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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="0.011"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18309?impressionId=1265799165989"
                     
      &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="-0.004"
                     href="http://www.medpagetoday.com/Dermatology/Psoriasis/tb/18028?impressionId=1265799165989"
                     
      &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_717"
                     title="AAD: Topical Anti-Inflammatory Eases Plaque Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13191?impressionId=1265799165989"
                     
      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>
    <recommendedItem id="20090101_19_724"
                     title="AAD: Sequential Topical Therapy Helps Holds Psoriasis at Bay"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13200?impressionId=1265799165989"
                     
      SAN FRANCISCO, March 10 -- Three out of four patients with plaque psoriasis had a least a one-grade improvement in disease severity after 12 weeks of treatment with sequential topical therapy, according to interim data from an open-label study.
              &lt;br&gt; 
              &lt;br&gt;Four weeks of a steroid spray followed by eight weeks of treatment with a calcitriol-based ointment proved effective for achieving and maintaining disease control, Mark Lebwohl, M.D., of Mount Sinai Medical Center in New York, reported at the American Academy of Dermatology meeting.
              &lt;br&gt; 
              &lt;br&gt;&quot;We haven&apos;t had a vitamin D ointment since calcipotriene was taken off the market,&quot; said Dr. Lebwohl. &quot;The calcitriol ointment we used in this study is now available in the U.S., and these results show that it can be used effectively with clobetasol spray to control psoriasis disease activity.&quot;
              &lt;p&gt; 
              &lt;p&gt;Topical corticosteroids have formed the basis of therapy for psoriasis since the 1950s. During that time, clinical emphasis has shifted from short-term treatment for disease flares to maintenance therapy for long-term control.
              &lt;p&gt; 
              &lt;p&gt;The change in clinical philosophy has given rise to therapeutic strategies involving sequential, combination, and rotational therapy, said Dr. Lebwohl. Topical steroids have remained central to these strategies, but need for a nonsteroidal component of therapy has increased.
              &lt;p&gt; 
              &lt;p&gt;Investigators in a multicenter open-label trial evaluated the safety and efficacy of sequential therapy with clobetasol propionate spray followed by an ointment formulation of calcitriol, the active form of vitamin D&lt;sub&gt;3&lt;/sub&gt;.
              &lt;p&gt; 
              &lt;p&gt;Dr. Lebwohl reported findings on the first 176 patients enrolled in the 300-patient trial.
              &lt;p&gt; 
              &lt;p&gt;Eligibility requirements for the trial included moderate to severe plaque psoriasis (3% to 20% involved body surface area) and an overall disease severity ?3. Disease severity was assessed by means of a five-point scale wherein 0 represented clear and 4 represented severe/very severe.
              &lt;p&gt; 
              &lt;p&gt;Patients began treatment with clobetasol spray twice a day for two weeks. If overall disease severity was clear at that point, the patient was withdrawn. If not, clobetasol treatment continued for another two weeks.
              &lt;p&gt; 
              &lt;p&gt;Patients whose disease severity fell within the range of clear to moderate after four weeks switched to twice-daily application of calcitriol ointment for eight weeks.
              &lt;p&gt; 
              &lt;p&gt;Patients with more severe disease after four weeks on clobetasol spray withdrew from the study.
              &lt;p&gt; 
              &lt;p&gt;After four weeks of treatment with calcitriol ointment, patients who had severe disease or whose disease severity had returned to baseline withdrew from the study.
              &lt;p&gt; 
              &lt;p&gt;All others continued the ointment for another four weeks.
              &lt;p&gt; 
              &lt;p&gt;The primary endpoint was improvement in overall disease severity by at least one grade after 12 weeks. By that criterion, 73.9% of patients had successful treatment, Dr. Lebwohl said.
              &lt;p&gt; 
              &lt;p&gt;At the interim analysis, the most common cutaneous irritations were mild to moderate pruritis, stinging and burning, and telangiectasia. No patient reported skin atrophy. One patient had folliculitis after 12 weeks, compared with two at baseline.
              &lt;p&gt; 
              &lt;p&gt;Dr. Lebwohl reported that 91 adverse events occurred in 49 patients. Most of the events were mild or moderate and tended to decrease in severity over time. Fifteen adverse events were considered possibly, probably, or definitely related to study medication. Seven of the 91 events were classified as serious adverse events, all of which were deemed unlikely to be or definitely not related to study medication.
              &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 supported by Galderma Laboratories, which makes and markets Clobetasol.
              &lt;p&gt; 
              &lt;p&gt;Dr. Lebwohl disclosed relationships with Centocor and Galderma.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
         
    </recommendedItem>
    <recommendedItem id="20090101_19_767"
                     title="AAD: Signal Transduction Inhibitor Has Activity in Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13253?impressionId=1265799165989"
                     
      SAN FRANCISCO, March 12 -- Experimental creams containing cytokine signal transduction inhibitors reduced psoriasis lesion scores by more than 50% in two month-long studies reported here. 
              &lt;p&gt;
              &lt;p&gt;In one study, two different cream formulations of INCB018424 decreased total lesion scores by 53% and 54%, Alice Gottlieb, M.D., of Tufts-New England Medical Center in Boston, said at the American Academy of Dermatology meeting.
              &lt;p&gt; 
              &lt;p&gt;Preliminary data from the second study indicated total lesion score reductions as high as 61% compared with untreated lesions. 
              &lt;p&gt;
              &lt;p&gt;&quot;Not just one of the components of the target lesion score drove the results,&quot; said Dr. Gottlieb. &quot;All of the components -- thickness, scaling, and erythema -- decreased.&quot; 
              &lt;p&gt;
              &lt;p&gt;INCB018424 is an inhibitor of Janus kinases (JAKs), which mediate signal transduction from a variety of cytokines implicated in the pathogenesis of psoriasis. Though multitargeted in design, INCB018424 has preferential activity for JAK1 and JAK2, Dr. Gottlieb said. 
              &lt;p&gt;
              &lt;p&gt;INCB018424 disrupts signaling through the Th1 and Th17 pathways, which includes interleukins 12 and 23, and interferon-?. However, the agent does not inhibit tumor necrosis factor, which could limit its clinical use, said Dr. Gottlieb. 
              &lt;p&gt;
              &lt;p&gt;To assess the safety and efficacy of the agent, investigators performed two small clinical studies. The first included 28 patients with active but stable plaque psoriasis. Each patient underwent five assessments that involved three cream formulations of INCB018424 (0.5% QD, 1.0% QD, and 1.5% BID), calcipotriene ointment, and betamethasone dipropionate ointment. 
              &lt;p&gt;
              &lt;p&gt;Each therapy was applied to paired psoriasis lesions that were separated by at least 15 cm. Investigators scored lesions separately (0 to 4) for thickness, erythema, and scaling. They combined the three scores for a total lesion score and measured the lesion area. 
              &lt;p&gt;
              &lt;p&gt;After 28 days, the 1.0% cream reduced total lesion score by 53% from baseline, and the 1.5% cream reduced total lesion score by 54%. In contrast, a vehicle control reduced lesion score by 32% (&lt;em&gt;P&lt;/em&gt;&lt;0.05). The 0.5% cream did no better than the vehicle. 
              &lt;p&gt;
              &lt;p&gt;When tested against active comparators, the 1.5% cream reduced lesion score by 46% versus 40% for calcipotriene and by 58% versus 44% for betamethasone dipropionate. 
              &lt;p&gt;
              &lt;p&gt;Adverse events were generally mild or moderate, and most were unrelated to treatment. The most common application site problems a were dry skin, pruritus, erythema, and skin exfoliation. They and occurred at a similar rate with INCB018424 and vehicle. No laboratory safety issues arose. 
              &lt;p&gt;
              &lt;p&gt;In the second study, INCB018424 was compared with vehicle in 25 patients who had increasing body surface area involvement by psoriasis. Each patient was treated for 28 days with 1.0% INCB018424 cream QD and BID and 1.5% cream QD and BID. Each treated lesion was paired with an untreated lesion. 
              &lt;p&gt;
              &lt;p&gt;Evaluations have been completed, with patients who have 2% to 7% body surface involvement and 8% to 13% involvement. Evaluations have yet to be completed in patients with 14% to 20% body surface involvement. 
              &lt;p&gt;
              &lt;p&gt;Among patients who have completed the study, mean lesions scores for treated lesions decreased by 55% to 61%, compared with 14% to 21% for untreated lesions. Mean total lesion area declined by 59% with the JAK inhibitor versus 3% for untreated lesions. 
              &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 supported by InCyte.
              &lt;p&gt; 
              &lt;p&gt;Dr. Gottlieb disclosed relationships with Abbott Laboratories, Acetelion, Almirall, and Amgen.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>