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Numero 3, 2009

Trattamento intermittente con etanercept nella psoriasi a placche: efficacia del ritrattamento nel lungo periodo

GINO A. VENA
ANNA FAVIA
FRANCESCO LOCONSOLE
NICOLETTA CASSANO
Clinica Dermatologica II
Università degli Studi di Bari

Etanercept is an anti-Tumor Necrosis Factor (TNF) fusion protein approved for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. The aim of this study was to evaluate the effi cacy, safety and tolerability of intermittent treatment with etanercept in psoriasis patients. A retrospective analysis was carried out in 37 patients affected with psoriasis, without concomitant arthritis, who underwent one or two re-treatment courses with etanercept. Effi cacy of etanercept, defi ned as PASI 50 response rate, was maintained in each re-treatment course, in the absence of any serious and/or unexpected adverse events. Re-treatment with etanercept was effective and well tolerated in all cases.

 

 

Trattamento della psoriasi con ciclosporina associata a calcipotriolo/betametasone dipropionato unguento

Risultati dello studio retrospettivo DOSAGE (Dovobet® Ointment/Sandimmun [Neoral®] Association: Gaining Experience)

 


GINO A. VENA

DARIO FAI*

IVANA ROMANO*

SERGIO G. ARESTA*

ANTONIO MANCINO*

NICOLA CARRINO*

STEFANO PELLÈ*

EUGENIO ROMANELLO*

COSIMO MALVINDI*

M. DONATELLA DI GIUSEPPE*

ANTONIO PUGLIESE*

MICHELANGELO VESTITA

MONICA CARBONARA**

NICOLETTA CASSANO

Clinica Dermatologica II, Dipartimento MIDIM

Università degli Studi di Bari

*ADMG - Sezione Jonico-Salentina

**ISTAT - Istituto Nazionale di Statistica, Bari

 

Combination of a systemic drug with a topical one has been already established as an effective therapeutic approach to psoriasis. Data demonstrating the effectiveness of topical calcipotriol combined with cyclosporine (CsA) are available, while studies on the association of calcipotriol/betamethasone dipropionate (CBD) ointment and CsA are lacking. The aim of this retrospective experience was to evaluate the adjuvant role of CBD ointment in psoriatic patients treated with CsA. For this purpose 130 patients affected with moderate-to-severe psoriasis (defi ned by a PASI value ≥10) were included in the analysis: 59 of these patients were under CsA as monotherapy, while 71 were treated with the combination CBD + CsA. Throughout a 4-month treatment phase, the PASI value was assessed at monthly intervals. CsA daily dose was adjusted according to clinical response and tolerability. A progressive PASI improvement was noted in both groups. The proportion of subjects who reached a PASI 75 response at month 3 was significantly higher among patients treated with CBD + CsA (43% vs 29%; p = 0.02). Moreover, starting from a similar CsA dosage used in the two groups, a signifi cant reduction in CsA daily dose was registered at months 2 and 3 in the combination therapy group (p = 0.002). Despite the intrinsic limits of the study due to its retrospective nature and the small sample size, our results support the synergic effect of CBD ointment when associated with CsA and especially its potential CsA-sparing activity.

 

 

 

Trattamento della psoriasi artropatica: esperienza a lungo termine con etanercept

 

ANNAMARIA MAZZOTTA

MARIA ESPOSITO

CATERINA SCHIPANI

SERGIO CHIMENTI

Clinica Dermatologica

Università degli Studi di Roma “Tor Vergata”

 

Arthropathic psoriasis is a seronegative infl ammatory arthritis commonly associated to plaque-type psoriasis, with a prevalence in psoriatic patients varying from 5 to 42 percent and with a very strong negative impact on the quality of life, causing pain, rigidity and reduced articular function. A long-term observational study was conducted on 32 patients to evaluate etanercept safety and effectiveness with 50 mg administered subcutaneously twice weekly for 12 weeks, followed by 50 mg once weekly for 144 weeks. During the three-year study period, etanercept showed no severe side effect and to improve arthropathic psoriasis signs and symptoms.

 

 

 

Valutazione del profilo di espressione genica in pazienti psoriasici in terapia con etanercept

 

GIANFRANCO ALTOMARE*

EVA REALI**

*Dermatologia IRCCS Galeazzi, Università degli Studi di Milano

**INGM - Istituto Nazionale di Genetica Molecolare, Milano

 

Patients affected by psoriasis were enrolled in a study for etanercept therapy, an anti-TNFα biologic drug, with the aim of showing the effect of such therapy on gene expression modulation for proinfl ammatory cytokines and chemokines involved in the pathogenesis of the disease. The results of this study may help to understand psoriasis pathogenetic mechanisms with the possibility to identify those associated with the regression of psoriasis.

 

 

 

Psoriasi e vitiligine

 

SERENA LEMBO*

CARLO DONADIO**

CLAUDIO LEMBO*

DARIO DONADIO**

*Dipartimento di Patologia Sistematica - Sezione di Dermatologia Clinica, Allergologica e Venereologica

Università degli Studi di Napoli “Federico II”

**U.O.C. Dermatologia - Azienda Universitaria Ospedaliera San Giovanni di Dio e Ruggi d’Aragona, Salerno

 

Psoriasis and vitiligo are two common chronic infl ammatory autoimmune disorders whose pathogenesis has not been well defi ned yet. Nevertheless, several studies recently showed the existence of a possible common autoimmune pathogenetic mechanism. Psoriasis and vitiligo in fact often coexist in the same patient, with vitiligo preceding psoriasis in most cases.

 

 

 

Un caso di psoriasi pustolosa generalizzata trattato con un anti-TNF

 

STEFANO PIASERICO

LORENZO SCHIESARI

MAURO ALAIBAC

Clinica Dermatologica

Università degli Studi di Padova

 

The clinical case refers to a 38-year-old woman who has been affected by psoriasis for 10 years. Five years ago the patient complained a generalized pustular psoriasis of von Zumbusch that was successfully treated in another medical centre with systemic corticosteroids and cyclosporine. Four months ago she was referred to us due to a severe relapse of the illness. We chose a treatment with etanercept 50 mg twice a week since ciclosporine was incompatible with her desire to have a baby. Etanercept showed a good control of the disease with the pustules improving after 1 month of treatment.

 

 

La psoriasi nella pelle nera

 

FEDERICA RICCERI*

FRANCESCA PRIGNANO*

TORELLO LOTTI*

ALDO MORRONE**

*Dipartimento di Scienze Dermatologiche

Cluster II, Università degli Studi di Firenze

Villa Basilewsky, Firenze

**Struttura Complessa di Medicina Preventiva

delle Migrazioni, del Turismo e di Dermatologia

Tropicale, Istituto San Gallicano, IRCC

 

Common dermatoses may appear atypical in black skin, as so many of the familiar key features are masked, and this can lead to diagnostic confusion for physicians more used to examine white skin. In Africans and in black Americans, psoriasis is less common than in the Caucasian population with different varieties in ethnic groups, and they present a more benign course. However, in black patients, psoriasis can present a diagnostic challenge because of variations in clinical appearance. On dark skin, the plaques appear greyish, and the skin assumes a copper-like tonality. The dermatosis has a marked predilection for the extensor surfaces of the extremities, the scalp, the back and the sacral region.

 

 

La psoriasi in età pediatrica

 

ANDREA DIOCIAIUTI*

MAYA EL HACHEM**

*Dirigente Medico I liv. UO Dermatologia

**Responsabile struttura complessa

UO Dermatologia - Ospedale Pediatrico Bambino Gesù, Roma

 

Psoriasis is not rare in childhood, in fact 35% of the cases appear before the age of 20. Familiarity is stronger (50-70%) in children compared to adults because genetic factors have a greater weight. The triggers responsible for the onset of the lesions in children are basically infections, physical trauma and

stress. Common forms of the disease are the minimal psoriasis of the face and the so-called “inverse forms” in infancy together with napkin psoriasis. Other frequent forms are the “guttata” and the follicular, but the plaque-type form remains the most common in pediatrics (in the older child). The most severe forms are the

arthropathic, the erythrodermic, the pustular, but fortunately they are rare. The treatment of psoriasis in children is based on the same drugs used for adults, but with some limitations due to the toxicity of some of them or to the attention needed when using off-label drugs. In fact, randomized controlled clinical trials for

psoriasis in children are very few and almost exclusively conducted on steroid, calcipotriol and more recently etanercept. An “evidence based medicine” therapeutic approach is fundamental, but currently is rarely practised in childhood psoriasis. For this reason, the involvement of pediatric centers in clinical trials

and drug surveys is an urgent issue. 

 

 

 

Associazioni terapeutiche nella gestione della psoriasi

 

PATRIZIA MARTINI

ALBERTO GHILARDI

U.O.Dermatologia

Ospedale Campo di Marte, Lucca

 

Psoriasis is a chronic and disabling disease. It may severely compromise the quality of life such as major medical disorders as myocardial infarction, congestive heart failure, chronic lung disease, and cancer. Moderate-to-severe psoriasis should be treated with aggressive therapies. Traditional therapeutic options

such as acitretin, cyclosporin, methotrexate, PUVA and UVB narrow band phototherapy might have important side effects. Monotherapy has a higher risk to develop them. Alternative therapeutic schemes using different but with-synergic-action drugs allowed to reduce adverse effects with better clinical outcomes. The emergence of new biologic therapies, with their relative safety, allowed dermatologists to have a wider array of tools for use against this lifelong disease. But a wide experience showing how

the association between biologic and traditional therapy might be advantageous does not exist.

 

 

 

Indicatori clinici e strumentali per l’identificazione dell’artrite psoriasica in fase precoce

 

MARIA VITTORIA GIORDANO

GIAMPIERO GIROLOMONI

PAOLO GISONDI

Dipartimento di Medicina

Sezione di Dermatologia e Venereologia

Università degli Studi di Verona

 

Psoriatic arthritis (PsA) is a chronic infl ammatory musculoskeletal disorder associated with a varied disease expression and an unpredictable but often chronically destructive clinical course. The term “early PsA” remains imprecisely defi ned and the duration of “early” disease can range from several months to anything less than 5 years. Some questionnaires have been validated to help dermatologists to recognize the presence of joint involvement in patients with psoriasis. However, the diagnosis of early PsA should be confi rmed using imaging modalities including ultrasonography, magnetic resonance and bone scintigraphy. Most patients with early PsA are initially treated with NSAIDs but this approach is often not tolerated on the long term, whenever effective. Methotrexate is the most commonly used DMARDs, and

it could be effective in inducing clinical remission. TNFα antagonists can alleviate both the signs and the symptoms of PsA and prevent bone erosions.