Background: Psoriasis is a chronic disease that significantly diminishes the health- related quality of life (HRQOL). Infliximab is a chimeric, tumour necrosis factor α monoclonal antibody that has been shown to impr...Background: Psoriasis is a chronic disease that significantly diminishes the health- related quality of life (HRQOL). Infliximab is a chimeric, tumour necrosis factor α monoclonal antibody that has been shown to improve the signs and symptoms of plaque psoriasis. Objectives: The objective of this study was to evaluate the effect of infliximab induction therapy on the HRQOL of patients with severe plaque psoriasis. Methods: In this double- blind, placebo- controlled trial, 249 patients were randomly assigned to receive intravenous infusions of 3 or 5 mg kg- 1 of infliximab or placebo and were treated at weeks 0, 2 and 6. Patients completed the Dermatology Life Quality Index (DLQI) at baseline and week 10. Results: Infliximab induction therapy resulted in a substantial improvement in HRQOL. At week 10, patients in the infliximab 3- and 5- mg kg- 1 groups showed a median percentage improvement in DLQI scores of 84.0% and 91.0% , respectively, compared with 0% in the placebo group (P < 0.001). The median decrease from baseline in DLQI score at week 10 was 8.0 and 10.0 for the 3 and 5 mg kg- 1 infliximab groups, respectively, compared with 0 in the placebogroup(P < 0.001). Thirty- three per cent and 40% of patientsinthe 3 and 5 mgkg- 1 infliximab groups, respectively, had a DLQI score of 0 at week 10, compared with 2% in the placebo group (P < 0.001). There was a strong correlation between the percentage change from baseline at week 10 in Psoriasis Area and Severity Index (PASI) scores and the percentage change in DLQI scores during the same period (Spearman’ s correlation, 0.61, P < 0.001). When the infliximab and placebo treatment groups were combined, patients with at least 75% improvement in PASI scores between baseline and week 10 had a greater mean improvement in DLQI scores (81% ) than those with 50- 75% improvement in PASI during the same period (60% ). Conclusions: Infliximab induction therapy resulted in significant improvement in HRQOL in patients with severe psoriasis.展开更多
Background: Patients are commonly nonadherent to medication regimens. In derm atology, there has been little study of the effect of nonadherence on outcomes. Objectives: To test the association between adherence behav...Background: Patients are commonly nonadherent to medication regimens. In derm atology, there has been little study of the effect of nonadherence on outcomes. Objectives: To test the association between adherence behaviour and changes in s everity of psoriasis. Methods: Twenty-four subjects with psoriasis were enroll ed in an 8- week, left/right, controlled trial of salicylic acid plus topical t acrolimus ointment vs. salicylic acid plus placebo. Subjects were given salicyli c acid to apply to all lesions. The salicylic acid was supplied in a bottle with a medication event monitoring system cap in order to assess adherence to the sa licylic acid. The primary outcome for this study was the relationship between th e change in the disease severity (change in sum score of erythema, scale and thi ckness scores for a target plaque) and medication adherence. Results: The mean i nitial disease severity was 5- 8 on a nine-point sum score scale. For the top ical tacrolimus-treated side, a decrease in adherence rate of 10% was associ ated with a 1- point increase in severity (P < 0.05). For the placebo-treated side, adherence was not significantly correlated with changes in severity. Conc lusions: Nonadherence may have a significant role in altering clinical trial dat a, skewing it towards ineffectiveness. Improved outcomes in psoriasis may be ach ievable through interventions that improve patients’adherence to treatment.展开更多
Psoriasis is a common disease with substantial effects on quality of life. Few quality of life studies have been performed in psoriasis patients from the general US population. To describe the determinants of quality ...Psoriasis is a common disease with substantial effects on quality of life. Few quality of life studies have been performed in psoriasis patients from the general US population. To describe the determinants of quality of life in psoriasis patients from the US population. Patients were randomly selected from the US population. Patients who identified themselves as having been diagnosed with psoriasis by a physician were invited to complete a more detailed survey about quality of life. Two hundred sixty-six psoriasis patients from the US population completed the detailed survey. Body surface area showed the strongest association with decrements in quality of life (Spearman 0.50, P < . 0001). Younger patients and female patients also had statistically significant reductions in quality of life. Increasing psoriasis severity was associated with seeking care from multiple physicians and having decrements in income. Patients with more extensive skin involvement have great erreductions in quality of life. Female patients and young patients are affected to a greater extent.展开更多
文摘Background: Psoriasis is a chronic disease that significantly diminishes the health- related quality of life (HRQOL). Infliximab is a chimeric, tumour necrosis factor α monoclonal antibody that has been shown to improve the signs and symptoms of plaque psoriasis. Objectives: The objective of this study was to evaluate the effect of infliximab induction therapy on the HRQOL of patients with severe plaque psoriasis. Methods: In this double- blind, placebo- controlled trial, 249 patients were randomly assigned to receive intravenous infusions of 3 or 5 mg kg- 1 of infliximab or placebo and were treated at weeks 0, 2 and 6. Patients completed the Dermatology Life Quality Index (DLQI) at baseline and week 10. Results: Infliximab induction therapy resulted in a substantial improvement in HRQOL. At week 10, patients in the infliximab 3- and 5- mg kg- 1 groups showed a median percentage improvement in DLQI scores of 84.0% and 91.0% , respectively, compared with 0% in the placebo group (P < 0.001). The median decrease from baseline in DLQI score at week 10 was 8.0 and 10.0 for the 3 and 5 mg kg- 1 infliximab groups, respectively, compared with 0 in the placebogroup(P < 0.001). Thirty- three per cent and 40% of patientsinthe 3 and 5 mgkg- 1 infliximab groups, respectively, had a DLQI score of 0 at week 10, compared with 2% in the placebo group (P < 0.001). There was a strong correlation between the percentage change from baseline at week 10 in Psoriasis Area and Severity Index (PASI) scores and the percentage change in DLQI scores during the same period (Spearman’ s correlation, 0.61, P < 0.001). When the infliximab and placebo treatment groups were combined, patients with at least 75% improvement in PASI scores between baseline and week 10 had a greater mean improvement in DLQI scores (81% ) than those with 50- 75% improvement in PASI during the same period (60% ). Conclusions: Infliximab induction therapy resulted in significant improvement in HRQOL in patients with severe psoriasis.
文摘Background: Patients are commonly nonadherent to medication regimens. In derm atology, there has been little study of the effect of nonadherence on outcomes. Objectives: To test the association between adherence behaviour and changes in s everity of psoriasis. Methods: Twenty-four subjects with psoriasis were enroll ed in an 8- week, left/right, controlled trial of salicylic acid plus topical t acrolimus ointment vs. salicylic acid plus placebo. Subjects were given salicyli c acid to apply to all lesions. The salicylic acid was supplied in a bottle with a medication event monitoring system cap in order to assess adherence to the sa licylic acid. The primary outcome for this study was the relationship between th e change in the disease severity (change in sum score of erythema, scale and thi ckness scores for a target plaque) and medication adherence. Results: The mean i nitial disease severity was 5- 8 on a nine-point sum score scale. For the top ical tacrolimus-treated side, a decrease in adherence rate of 10% was associ ated with a 1- point increase in severity (P < 0.05). For the placebo-treated side, adherence was not significantly correlated with changes in severity. Conc lusions: Nonadherence may have a significant role in altering clinical trial dat a, skewing it towards ineffectiveness. Improved outcomes in psoriasis may be ach ievable through interventions that improve patients’adherence to treatment.
文摘Psoriasis is a common disease with substantial effects on quality of life. Few quality of life studies have been performed in psoriasis patients from the general US population. To describe the determinants of quality of life in psoriasis patients from the US population. Patients were randomly selected from the US population. Patients who identified themselves as having been diagnosed with psoriasis by a physician were invited to complete a more detailed survey about quality of life. Two hundred sixty-six psoriasis patients from the US population completed the detailed survey. Body surface area showed the strongest association with decrements in quality of life (Spearman 0.50, P < . 0001). Younger patients and female patients also had statistically significant reductions in quality of life. Increasing psoriasis severity was associated with seeking care from multiple physicians and having decrements in income. Patients with more extensive skin involvement have great erreductions in quality of life. Female patients and young patients are affected to a greater extent.
