Tofacitinib in Pediatric Psoriasis: An Open-Label Trial to Study Its Safety and Efficacy in Children

Dermatology ◽  
2019 ◽  
Vol 236 (3) ◽  
pp. 191-198 ◽  
Author(s):  
Nawaf AlMutairi ◽  
Tarek Nour
Keyword(s):  
Pediatric Patients ◽  
Life Quality ◽  
Severity Index ◽  
Inflammatory Disorder ◽  
Open Label ◽  
Multicenter Trials ◽  
Pasi Score ◽  
Open Label Trial ◽  
Underlying Inflammation

Introduction: Psoriasis is a chronic, multifactorial, inflammatory disorder, with an estimated prevalence of 0.71% in children. The commonly used therapeutic agents target the underlying inflammation. Tofacitinib has demonstrated efficacy in adult psoriasis. Aim: To study the efficacy, safety, and tolerability of tofacitinib in pediatric patients with moderate to severe chronic plaque psoriasis. Methods: The study included children aged between 8 and 17 years, with moderate to severe psoriasis, given tofacitinib 5 mg orally twice daily for at least 36 weeks. The clinical response was estimated using the Psoriasis Area and Severity Index (PASI) score, Physician’s Global Assessment (PGA), and the Children’s Dermatology Life Quality Index (CDLQI). The incidence and severity of adverse events (AEs) were meticulously recorded in each case. Results: A total of 47 patients, with a median age of 12.3 years, completed the study. At week 12, 55.32% achieved PASI 75, and 70.21% at week 36. PGA of clear or almost clear responses at week 12 were 59.57 and 65.96%, ­respectfully, at week 36. Relatively few and mostly minor ­adverse effects were noted. No severe AEs were reported. ­Conclusion: The treatment with tofacitinib was safe and well tolerated, and led to significant improvement of their disease and quality of life as reflected in CDLQI scores. However, the results need to be validated in larger multicenter trials.

scholarly journals Correlation of Disease Activity and Quality of Life of Patients with Psoriasis after Narrow-band Ultraviolet B Therapy

Folia Medica ◽  
2020 ◽  
Vol 62 (1) ◽  
pp. 89-93
Author(s):  
Lyubomir A. Dourmishev ◽  
Karolina Lyubomirova
Keyword(s):  
Quality Of Life ◽  
Narrow Band ◽  
Life Quality ◽  
Clinical Effectiveness ◽  
Symptom Assessment ◽  
Severity Index ◽  
Ultraviolet B ◽  
Effective Treatment Option ◽  
Pasi Score

Introduction: Treatment with ultraviolet light is a well-established and effective treatment option for mild to moderate psoriasis. The aims of the study were to measure the psoriasis area and severity index (PASI) reduction after narrow-band ultraviolet B (NB UVB) therapy, to evaluate the quality of life before and after treatment using the dermatology life quality index (DLQI), and to compare the clinical effectiveness with quality of life improvement.   Material and methods: Twenty two patients (13 male and 9 female patients), aged between 21 to 70 years (mean age 40±14.65 years) were enrolled in the study. NB UVB treatment was performed with 10 to 25 (mean 18.5; SD 3.39) procedures with cumulative doses of 5 to 19.4 J/cm2. The baseline median PASI score was 20.027 which decreased after therapy to 11.11. More than PASI 50% reduction was achieved in 40.91% of the patients after at least 6 weeks of treatment and the results are highly statistically significant. Quality of life (QoL) assessed using DLQI was found moderately affected by disease pretreatment. NB UVB therapy significantly increased DLQI score in spectrum of ‘symptoms and feelings’ and ‘treatment’.   Discussion: The PASI score reduction that we observed after NB-UVB therapy is consistent with the results reported by other authors. Baseline DLQI scores were indicative of moderate QoL impairments associated with disease. At the same time, the reduction of the DLQI index corresponding to improved QoL correlated with the objective clinical symptom assessment.    Conclusion: Our data suggest that DLQI and PASI indexes are important complementary methods for comprehensive health assessment of patients with psoriasis. 

scholarly journals A comparison of efficacy and safety with add on therapy of pioglitazone in adult patients of psoriasis with and without metabolic syndrome

2020 ◽  
Vol 9 (6) ◽  
pp. 943
Author(s):  
Mahesh Chander Gupta ◽  
Kartik Nayak ◽  
Kamal Aggarwal
Keyword(s):  
Metabolic Syndrome ◽  
Dose Range ◽  
Life Quality ◽  
Severity Index ◽  
Clinical Severity ◽  
Open Label ◽  
Psoriasis Area Severity Index ◽  
Comparative Clinical Study ◽  
Pasi Score

Background: Psoriasis is a chronic disease involving skin with systemic manifestations whose etiology remains unknown. In recent times, an increased occurrence of metabolic syndrome has been seen in psoriatic patients and potential role of antihyperglycemic in such conditions is being evaluated.Methods: This was a prospective, controlled, randomized, open label comparative clinical study conducted on 51 psoriatic patients. The patients were divided into two groups with and without MS and both these groups were further randomised to receive either standard therapy alone (topical 0.05% betamethasone dipropionate applied twice daily) or therapy with pioglitazone 15 mg orally once daily as add on to standard treatment. The study was conducted over a period of 12 weeks and the primary efficacy outcome was assessed by a change in psoriasis area severity index (PASI). The secondary outcomes were achievement PASI 50/75 and change in parameters of metabolic syndrome (MS). Change in quality of life assessed using dermatological life quality index (DLQI). Results: Both the treatments significantly reduced the PASI score in psoriatic patients with and without MS, maximum being at 12 weeks. In patients with and without MS, pioglitazone caused a greater reduction in PASI score and DLQI score though it was found comparable to ST alone. Significant improvement in parameters of metabolic syndrome was observed in pioglitazone treated group.Conclusions: Pioglitazone given as add on therapy caused an additional improvement in clinical severity and QOL in both the group of psoriatic patients with and without metabolic syndrome. Role of pioglitazone needs to be further explored with higher recommended dose range (30 mg and 45 mg) to demonstrate the usefulness of this drug in psoriatic patients.

scholarly journals Association of Pathogenic Th17 Cells with the Disease Severity and Its Potential Implication for Biological Treatment Selection in Psoriasis Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-16
Author(s):  
Cristina Aguilar-Flores ◽  
Octavio Castro-Escamilla ◽  
Elizabeth M. Ortega-Rocha ◽  
César Maldonado-García ◽  
Fermín Jurado-Santa Cruz ◽  
...  
Keyword(s):  
Disease Severity ◽  
Peripheral Blood ◽  
Th17 Cells ◽  
Life Quality ◽  
Severity Index ◽  
Experimental Models ◽  
Cutaneous Lesions ◽  
Potential Implication ◽  
Th17 Lymphocytes ◽  
Pasi Score

Psoriasis is an inflammatory autoimmune disease characterized by cutaneous lesions in plaques. It has been proposed that the immune response has a key role in the disease progression. Particularly, the Th17 cells through IL-17 can contribute to maintain the inflammatory process. The pathogenic Th17 phenotype has been described in human diseases and associated with high severity in inflammatory experimental models. However, it is not clear if the pathogenic phenotype could be present in the skin and peripheral blood as well as its possible association to severity in psoriasis. In the lesional skin, we found high infiltration of Th17 cells and the pathogenic phenotype, finding a correlation between the frequency of Th17 cells and the Psoriasis Area and Severity Index (PASI) score. In peripheral blood, we observed a pool of Th17 lymphocytes with potential to acquire pathogenic features. Interestingly, the percentage of pathogenic Th17 cells (CD4+ RORγt+ IFN-γ+) correlates with disease severity. Moreover, we distinguished three groups of patients based on their IL-17/IFN-γ production by Th17 lymphocytes, which seems to be related with a dynamic or stable potential to express these cytokines. Remarkably, we evaluated the cytokine production by Th17 cells as an immunological marker for the adequate selection of biologic therapy. We found that patients analyzed by this immunological approach and treated with antibodies against IL-17 and TNFα showed great improvement depicted by reduction in PASI and Dermatology Life Quality Index (DLQI) score as well as the percentage of Body Surface Area (BSA). Altogether, our results highlight the importance of the assessment of the pathogenic phenotype in Th17 cells as an immune personalized analysis with the potential to support the therapy choice in the clinical practice.

Clinical Efficacy of 25% l-Ascorbic Acid (C'ensil) in the Treatment of Melasma

2009 ◽  
Vol 13 (2) ◽  
pp. 74-81 ◽  
Author(s):  
Seon-Wook Hwang ◽  
Doo-Jin Oh ◽  
Deborah Lee ◽  
Jung-Wook Kim ◽  
Sung-Wook Park
Keyword(s):  
Quality Of Life ◽  
Ascorbic Acid ◽  
Skin Pigmentation ◽  
Severity Index ◽  
Transepidermal Water Loss ◽  
Open Label ◽  
Effective Treatment Modality ◽  
Quality Of Life Scale ◽  
Life Scale

Background: l-Ascorbic acid is used to treat melasma; however, it is quickly oxidized in aqueous solutions. Thus, C'ensil, a formulation containing 25% l-ascorbic acid and a chemical penetration enhancer, was created to promote the penetration of l-ascorbic acid into the skin. Objective: To evaluate the efficacy of C'ensil in patients with melasma. Methods: Forty subjects with melasma were treated with C'ensil during an open-label trial over a period of 16 weeks. Each subject's skin pigmentation was assessed every 4 weeks using the Melasma Area and Severity Index (MASI) and mexameter score. In addition, transepidermal water loss, skin dryness and irritation, and quality of life (Melasma Quality of Life Scale [MelasQoL]) were evaluated. Results: After 16 weeks, a significant decrease was noted in the degree of pigmentation based on the patients' MASI and mexameter scores. MelasQoL scores also decreased, indicating an increase in the subjects' quality of life. Conclusion: Our data indicate that C'ensil is an effective treatment modality for melasma.

scholarly journals Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil

2012 ◽  
Vol 87 (5) ◽  
pp. 697-702 ◽  
Author(s):  
Magda Blessmann Weber ◽  
Daniel Lorenzini ◽  
Clarissa Prieto Herman Reinehr ◽  
Bárbara Lovato
Keyword(s):  
Quality Of Life ◽  
Skin Disease ◽  
Dermatology Life Quality Index ◽  
Quality Index ◽  
Pediatric Patients ◽  
Skin Diseases ◽  
Life Quality ◽  
Chronically Ill ◽  
Life Quality Index

BACKGROUND: Skin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions. OBJECTIVE: This study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life. METHODS: Cross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Children's Dermatology Life Quality Index questionnaire and the AUEQI questionnaire. RESULTS: A total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Children's Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Children's Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis. CONCLUSIONS: The data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

The evaluation of the effectiveness of structural resonance therapy in the patients with lupus erythematosus and comorbid pathology of the gastrointestinal tract

2016 ◽  
Vol 15 (6) ◽  
pp. 305-308
Author(s):  
Roman Nikolaevich Levshin ◽  
K. V Kotenko ◽  
L. S Kruglova ◽  
N. B Korchazhkina
Keyword(s):  
Gastrointestinal Tract ◽  
Lupus Erythematosus ◽  
Dermatology Life Quality Index ◽  
Life Quality ◽  
Severity Index ◽  
Combined Approach ◽  
General Health Status ◽  
Combined Application ◽  
Medicinal Treatment

The authors report the results obtained during the combined application of various regimens of structural resonance therapy (SRT) for the treatment of 40 patients presenting with lupus erythematosus (LE) and comorbid pathology of the gastrointestinal tract. The use of this approach in the combination with the standard medicinal treatment made it possible to achieve clinical remission of the disease and to significantly improve the skin process in 100% of the patients as appears from the data on dynamics of the severity index of the cutaneous process. Simultaneously, the general health status of the patients was considerably improved. It is concluded that the proposed combined approach markedly increases the patients’ quality of life being responsible for a 87% reduction of the quality of the dermatology life quality index which allows to recommend this method for the wide application in the clinical practice for the management of the patients with the widespread forms of lupus erythematosus and comorbid pathology of the gastrointestinal tract.

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