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MARCH 2015    A Monthly Review of Articles of Interest for the Clinical Community

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<This Month's Clinical Focus:<

<DERMATOLOGY>

 

  One-third of patients with psoriasis have PsA in a Brazilian cohort

Approximately one-third of patients with psoriasis from a Brazilian cohort also had psoriatic arthritis, half of whom had not been previously diagnosed or properly treated, according to study findings.

In a cross-sectional, multicenter study conducted at four university dermatology clinics between January and March 2011, researchers evaluated 524 patients with psoriasis. Half of the patients were women; mean age was 48.5 years, and mean psoriasis duration was 15.4 years.

A detailed medical history was taken, and information about psoriasis characteristics was collected. A rheumatologist performed a physical examination focused on musculoskeletal involvement, and radiographs and laboratory tests were taken on an as-needed basis at the judgment of the rheumatologist on the same day.

Most patients had plaque psoriasis (78.8%), with a mean Psoriasis Area and Severity Index (PASI) score of 8.2, and nearly 60% of patients were being treated systemically for their dermatologic condition, according to the researchers. Additionally, psoriatic nail involvement was present in 50.8% of the patients.

Of the patients with psoriasis, 233 (44.5%) had no other rheumatic conditions; osteoarthritis (OA) or chromic myofascial pain (CMP) was seen in 116 (22.1%) patients, and psoriatic arthritis (PsA) was seen in 175 (33.3%) of patients. PsA was associated with OA or CMP in 38 (7.2%) of patients. In 42 of the patients with PsA, laboratory or radiographic tests were performed to establish the diagnosis. Overall, the researchers established a new diagnosis of PsA in 86 psoriasis patients after rheumatological assessment, and a prior diagnosis was confirmed in 89 patients.

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Further analysis revealed similar sex distributions and skin involvement between patients with psoriasis and PsA, but patients with PsA tended to be older (50.6 years vs. 47.5 years), were less frequently white (78% vs. 65%) and were more likely to present nail involvement (59.2% vs. 46.8%). However, multivariate regression analysis showed that male sex may be a protective factor against PsA, according to the researchers.

Source:  Shirley Pulawski for Helio News  http://www.healio.com/dermatology/psoriasis/news/online/%7B5592fa14-b241-4d6d-925e-a9776ce6f64d%7D/one-third-of-patients-with-psoriasis-have-psa-in-a-brazilian-cohort
 


 

  Pimecrolimus for Eczema May Have No Added Cancer Risk After All


Topical pimecrolimus as a treatment for eczema may have no significant cancer risk, contrary to a U.S Food and Drug Administration warning

"At this time the clinical evidence does not seem to support the potential safety concerns," said Dr. David Margolis, a professor of dermatology at the University of Pennsylvania in Philadelphia, who led the study. "When pimecrolimus was first released it was a member of a new class of topical treatments. There was concern about its safety, not because of clinical trial information but because of potential effects of the molecule itself," Dr. Margolis stated.

Pimecrolimus, a calcineurin inhibitor, is one of only a few topical treatments approved for eczema in children, and the FDA has issued a warning that it may have a cancer risk. The warning stems from oral and topical doses in animal studies and case reports in people. As such, the FDA limits the topical agent to a second-line treatment.

Dr. Margolis and colleagues evaluated a 10-year span of data from nearly 7500 children enrolled in PEER, an ongoing long-term study of children with eczema. In nearly 27,000 person-years, the patients developed five malignancies, none of which was skin cancer. The standardized incidence ratio was not statistically different from that of a general population database at the National Cancer Institute.  In light of these findings, the regulatory warning may have had the unintended effect of harming patients who needed treatment, Dr. Jon Hanifin, a dermatologist at Oregon Health and Science University in Portland, Oregon, said.

"Atopic dermatitis is a disease that causes discomfort, sleep loss and anxiety but those problems tend to be ignored by many doctors and by the FDA. These patients need help and the FDA and their medical consultants have been slow to deal with the problem," Dr. Hanifin says.  This new research may improve treatment, Dr. Hanifin says in an accompanying editorial in the Feb 18 JAMA Dermatology journal.

Professional associations including the American Academy of Dermatology and the National Eczema Association are urging the FDA to speed the approval of new drugs for children, Dr. Hanifin says.

Valeant Pharmaceuticals International, the manufacturer of Elidel, which is the brand name of topical pimecrolimus, funded this study through a grant to the Trustees of the University of Pennsylvania. Dr. Margolis reports serving on a data safety monitoring board for an Astellas Pharma atopic dermatitis study.

Source: Rob Goodier for Reuters Health Information
http://archderm.jamanetwork.com/article.aspx?articleid=2119345
http://archderm.jamanetwork.com/article.aspx?articleid=2119340 JAMA Dermatol 2015
http://www.medscape.com/viewarticle/840379

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