Publications by authors named "Sergio Chimenti"

217 Publications

Prevalence and risk factors of actinic keratosis in patients attending Italian dermatology clinics.

Eur J Dermatol 2017 Dec;27(6):599-608

Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.

Actinic keratosis (AK) is a common keratinocyte intra-epidermal neoplasia. To assess AK prevalence and potential risk factors in patients attending Italian general dermatology clinics. This retrospective study was conducted on clinical data from consecutive white outpatients aged ≥30 years, attending 24 general dermatology clinics between December 2014 and February 2015. AK prevalence (entire population) and multivariate risk factor analysis (patients with current/previous AK and complete data) are presented. AK prevalence in 7,284 patients was 27.4% (95% CI: 26.4-28.4%); 34.3% in men and 20.0% in women (p<0.001). Independent AK risk factors in 4,604 patients were: age (OR: 4.8 [95% CI: 3.5-6.5] for 46-60 years, increasing with older age to OR: 41.5 [95% CI: 29.5-58.2] for >70 years), history of other non-melanoma skin cancers (OR: 2.7 [2.2-3.3]), residence in southern Italy/Sardinia (OR: 2.6 [2.1-3.0]), working outdoors >6 hours/day (OR: 1.9 [1.4-2.4]), male gender (OR: 1.7 [1.4-2.0]), facial solar lentigos (OR: 1.6 [1.4-1.9]), light hair colour (OR: 1.5 [1.2-1.8]), prolonged outdoor recreational activities (OR: 1.4 [1.2-1.7]), light eye colour (OR: 1.3 [1.1-1.6]), skin type I/II (OR: 1.3 [1.1-1.6]), and alcohol consumption (OR: 1.2 [1.0-3.3]). BMI ≥25.0 (OR: 0.6 [0.5-0.7]), regular sunscreen use (OR: 0.7 [0.6-0.8]), and a lower level of education (OR: 0.8 [0.7-1.0]) were independent protective factors. AK prevalence was high in Italian dermatology outpatients. We confirm several well-known AK risk factors and reveal possible novel risk and protective factors. Our results may inform on the design and implementation of AK screening and educational programmes.
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http://dx.doi.org/10.1684/ejd.2017.3126DOI Listing
December 2017

Use of biological drugs in patients with psoriasis and psoriatic arthritis in Italy: Results from the PSONG survey.

Dermatol Ther 2018 Jan 7;31(1). Epub 2017 Dec 7.

Humanitas Clinical and Research Center, Skin Pathology Lab, Rozzano-Milan, Italy.

This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 was analyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug survival rate and probability of maintaining PASI response were evaluated. The impact of dependent variables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients were included, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumab followed by etanercept and infliximab in PsO and PsA patients. The probability of maintaining PASI response was significantly higher for adalimumab followed by infliximab. For PsO patients, the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2-15.6, p < .001) or infliximab (OR: 6.6; 95% CI: 2.6-16.3, p < .001) vs. adalimumab. Likewise, for PsA patients the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 2.3; 95% CI: 1.4-3.8, p = .01) or infliximab (OR: 2.2; 95% CI: 1.1-4.1, p = .018) vs. adalimumab. Adalimumab could be the best therapeutic option over other anti-TNF agents for the treatment of PsO and PsA patients.
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http://dx.doi.org/10.1111/dth.12565DOI Listing
January 2018

Eruptive xanthomas and pancretitis: clinical, dermatoscopy, confocal and pathological correlation.

G Ital Dermatol Venereol 2017 08;152(4):394-396

Department of Dermatology, "Tor Vergata" University of Rome, Rome, Italy.

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http://dx.doi.org/10.23736/S0392-0488.16.05334-7DOI Listing
August 2017

The GENDER ATTENTION Observational Study: Gender and Hormonal Status Differences in the Incidence of Adverse Events During Cyclosporine Treatment in Psoriatic Patients.

Adv Ther 2017 06 21;34(6):1349-1363. Epub 2017 Apr 21.

UCB Pharma Italia, Milan, Italy.

Introduction: Female sex has been shown to be a risk factor for the development of adverse drug reactions; however, this has not been studied for cyclosporine (CsA). The aim of this study was to investigate, in Italian dermatological practice, the influence of gender and menopause and related hormones on the incidence of adverse events (AEs) during CsA treatment in psoriatic patients.

Methods: Multicenter, prospective, observational study conducted from May 2011 to June 2013. Patients with plaque psoriasis, undergoing a new CsA administration course, or about to start it, were enrolled in the outpatient clinics of Italian dermatological centers. During the 2-6 months of study duration, patients had to note all AEs that occurred in a diary that was reviewed by the investigators at the follow-up visit. Sex hormone levels were measured within 7 days from the start date of a menstrual cycle.

Results: A total of 969 adult psoriatic patients were enrolled in the study, divided into four cohorts: fertile women and corresponding age-matched men; postmenopausal women and corresponding age-matched men. A significant difference in the percentage of patients with AEs was observed between fertile and postmenopausal women, but not between women and age-matched men. AE incidence rate was about 37% higher in fertile women than in age-matched men and about 18% higher in postmenopausal women than in age-matched men, but differences were not statistically significant. Incidence rate ratio of fertile vs. postmenopausal women was 0.67, reaching statistical significance. AEs were mild or moderate in severity in the great majority of patients of all cohorts and postmenopausal women had significantly less grade 1-2 AEs compared to fertile women, but more grade 3-4 AEs. FSH levels were significantly higher in postmenopausal women reporting no AEs, and DHEA sulfate levels were about 10% higher in men with no AEs, compared to those reporting at least one AE. Cortisol levels were slightly though significantly higher in postmenopausal women with no AE.

Conclusions: A better understanding of sex- and hormone-related influences on drug responses may help to improve drug safety and efficacy, by permitting one to tailor pharmacological treatments to individual subjects or defined patient cohorts.

Funding: Novartis Farma S.p.A., Italy.
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http://dx.doi.org/10.1007/s12325-017-0526-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487861PMC
June 2017

Granuloma annulare: a case treated with infliximab successfully.

G Ital Dermatol Venereol 2017 Apr;152(2):193-195

Section of Dermatology, Academic Department of Systems Medicine, School of Medicine, Tor Vergata University Hospital, Rome, Italy.

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http://dx.doi.org/10.23736/S0392-0488.16.05320-7DOI Listing
April 2017

The nitrobenzoxadiazole derivative MC3181 blocks melanoma invasion and metastasis.

Oncotarget 2017 Feb;8(9):15520-15538

Department of Experimental Medicine and Surgery, University of Tor Vergata, 00133 Rome, Italy.

The novel nitrobenzoxadiazole (NBD) derivative MC3181 is endowed with remarkable therapeutic activity in mice bearing both sensitive and vemurafenib-resistant human melanoma xenografts. Here, we report that subtoxic concentrations of this compound significantly reduced invasiveness of BRAF-V600D mutated WM115 and WM266.4 melanoma cell lines derived from the primary lesion and related skin metastasis of the same patient, respectively. The strong antimetastatic activity of MC3181 was observed in both 2D monolayer cultures and 3D multicellular tumor spheroids, and confirmed in vivo by the significant decrease in the number of B16-F10 melanoma lung metastases in drug-treated mice. Our data also show that MC3181 affects the lactate production in the high glycolytic WM266.4 cell line. To unveil the MC3181 mechanism of action, we analyzed the ability of MC3181 to affect the degree of activation of different MAPK pathways, as well as the expression/activity levels of several proteins involved in angiogenesis, invasion, and survival (i.e. AP2, MCAM/MUC18, N-cadherin, VEGF and MMP-2). Our data disclosed both a decrease of the phospho-active form of JNK and an increased expression of the transcription factor AP2, events that occur in the very early phase of drug treatment and may be responsible of the antimetastatic effects of MC3181.
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http://dx.doi.org/10.18632/oncotarget.14690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362503PMC
February 2017

Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice.

J Int Med Res 2016 Sep;44(1 suppl):100-105

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy

Objective: To investigate the efficacy and safety outcomes of combination therapy used to optimize etanercept treatment in patients with psoriasis treated in real-life clinical practice.

Methods: Data from patients presenting with psoriasis, treated initially with etanercept monotherapy, were analysed retrospectively. Patients subsequently treated with combination therapy were further analysed. The Psoriasis Area and Severity Index (PASI) score was recorded for all patients receiving comedication; a subjective pain score was recorded in those with psoriatic arthritis receiving comedication after 12, 24 and 48 weeks' treatment and thereafter at 6-month intervals.

Results: From the database of 400 patients treated with etanercept, 37 patients (18 male; 19 female; mean age 59.43 years) underwent combination therapy due to lack of efficacy. Patients received mostly short-term (range 4-34 weeks) comedication with corticosteroids, cyclosporine, methotrexate, nonsteroidal anti-inflammatory drugs, acitretin or sulphasalazine. There were significant reductions in the mean PASI score from baseline at all timepoints. There were also significant reductions in the mean pain VAS score from baseline at all timepoints in patients with psoriatic arthritis. The drug survival rate was 59.6% over a mean duration of 323 weeks of etanercept treatment. The safety profile of combination therapy was satisfactory.

Conclusions: Short-term comedication in combination with etanercept may optimize treatment options and improve long-term drug survival in patients with psoriasis.
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http://dx.doi.org/10.1177/0300060515593260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536526PMC
September 2016

From patients' needs to treatment outcomes in psoriasis: Results from the 'pSORRIDI' experience.

J Int Med Res 2016 Sep;44(1 suppl):95-99

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.

Objective: To evaluate results of the 'pSORRIDI' experience (which is a prevention campaign to evaluate the prevalence of comorbidities, multidisciplinary needs and appropriateness of the therapeutic approach for comorbidities) in patients already being treated for psoriasis.

Methods: Telephone interviews were conducted in patients with psoriasis, who then underwent comprehensive evaluation and investigation of comorbidities. If necessary, patients were referred to specialist cardiology, endocrinology and/or rheumatology services.

Results: Overall, 72.0% (54/75) of patients required a multidisciplinary consultation. Among patients referred to cardiology, therapeutic adjustment was needed in 33.3% (five of 15) patients and a redefined diagnosis in 26.7% (four of 15) cases. Among patients undergoing endocrinology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 61.1% (11/18) and 33.3% (six of 18) patients, respectively; for rheumatology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 76.2% (16/21) and 19.0% (four of 21) of patients, respectively.

Conclusions: Among patients with psoriasis, there may be a need for an improvement in the diagnosis of underlying comorbid conditions, and in disease management of both psoriasis and any comorbid conditions.
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http://dx.doi.org/10.1177/0300060515593265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536524PMC
September 2016

Influence of body mass index and weight on etanercept efficacy in patients with psoriasis: A retrospective study.

J Int Med Res 2016 Sep;44(1 suppl):72-75

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.

Aim: To investigate the role of body mass index (BMI) and weight in the long-term efficacy of etanercept in patients with psoriasis.

Methods: Medical records were retrospectively analysed. Extracted data included weight, BMI, comorbidities and psoriasis area severity index (PASI). Patients were stratified by weight (<80 kg or ≥80 kg) and BMI (healthy, BMI 22 - 24.99 kg/m; overweight, BMI 25 - 29.99 kg/m; obese, BMI ≥30 kg/m).

Results: The study included 66 patients. Body weight had no effect on etanercept efficacy. There was a significant reduction in etanercept efficacy in obese patients (n = 12) compared with healthy weight (n = 33) or overweight (n = 21) patients.

Conclusion: Obesity has a negative effect on the efficacy of etanercept in psoriasis.
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http://dx.doi.org/10.1177/0300060515593254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536536PMC
September 2016

Pharmacodynamic assessment of apremilast for the treatment of moderate-to-severe plaque psoriasis.

Expert Opin Drug Metab Toxicol 2016 Sep 14;12(9):1121-8. Epub 2016 Jul 14.

b Division of Dermatology, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.

Introduction: Psoriasis is a chronic inflammatory skin disease affecting 2-3% of the population. Certain systemic drugs currently available for its treatment could be associated, in the long term, with organ toxicity and adverse events, thus, clinical monitoring throughout treatment is required. Moreover, tolerability issues, parenteral administration, and barriers to patient access, such as high cost and specialist management lead to treatment failure.

Areas Covered: Apremilast is an oral small molecule inhibitor of phosphodiesterase 4 (PDE4i). PDE is the major enzyme class responsible for the hydrolysis of cyclic adenosine monophosphate in immune cells (cAMP). With PDE4 inhibition, apremilast works intracellularly to modulate pro-inflammatory and anti-inflammatory mediator production critically involved in psoriasis. The aim of this paper is to focus the attention on apremilast pharmacodynamics effects, its efficacy and safety in treating moderate-to-severe plaque psoriasis.

Expert Opinion: Apremilast is an effective and well-tolerated option in treating moderate-to-severe plaque psoriasis. Its safety profile and the oral administration offer significant advantages in prescribing apremilast for the treatment of psoriasis, particularly in some subsets of patients.
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http://dx.doi.org/10.1080/17425255.2016.1206886DOI Listing
September 2016

Small molecules and antibodies for the treatment of psoriasis: a patent review (2010-2015).

Expert Opin Ther Pat 2016 Jul 13;26(7):757-66. Epub 2016 Jun 13.

c Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine , University of Tor Vergata , Rome , Italy.

Introduction: Psoriasis is a chronic condition whose therapeutic armamentarium is increasingly being discussed, particularly when compared to past decades. The use of biologic agents has profoundly changed the history of this disease, as well as the management of psoriatic patients. Due to the enormous interest in psoriasis, as demonstrated within the scientific community and pharmaceuticals, new therapeutic targets have been identified and novel patented therapeutics are being tested.

Areas Covered: This review sought to give an overview of small molecules and antibodies patented in the last five years for the treatment of psoriasis. Therapeutic agents either in the early or advanced phase of development have been described, primarily based on a systematic search using the PubMed Medline database.

Expert Opinion: Though the recent introduction of new antipsoriatic agents has facilitated the management of long-term psoriasis, there is still a strong desire for alternative therapeutic options. Indeed, there remain unmet needs regarding safety and efficacy of psoriasis treatment that should be addressed. In this context, recently patented drugs may prove valid, interesting, and promising within the therapeutic paradigm.
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http://dx.doi.org/10.1080/13543776.2016.1192129DOI Listing
July 2016

UVA1 Laser in the Treatment of Vitiligo.

Photomed Laser Surg 2016 May 12;34(5):200-4. Epub 2016 Apr 12.

1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy .

Objective: The purpose of this article was to evaluate the clinical efficacy and safety of a monochromatic 355 nm ultraviolet (UVA) laser in the treatment of vitiligo.

Background Data: Broadband and narrow-band UV phototherapy has been proposed as an effective therapeutic option in vitiligo patients.

Methods: Seventeen consecutive, unselected patients (7 men and 10 women) were enrolled in an open-label, prospective study and treated twice weekly for 8 weeks at a fixed dose of 80-140 J/cm(2). Follow-up was 12 weeks.

Results: Clinical repigmentation was observed in 15/17 patients (88.23%), with limited side effects (mild post-treatment erythema and itching). Results were maintained during the 12 week phototherapy-free follow-up period.

Conclusions: the present report suggests that UVA1 laser could be an applicable therapeutic option in patients with vitiligo.
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http://dx.doi.org/10.1089/pho.2015.4004DOI Listing
May 2016

Long-term use of a new topical formulation containing piroxicam 0.8% and sunscreen: efficacy and tolerability on actinic keratosis. A proof of concept study.

Curr Med Res Opin 2016 08 15;32(8):1345-9. Epub 2016 Apr 15.

a Department of Dermatology , University of Rome Tor Vergata , Rome , Italy ;

Introduction: Cyclooxygenase (COX) 1 and 2 enzyme up-regulation is involved in the pathogenetic process of actinic keratosis (A.K.) and non-melanoma skin cancers. Diclofenac, a non-steroidal anti-inflammatory (N.S.A.I.D.) drug, is used as topical treatment of A.K. Piroxicam is a N.S.A.I.D. characterized by a high COX-1 inhibition activity.

Study Aim: We conducted an 18 month exploratory open-label study on A.K., to assess the efficacy and tolerability of a new topical formulation of piroxicam and sunscreen in A.K.

Patients: Enrolled subjects applied a galenic formulation of piroxicam 0.8%, vehiculated in a topical product containing sun filters with high (50+) and broad spectrum (UVA) actions, twice a day for 6 months. Subjects were then followed up for additional 12 months. Thirty-eight subjects with a total of 69 A.K. lesions participated in the trial. The primary outcome was the evolution of the Actinic Keratosis Erythema Scale Atrophy (A.K.E.S.A) score assessing erythema, scale, and atrophy of a target A.K. lesion. Secondary outcomes were the percentage of treated lesions with complete (100%) or partial (≥75%) clearance and the evaluation skin tolerability.

Results: A.K.E.S.A. mean (S.D.) score at baseline was 7.5 (1.2). After 6 months of treatment, A.K.E.S.A. score decreased to 0.9 (1.1), a -88% reduction versus baseline. At the end of follow-up, A.K.E.S.A. score was 0.8 (1.2). A complete response was achieved in 38 of the 69 lesions (55%, 95% C.I.: 43% to 66%) and clearance was maintained 1 year post-treatment. A partial clearance was observed in 57 of 69 treated lesions (83%, 95% C.I.: 73% to 91%). Adverse events were limited to mild local irritation.

Conclusion: Our experience suggests that 6 month topical piroxicam 0.8% is efficacious and well tolerated in A.K. Clinical efficacy is maintained 1 year post-treatment. The main limitation of our study is that it was an open label non-controlled trial. Future controlled trials are warranted in order to compare the efficacy and tolerability of this topical piroxicam preparation with standard treatments in the management of A.K.
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http://dx.doi.org/10.1080/03007995.2016.1174678DOI Listing
August 2016

Lack of efficacy of imiquimod in patients with basal cell carcinoma previously treated with rituximab for B cell lymphoma: two case reports.

J Med Case Rep 2016 Mar 11;10:57. Epub 2016 Mar 11.

Department of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.

Background: Non-Hodgkin lymphomas are a heterogeneous group, which involve either B or T lymphocytes. The most used treatment is a chemotherapy regimen, which includes cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone combined with rituximab - a monoclonal antibody specific for CD20 - an antigen expressed on B lymphocyte membrane. Nonmelanoma skin cancers are the most common forms in patients who have lymphomas.

Case Presentation: We reported the cases of two Caucasian men affected by non-Hodgkin disease, treated with chemotherapy and rituximab. After treatment, they both presented superficial basal cell carcinoma and we prescribed imiquimod 5 % cream. Unfortunately, the drug was not effective in either patient and the tumors were excised.

Conclusions: We speculated about the effect of rituximab on B lymphocytes, on a particular population of T cells and on antigen-presenting dendritic cells that may have determined a lower expression of some surface antigens involved in antigen presentation. These cells are the specific targets of imiquimod to promote skin cancer cells apoptosis. A lack of action by imiquimod on skin cancer after treatment with rituximab is likely due to its transitory inhibitory effects on lymphocytes and Langherans cells. Further studies could be useful to understand the mechanism behind the lack of response.
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http://dx.doi.org/10.1186/s13256-016-0834-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788900PMC
March 2016

Serum Protein Profile Changes in Psoriatic Patients Undergoing Treatment With Infliximab.

J Drugs Dermatol 2016 02;15(2):134-8

Unlabelled: The therapeutic paradigm in psoriasis includes antitumor necrosis alpha agents that have been proved effective and safe as long-term therapy. Recently, it has been described a correlation between the use of biologic agents and the occurrence of monoclonal gammopathies, which are haematological conditions characterized by clonal plasma cells proliferation producing a monoclonal immunoglobulin that accumulates in the blood.

Objective: The aim of this study is to detect electrophoretic abnormalities in psoriatic patients undergoing treatment with infliximab.

Research Design And Methods: A retrospective study evaluating all charts from the clinic database of all patients treated with infliximab. The evaluation of serum protein profile is routinely performed in the clinical setting during biologic therapies. We reported the occurrence MGUS in infliximab-treated patients.

Results: The study analysis included 141 charts. Overall, 23 patients showed a MGUS in their electrophoretic profile, though in 6 cases MGUS was detected at the baseline. Thereby, 17 cases (12.06% of the study population) developed MGUS during infliximab therapy.

Conclusions: Serum protein electrophoresis test represents a useful tool to detect and monitor any potentially harmful condition that could occur during treatment with a biologic agent. Particularly, it could be crucial for the detection of MGUS, which does not affect clinical response, and it does not represent a criteria to withdraw the treatment.
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February 2016

Efficacy of cyclosporine A as monotherapy in patients with psoriatic arthritis: a subgroup analysis of the SYNERGY Study.

G Ital Dermatol Venereol 2017 Jun 2;152(3):297-301. Epub 2016 Feb 2.

Novartis Farma Italia, Origgio, Varese, Italy.

Background: The SYNERGY Study is an observational, multicenter Italian study, conducted in patients with diagnosis of psoriatic arthritis (PsA) treated from at least 3 months with cyclosporine and aimed at assessing patients' seropositivity for viral infections and efficacy and safety of cyclosporine, administered as monotherapy or in combination with other systemic drugs in the routine clinical practice. The aim of this subanalysis of the SYNERGY study was to evaluate the effects of CsA as monotherapy only in PsA over 12 months of observation.

Methods: Psoriasis was evaluated by Body Surface Area and the Psoriasis Area Severity Index (PASI). PsA was evaluated by number of swollen and tender joints, painful entheses and fingers with dactylitis, the Bath Ankylosing Spondylitis Activity Index (BASDAI) and by patients' and physicians' global assessment on a 10-point Visual Analogue Scale.

Results: Cyclosporine in monotherapy was effective in reducing all the measured disease parameters. The major indexes of cutaneous and spinal involvement, PASI and BASDAI were significantly reduced over the study period, as were the number of swollen and tender peripheral joints, and enthesitis and dactylitis.

Conclusions: Cyclosporine in monotherapy confirmed its efficacy in cutaneous psoriasis and suggested to be effective also on PsA, reducing spinal and peripheral joints' signs and symptoms.
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http://dx.doi.org/10.23736/S0392-0488.16.05301-3DOI Listing
June 2017

HLA-C*06 and response to ustekinumab in Caucasian patients with psoriasis: Outcome and long-term follow-up.

J Am Acad Dermatol 2016 Feb;74(2):374-5

Dermatology Unit, Neurosciences, Mental Health, and Sensory Organs Department, Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1016/j.jaad.2015.08.055DOI Listing
February 2016

Rhodamine intense pulsed light versus conventional intense pulsed light for facial telangiectasias.

J Cosmet Laser Ther 2016 25;18(2):80-5. Epub 2016 Feb 25.

f Department of Dermatology , University of Rome Tor Vergata , Rome , Italy.

Facial telangiectasias represent the major aesthetic alterations of several chronic inflammatory disorders arising on facial skin. We herein report on relevant clinical results of a new subtype of intense pulsed light treatments, the so-called rhodamine intense pulsed light (r-IPL), in comparison with conventional IPL (c-IPL) treatments on forty-five patients affected by facial telangiectasias. The aim of this study is to determinate whether r-IPL represents an effective and safe treatment for the most common superficial vascular alterations and could be advised as a first choice therapy for facial telangiectasias.
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http://dx.doi.org/10.3109/14764172.2015.1114641DOI Listing
January 2017

Prevalence of acute and chronic viral seropositivity and characteristics of disease in patients with psoriatic arthritis treated with cyclosporine: a post hoc analysis from a sex point of view on the observational study of infectious events in psoriasis complicated by active psoriatic arthritis.

Clin Cosmet Investig Dermatol 2016 22;9:1-7. Epub 2015 Dec 22.

Novartis Farma Italia, Origgio (VA), Varese, Italy.

Background: Sex medicine studies have shown that there are sex differences with regard to disease characteristics in immune-mediated inflammatory diseases, including psoriasis, in immune response and susceptibility to viral infections. We performed a post hoc analysis of the Observational Study of infectious events in psoriasis complicated by active psoriatic arthritis (SYNERGY) study in patients with psoriatic arthritis (PsA) treated with immunosuppressive regimens including cyclosporine, in order to evaluate potential between-sex differences in severity of disease and prevalence of viral infections.

Methods: SYNERGY was an observational study conducted in 24 Italian dermatology clinics, which included 238 consecutively enrolled patients with PsA, under treatment with immunosuppressant regimens including cyclosporin A. In this post hoc analysis, patients' demographical data and clinical characteristics of psoriasis, severity and activity of PsA, prevalence of seropositivity for at least one viral infection, and treatments administered for PsA and infections were compared between sexes.

Results: A total of 225 patients were evaluated in this post hoc analysis, and 121 (54%) were males. Demographic characteristics and concomitant diseases were comparable between sexes. Statistically significant sex differences were observed at baseline in Psoriasis Area and Severity Index score (higher in males), mean number of painful joints, Bath Ankylosing Spondylitis Disease Activity Index, and the global activity of disease assessed by patients (all higher in females). The percentage of patients with at least one seropositivity detected at baseline, indicative of concomitant or former viral infection, was significantly higher among women than among men. No between-sex differences were detected in other measures, at other time points, and in treatments. Patients developed no hepatitis B virus or hepatitis C virus reactivation during cyclosporine treatment.

Conclusion: Our post hoc sex analysis suggests that women with PsA have a greater articular involvement and a higher activity of disease compared to males. Immunosuppressive treatment with cyclosporine seems not to increase susceptibility to new infections or infectious reactivations, with no sex differences.
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http://dx.doi.org/10.2147/CCID.S88306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694613PMC
January 2016

A new therapeutic for the treatment of moderate-to-severe plaque psoriasis: apremilast.

Expert Rev Clin Immunol 2016 ;12(3):237-49

a Dermatology Department, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.

Psoriasis is a common, chronic, inflammatory skin disease. Being a life-long condition, a prolonged and safe control of the disease is needed. Current anti-psoriatic treatments show some limits in terms of tolerability and route of administration. Recently, a new oral small molecule, apremilast, has been approved for the treatment of patients with moderate-to-severe plaque psoriasis. Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that regulates the transduction of intracellular signals, including pro-inflammatory and anti-inflammatory pathways. Because of the favorable safety profile and the oral route of administration, apremilast may represent a promising therapeutic target for moderate-to-severe psoriasis. In this review, we report an updated overview about clinical trials testing apremilast in the treatment of psoriasis and seek to provide comprehensive information about this anti-psoriatic drug and a future perspective of the therapeutic algorithm for psoriasis.
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http://dx.doi.org/10.1586/1744666X.2016.1134319DOI Listing
December 2016

IL12B (p40) Gene Polymorphisms Contribute to Ustekinumab Response Prediction in Psoriasis.

Dermatology 2016 18;232(2):230-6. Epub 2015 Dec 18.

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.

Background: Psoriasis is characterized by multiple genetic variations. Some of these variations, such as the presence of HLA-Cw6 or TNFAIP3 single-nucleotide polymorphisms (SNPs), have been correlated to the response to biologic treatments.

Objective: The aim of our study was to evaluate the effects of IL12B and IL6 SNPs on the response to ustekinumab.

Methods: We retrospectively analyzed the genotypes of 64 patients who had been treated with ustekinumab for up to 1 year. Efficacy data were evaluated using 'intention to treat-last observation carried forward' analysis.

Results: We confirmed the positive role of HLA-Cw6 as a predictor of the response to ustekinumab and discovered that presence of the GG genotype on the IL12B rs6887695 SNP and absence of the AA genotype on the IL12B rs3212227 SNP significantly increase the probability of therapeutic success in HLA-Cw6 positive patients.

Conclusions: The availability of pharmacogenetic data will influence therapeutic decisions in the clinical management of psoriatic patients.
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http://dx.doi.org/10.1159/000441719DOI Listing
January 2017

New therapeutic approaches in the treatment of anogenital lichen sclerosus: does photodynamic therapy represent a novel option?

G Ital Dermatol Venereol 2017 Apr 3;152(2):117-121. Epub 2015 Dec 3.

Division of Dermatology, Department of Medicine, School of Medicine, Tor Vergata University Hospital, Rome, Italy.

Background: Lichen sclerosus et atrophicus (LSA) is an inflammatory, mucocutaneous disorder that affects male and especially female with a debilitating impact on the quality of life. Common localization is the anogenital area. If not treated LSA can leave scars, functional impairment and can evolve in squamous cell carcinoma. The first line of treatment is represented by topical, ultra-potent corticosteroids, but often patients are unresponsive; moreover this therapy is frequently associated to relapses of the disease after discontinuation.

Methods: In this prospective observational study, the efficacy of three different treatments - topical calcineurin inhibitors, avocado and soya beans extracts, and methyl aminolevulinate photodynamic therapy (MAL-PDT) - was evaluated, and an effort has been made to define a therapeutic algorithm according to the severity of the disease.

Results: Of the 150 patients who were referred to the outpatient clinic for a dermatological and gynecological visit, 33 met the inclusion criteria. Sixteen (88%) patients showed an improvement of the lesion and a reduction of the itch; 3 (16.7%) patients with sever itch and fissurated lesions were evaluated for the MAL-PDT therapy. A total of 9 patients, after accurate examination of the lesions, were treated with MAL-PDT. The totality of the patients experienced a resolution of the lesions.

Conclusions: In the early stages the use of ASE can represent a valid alternative that is well tolerated by the patients reducing the itching, dryness and improving the mucosal texture. The use of MAL-PDT represents a valid treatment in the moderate-severe stages of LSA.
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http://dx.doi.org/10.23736/S0392-0488.16.05272-XDOI Listing
April 2017

AISI: A New Disease Severity Assessment Tool for Hidradenitis Suppurativa.

Wounds 2015 Oct;27(10):258-64

University of Rome Tor Vergata, Rome, Italy.

Introduction: Hidradenitis suppurativa (HS) is a chronic, disabling, skin disorder. Because of renewed scientific interest in HS, different aspects of the condition, such as disease severity assessment, are being investigated and better defined. The aim of this study is to provide a novel tool for the assessment of disease severity.

Methods And Materials: An HS-tailored, composite, dynamic score, named the Acne Inversa Severity Index (AISI) was designed to include a physician-rated assessment that considers the type of lesions occurring and the affected body sites. Additionally, a 0-10 visual analog scale (VAS), named Illness-VAS, was created to assess a patient's pain, discomfort, and disability due to HS. The authors compared AISI with other validated measurements, namely the Hurley staging classification, modified Sartorius score, and the Dermatology Life Quality Index (DLQI).

Results: The AISI was tested in 46 patients with HS, demonstrating a significant correlation with Hurley staging (r: 0.70856; P = 0.0021), modified Sartorius score (r: 0.9730; P = less than 0.00001), and DLQI (r: 0.8257; P = 0.0221). According to AISI cut-offs, HS may be defined as mild (AISI less than 10), moderate (AISI 10 > 18), and severe (AISI > 18). Additionally, comparing the 2 dynamic scores, AISI and Sartorius, AISI proved significantly faster than the Sartorius score (46.44 ± 19.24 seconds vs 83.2 ± 19.04 seconds; P =1.31 x 10-6).

Conclusions: Being simple, fast, dynamic, and accurate, the AISI could represent the ideal measurement for HS severity in both real-life and clinical trial settings.
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October 2015

Atopic dermatitis and dental manifestations.

G Ital Dermatol Venereol 2017 Apr 7;152(2):122-125. Epub 2015 Oct 7.

Unit of Dermatology, University of Rome Tor Vergata, Rome, Italy.

Background: Atopic dermatitis is a chronic skin disease associated with epidermal dysfunction commonly seen in children. The aim of this study was to evaluate the possible correlation between atopic dermatitis and dental diseases in paediatric patients.

Methods: An observational study was conducted by the Department of Paediatric Dentistry of the Policlinico Tor Vergata among a group of 300 children, between 2 and 17 years of age and of both genders, for a period of 6 months from January 2013 to June 2013. Socio-demographic data including race, gender, and age were collected. Clinical and dermatological examinations were performed in all patients; family and medical history of atopy was recorded for each patient and relatives.

Results: Three hundred patients, aged between 2 and 17 years, with mean age of 8.9 (±2.12), were enrolled; 90/300 (30%) were affected by atopic dermatitis. Of those, 69/90 (76.6%) had a medical history of spoil habit, 49/90 (54%) had caries, 58/90 (64.4%) had malocclusion disease, 13/90 (14.4%) had anatomical dental abnormalities.

Conclusions: In conclusion, in the current investigation we found a higher prevalence of atopic dermatitis in pediatric dentistry patients compared to the general population suggesting that dental diseases could be involved in the pathogenesis of AD.
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http://dx.doi.org/10.23736/S0392-0488.16.05224-XDOI Listing
April 2017

Phase 3 Studies Comparing Brodalumab with Ustekinumab in Psoriasis.

N Engl J Med 2015 Oct;373(14):1318-28

From the Icahn School of Medicine at Mount Sinai, New York (M.L., L.K.); University of Connecticut School of Medicine, Farmington (B.S.); Probity Medical Research (B.S., L.S., D.T.) and XLR8 Medical Research (D.T.), Windsor, ON, K Papp Medical Research (K.P.), Waterloo, ON, and Dalhousie University, Halifax, NS (R.G.L.) - all in Canada; Baylor University Medical Center, Dallas (A.M.); Northwestern University, Feinberg School of Medicine, Chicago (K.G.); Niepubliczny Zakład Opieki Zdrowotnej multiMedica, Wrocław (J.W.), and Lubelskie Centrum Diagnostyczne, Świdnik (T.B.) - both in Poland; Hospital de la Santa Creu i Sant Pau, Barcelona (L.P.); Veracity Clinical Research, Woolloongabba, QLD, Australia (L.S.); Florida Academic Dermatology Center, Miami (F.K.); University of Colorado, Denver (A.W.A.); Medizinische Universität Wien, Vienna, Austria (G.S.); Massachusetts General Hospital and Harvard Medical School, Boston (A.B.K.); Sorbonne Paris Cité Université Paris Diderot, Assistance Publique-Hôpitaux de Paris Hôpital Saint Louis, Paris (H.B.), Paul Sabatier University, Toulouse (C.P.), and University Hospital of Nice, Nice (J.-P.L.) - all in France; Kaiser Permanente Los Angeles Medical Center, Los Angeles (J.J.W.), Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield (J.C.), University of California, San Francisco, San Francisco (J.K.), and Amgen, Thousand Oaks (G.A., J.L., W.S., C.E.M., Y.S., N.E., P.K., B.K., A.N.) - all in California.; University of Texas Health Science Center, Houston (S.T.); DermResearch, Louisville, KY (L.K.); University of Rome Tor Vergata, Rome (S.C.); University of Utah Medical Center, Salt Lake City (K.C.D.); and the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.).

Background: Early clinical studies suggested that the anti-interleukin-17 receptor A monoclonal antibody brodalumab has efficacy in the treatment of psoriasis.

Methods: In two phase 3 studies (AMAGINE-2 and AMAGINE-3), patients with moderate-to-severe psoriasis were randomly assigned to receive brodalumab (210 mg or 140 mg every 2 weeks), ustekinumab (45 mg for patients with a body weight ≤100 kg and 90 mg for patients >100 kg), or placebo. At week 12, patients receiving brodalumab were randomly assigned again to receive a brodalumab maintenance dose of 210 mg every 2 weeks or 140 mg every 2 weeks, every 4 weeks, or every 8 weeks; patients receiving ustekinumab continued to receive ustekinumab every 12 weeks, and patients receiving placebo received 210 mg of brodalumab every 2 weeks. The primary aims were to evaluate the superiority of brodalumab over placebo at week 12 with respect to at least a 75% reduction in the psoriasis area-and-severity index score (PASI 75) and a static physician's global assessment (sPGA) score of 0 or 1 (clear or almost clear skin), as well as the superiority of brodalumab over ustekinumab at week 12 with respect to a 100% reduction in PASI score (PASI 100).

Results: At week 12, the PASI 75 response rates were higher with brodalumab at the 210-mg and 140-mg doses than with placebo (86% and 67%, respectively, vs. 8% [AMAGINE-2] and 85% and 69%, respectively, vs. 6% [AMAGINE-3]; P<0.001); the rates of sPGA scores of 0 or 1 were also higher with brodalumab (P<0.001). The week 12 PASI 100 response rates were significantly higher with 210 mg of brodalumab than with ustekinumab (44% vs. 22% [AMAGINE-2] and 37% vs. 19% [AMAGINE-3], P<0.001). The PASI 100 response rates with 140 mg of brodalumab were 26% in AMAGINE-2 (P=0.08 for the comparison with ustekinumab) and 27% in AMAGINE-3 (P=0.007). Rates of neutropenia were higher with brodalumab and with ustekinumab than with placebo. Mild or moderate candida infections were more frequent with brodalumab than with ustekinumab or placebo. Through week 52, the rates of serious infectious episodes were 1.0 (AMAGINE-2) and 1.3 (AMAGINE-3) per 100 patient-years of exposure to brodalumab.

Conclusions: Brodalumab treatment resulted in significant clinical improvements in patients with moderate-to-severe psoriasis. (Funded by Amgen; AMAGINE-2 and AMAGINE-3 ClinicalTrials.gov numbers, NCT01708603 and NCT01708629.).
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http://dx.doi.org/10.1056/NEJMoa1503824DOI Listing
October 2015

Apremilast for the treatment of psoriasis.

Expert Opin Pharmacother 2015 4;16(13):2083-94. Epub 2015 Aug 4.

University of Rome "Tor Vergata", Rheumatology, Allergology and Clinical Immunology , Rome , Italy.

Introduction: Psoriasis is a chronic inflammatory skin disease characterized by dysregulation of the immune system and release of pro-inflammatory mediators. Drugs available for psoriasis show some limits as tolerability and route of administration. Apremilast , Otezla®, is an oral small molecule recently approved for the treatment of patients with moderate-to-severe plaque psoriasis. Compared to biologics that target a single cytokine, apremilast, degrading phosphodiesterase 4 (PDE4), interferes with cyclic anti-microbial peptides, which is involved in the transduction of intracellular signals, controlling the balance of pro-inflammatory and anti-inflammatory signals.

Areas Covered: This review reported the latest data available from Phase I, II and III trials on apremilast for the treatment of plaque psoriasis. A focus on the clinical management of apremilast, safety and clinical efficacy based on two pivotal clinical trials (ESTEEM 1 and ESTEEM 2) currently ongoing was described. A systematic search was conducted using the PubMed Medline database for primary articles.

Expert Opinion: Apremilast treatment was demonstrated effective and well tolerated in Phase II and III clinical trials. Several drug peculiarities, such as the low frequency of adverse events and the oral route of administration, make apremilast an innovative treatment for moderate-to-severe psoriasis.
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http://dx.doi.org/10.1517/14656566.2015.1076794DOI Listing
November 2015

Cyclosporine: a novel therapeutic approach for Burning Mouth Syndrome.

G Ital Dermatol Venereol 2016 Oct 19;151(5):480-4. Epub 2015 Jun 19.

Department of Dermatology, Tor Vergata University of Rome, Rome, Italy -

Background: The aim of this paper was to evaluate the efficacy and safety of topical cyclosporine applied as mouthwash in the treatment of burning mouth syndrome (BMS).

Methods: This was a prospective and pilot study conducted by the Department of Dermatology of the University of Rome Tor Vergata. Patients were treated with cyclosporine topically applied as mouthwash for 4 weeks. Clinical improvement was assessed using a 5 grade clinical evaluation scale and a visual analogue scale from 0 to 10 was also used to evaluate the burning symptoms.

Results: Fifteen patients between 22-85 years (61.1±19.3), 11 female and 4 male, with a mean duration of BMS of 12.5 months, completed the study. Five out of 15 patients presented a marked improvement, 6 patients showed a moderate response, 3 patients had a slight improvement and 1 patient did not show any change. The VAS showed a reduction from 8.7 to 3.5. Adverse events were not reported.

Conclusions: Cyclosporine mouthwash appeared to be safe and beneficial for reducing the burning sensation in patients with BMS representing an alternative therapy in this condition.
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October 2016

Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1).

J Am Acad Dermatol 2015 Jul;73(1):37-49

Dermatology Center, Salford Royal Hospital, University of Manchester, Manchester, United Kingdom.

Background: Apremilast works intracellularly to regulate inflammatory mediators.

Objective: ESTEEM 1 evaluated efficacy/safety of apremilast at 30 mg twice a day for moderate to severe plaque psoriasis.

Methods: This phase III, multicenter, double-blind, placebo-controlled study randomized adults (2:1) to apremilast or placebo. At week 16, the placebo group switched to apremilast through week 32, followed by a randomized treatment withdrawal phase to week 52. Binary end points were analyzed using χ(2) test; continuous end points used analysis of covariance.

Results: In all, 844 patients were randomized (n = 282, placebo; n = 562, apremilast). At week 16, significantly more patients taking apremilast achieved 75% or greater reduction from baseline Psoriasis Area and Severity Index score (PASI-75) (33.1%) versus placebo (5.3%, P < .0001; primary end point). Most (61.0%) patients rerandomized to apremilast at week 32 achieved PASI-75 at week 52 versus 11.7% rerandomized to placebo. Of patients rerandomized to apremilast at week 32, mean percentage change from baseline PASI score was -88% to -81% (weeks 32-52). During the placebo-controlled period, 55.7% and 69.3% of patients randomized to placebo and apremilast, respectively, had 1 or more adverse events. Most adverse events were mild/moderate in severity. No new significant adverse events emerged with continued apremilast exposure versus the placebo-controlled period.

Limitations: Data were limited to 52 weeks and may not generalize to nonplaque psoriasis.

Conclusions: Apremilast was effective in moderate to severe plaque psoriasis.
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http://dx.doi.org/10.1016/j.jaad.2015.03.049DOI Listing
July 2015

Tofacitinib versus etanercept or placebo in moderate-to-severe chronic plaque psoriasis: a phase 3 randomised non-inferiority trial.

Lancet 2015 Aug 4;386(9993):552-61. Epub 2015 Jun 4.

Pfizer Inc, Groton, CT, USA.

Background: New therapeutic options are needed for patients with psoriasis. Tofacitinib, an oral Janus kinase inhibitor, is being investigated as a treatment for moderate-to-severe chronic plaque psoriasis. In this study, we aimed to compare two tofacitinib doses with high-dose etanercept or placebo in this patient population.

Methods: In this phase 3, randomised, multicentre, double-dummy, placebo-controlled, 12-week, non-inferiority trial, adult patients with chronic stable plaque psoriasis (for ≥12 months) who were candidates for systemic or phototherapy and had a Psoriasis Area and Severity Index (PASI) score of 12 or higher and a Physician's Global Assessment (PGA) of moderate or severe, and had failed to respond to, had a contraindication to, or were intolerant to at least one conventional systemic therapy, were enrolled from 122 investigational dermatology centres worldwide. Eligible patients were randomly assigned in a 3:3:3:1 ratio to receive tofacitinib 5 mg or 10 mg twice daily at about 12 h intervals, etanercept 50 mg subcutaneously twice weekly at about 3-4 day intervals, or placebo. Randomisation was done by a computer-generated randomisation schedule, and all patients and study personnel were masked to treatment assignment. The co-primary endpoints were the proportion of patients at week 12 with at least a 75% reduction in the PASI score from baseline (PASI75 response) and the proportion of patients achieving a PGA score of "clear" or "almost clear" (PGA response), analysed in the full analysis set (all patients who were randomised and received at least one dose of study drug). This study is registered with ClinicalTrials.gov, number NCT01241591.

Findings: Between Nov 29, 2010, and Sept 13, 2012, we enrolled 1106 eligible adult patients with chronic plaque psoriasis and randomly assigned them to the four treatment groups (330 to tofacitinib 5 mg twice daily, 332 to tofacitinib 10 mg twice daily, 336 to etanercept 50 mg twice weekly, and 108 to placebo). Of these patients, 1101 actually received their assigned study medication (329 in the tofactinib 5 mg group, 330 in the tofacitinib 10 mg group, 335 in the etanercept group, and 107 in the placebo group). At week 12, PASI75 responses were recorded in 130 (39·5%) of 329 patients in the tofacitinib 5 mg group, 210 (63·6%) of 330 in the tofacitinib 10 mg group, 197 (58·8%) of 335 in the etanercept group, and six (5·6%) of 107 in the placebo group. A PGA response was achieved by 155 (47·1%) of 329 patients in the tofacitinib 5 mg group, 225 (68·2%) of 330 in the tofacitinib 10 mg group, 222 (66·3%) of 335 in the etanercept group, and 16 (15·0%) of 107 in the placebo group. The rate of adverse events was similar across the four groups, with serious adverse events occurring in seven (2%) of 329 patients in the tofacitinib 5 mg group, five (2%) of 330 in the tofacitinib 10 mg group, seven (2%) of 335 in the etanercept group, and two (2%) of 107 in the placebo group. Three (1%) of 329 patients in the tofacitinib 5 mg group, ten (3%) of 330 in the tofacitinib 10 mg group, 11 (3%) of 335 in the etanercept group, and four (4%) of 107 patients in the placebo group discontinued their assigned treatment because of adverse events.

Interpretation: In patients with moderate-to-severe plaque psoriasis, the 10 mg twice daily dose of tofacitinib was non-inferior to etanercept 50 mg twice weekly and was superior to placebo, but the 5 mg twice daily dose did not show non-inferiority to etanercept 50 mg twice weekly. The adverse event rates over 12 weeks were similar for tofacitinib and etanercept. This study indicates that in the future tofacitinib could provide a convenient and well-tolerated therapeutic option for patients with moderate-to-severe plaque psoriasis.

Funding: Pfizer Inc.
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http://dx.doi.org/10.1016/S0140-6736(14)62113-9DOI Listing
August 2015

Linear psoriasis following the typical distribution of the sciatic nerve.

J Dermatol Case Rep 2015 Mar 31;9(1):6-11. Epub 2015 Mar 31.

Department of Dermatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.

Background: Some studies suggest that the nervous system plays a role in the onset of psoriasis and psoriasis flares including the symmetry of lesions, sparing of denervated skin and the role of stress in inducing lesions.

Main Observations: We describe an unusual case of psoriasis occurring in the same distribution as sciatic pain from a prolapsed intervertebral disc. The patient, a 45-year-old man with plaque psoriasis was treated with ustekinumab for 104 weeks, at a standard dose. During the eight month of therapy he developed an asymptomatic linear eruption on the left lower extremity along the distribution of the sciatic nerve. On examination, erythematous scaly plaques were noted. Histopathology confirmed the diagnosis of psoriasis. The treatment was continued and clobetasol proprionate 0.05% cream was added. At week 12 after the eruption, the patient reported a pain radiating through the buttock and posterior left leg during jogging. Magnetic resonance imaging showed lumbar disc herniation with compression of the L5-S1 spinal nerve roots. The patient stopped running and the psoriasis spontaneously receded, in a slow but complete fashion, without any local treatment.

Conclusion: There is substantial evidence that nerves play a key role in the pathogenesis of psoriasis. We hypothesized that local TNF-alpha, neuropeptides and nerve growth factor, which are produced by nerve root compression, played a critical role in this case of psoriasis onset in an area of pain from a bulging lumbar intervertebral disc. To our knowledge, a correlation of psoriasis and nerve root compression has not been described previously.
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http://dx.doi.org/10.3315/jdcr.2015.1189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410884PMC
March 2015