantly between treatments at any of the assessments. 
              &lt;p&gt;At 12 weeks, ESI scores averaged 7.11 with tazarotene treatment and 5.93 with coal tar. 
              &lt;p&gt;The mean ESI score for lesions treated with coal tar was lower at six and 10 weeks, as well as at the end of the study. 
              &lt;p&gt;Dr. Kumar reported that 27 patients completed the study. Psoriasis lesions on both sides of the body improved by at least 50% in all patients. 
              &lt;p&gt;The investigators rated the improvement as marked in 40.7% of tazarotene-treated areas and in 59.2% of areas treated with coal tar. The figures were reversed for moderate improvement. 
              &lt;p&gt;&quot;Coal tar is one of the commonest conventional treatment modalities for psoriasis,&quot; Dr. Kumar and colleagues concluded. &quot;Various studies have proved its effectiveness time and again. 
              &lt;p&gt;&quot;Patient acceptability is the major problem with coal tar. The preparations are usually greasy and unpleasant smelling, and they can stain clothing.&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; The authors reported no competing interests.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1634"
                     title="ICD: Aloe Vera Shows Promise for Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Dermatology/ICD/tb/14382?impressionId=1265725056139"
                     
       PRAGUE, May 26 -- Patients with plaque psoriasis had a greater reduction in disease activity when treated with topical aloe vera compared with a topical steroid, data from a randomized trial demonstrated. 
              &lt;p&gt;&lt;p&gt;Patients treated with aloe vera had a significantly greater reduction in the Psoriasis Area and Severity Index (PASI) after eight weeks of treatment, Charoen Choonhakarn, M.D., of Khon Kaen University in Khon Kaen, Thailand, and colleagues reported here at the International Congress of Dermatology. 
              &lt;p&gt;The difference did not achieve statistical significance, but the magnitude of change from baseline to eight weeks differed significantly in an adjusted analysis. 
              &lt;p&gt;The advantage demonstrated in the study landed in a middle ground between two previous studies that produced conflicting results. 
              &lt;p&gt;&quot;Although contrary results were reported from two previous placebo-controlled studies, our study showed that aloe vera cream was more effective than 0.1% triamcinolone acetonide cream after eight weeks of treatment,&quot; the investigators concluded. 
              &lt;p&gt;&quot;The between-group difference in adjusted means was statistically significant,&quot; they added. &quot;Thus, aloe vera cream can be considered a safe alternative treatment for mild to moderate chronic plaque psoriasis.&quot; 
              &lt;p&gt;Topical steroids remain central to most management strategies for psoriasis, but chronic use poses a risk of local and systemic adverse effects. 
              &lt;p&gt;A systematic review of clinical applications of topical aloe vera suggested the agent is helpful in psoriasis (&lt;em&gt;Br J Gen Pract&lt;/em&gt; 1999; 49: 823-28). However, two small placebo-controlled clinical trials conducted a decade apart yielded widely disparate results, one showing a clear advantage for aloe vera and the other a significant placebo advantage (&lt;em&gt;Trop Med Int Health&lt;/em&gt; 1996; 1: 505-09, &lt;em&gt;J Eur Acad Dermatol Venereol&lt;/em&gt; 2005; 19: 326-31). 
              &lt;p&gt;In the current study, Dr. Choonhakarn and colleagues evaluated aloe vera and an active comparator. The study involved 80 patients who had a baseline PASI score of about 11. 
              &lt;p&gt;The patients were randomized to 70% aloe vera cream or 0.1% triamcinolone acetonide. The primary outcome was the change in PASI score from baseline to eight weeks. 
              &lt;p&gt;At the end of the study, the PASI score decreased by an average of 7.7 points in the aloe vera group and 6.6 in the patients treated with the topical steroid. The difference was statistically significant (&lt;em&gt;P&lt;/em&gt;=0.0237), although the 95% confidence intervals crossed 1.0 (2.13 to -0.16). 
              &lt;p&gt;The change in disease-related quality of life scores did not differ significantly between groups. 
              &lt;p&gt;No patient in either group had complete clearance of psoriasis lesions. 
              &lt;p&gt;Six patients (16.2%) in the aloe vera group had PASI 75 responses compared with four (10.5%) in the steroid group. 
              &lt;p&gt;More patients treated with the topical steroid had PASI 50 responses (66% versus 54%). 
              &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 study was supported by Khon Kaen University. 
              &lt;p&gt;The authors reported no disclosures. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_717"
                     title="AAD: Topical Anti-Inflammatory Eases Plaque Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13191?impressionId=1265725056139"
                     
      SAN FRANCISCO, March 9 -- Plaque psoriasis improved significantly in response to an investigational, anti-inflammatory ointment, data from a small placebo-controlled trial showed.
              &lt;p&gt; 
              &lt;p&gt;Almost 70% of patients treated with the multitargeted topical drug showed improvement in psoriasis severity at 28 days compared with an inert vehicle, Karin Hold, Ph.D., of Anacor Pharmaceuticals in Palo Alto, Calif., reported at the American Academy of Dermatology meeting.
              &lt;p&gt; 
              &lt;p&gt;The ointment demonstrated significant improvement versus the inert vehicle by the midway point of the trial, and the statistical advantage held through the follow-up.
              &lt;p&gt; 
              &lt;p&gt;&quot;We began to see a separation between the two groups as early as seven days, and the difference became statistically significant at 14 days,&quot; said Dr. Hold. &quot;A similar pattern was seen for the individual signs and symptoms of plaque severity: scaling, plaque elevation, and erythema. For the most part, each of the individual parameters was significantly different by day 14.&quot;
              &lt;p&gt; 
              &lt;p&gt;AN2728 inhibits the release of multiple cytokines, including tumor necrosis factor, interleukin-12, and interleukin 23. But researchers don&apos;t know exactly how they work, she said.
              &lt;p&gt; 
              &lt;p&gt;In two phase Ib trials, AN2728 5% ointment demonstrated significant antipsoriatic activity, leading to the phase II trials reported at the AAD meeting. A cream formulation of AN2728 also has been developed.
              &lt;p&gt; 
              &lt;p&gt;Dr. Hold reported findings from a randomized study of 35 adults with stable. plaque-type psoriasis. Twice daily for four weeks, patients applied AN2728 ointment to a lesion on one side and the inert vehicle to a comparable lesion on the opposite side. Neither patients nor investigators knew which side got which ointment.
              &lt;p&gt; 
              &lt;p&gt;The primary endpoint was the overall target plaque severity score, which ranged from 0 (clear) to 8 (very severe). Secondary endpoints were scaling, erythema, and plaque elevation.
              &lt;p&gt; 
              &lt;p&gt;After four weeks, target lesion plaque severity was reduced to a greater degree by AN2728 in 24 of 35 (68.6%) lesions compared with two (5.7%) in the vehicle group (&lt;em&gt;P&lt;/em&gt;&lt;0.001). Nine lesions were similar in severity.
              &lt;p&gt; 
              &lt;p&gt;By day 14 the two treatments were statistically different: 17 lesions improved with AN2728 versus three with vehicle (&lt;em&gt;P&lt;/em&gt;=0.003). The difference had increased to 19 versus one (&lt;em&gt;P&lt;/em&gt;&lt;0.0001) by day 21, 22 versus four (&lt;em&gt;P&lt;/em&gt;&lt;0.0001) on day 28, and 22 versus one (&lt;em&gt;P&lt;/em&gt;&lt;0.0001) during follow-up to day 35.
              &lt;p&gt; 
              &lt;p&gt;Differences in scaling, plaque elevation, and erythema achieved statistical significance by day 14 (&lt;em&gt;P&lt;/em&gt;=0.018 to &lt;em&gt;P&lt;/em&gt;=0.003) and remained significantly different until the end of the follow-up (&lt;em&gt;P&lt;/em&gt;&lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;Dr. Hold said no patient had treatment-related adverse events, application-site reactions, or laboratory abnormalities.
              &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 study was funded by Anacor Pharmaceuticals.
              &lt;p&gt; 
              &lt;p&gt;Dr. Hold is an employee of Anacor Pharmaceuticals.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>