Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impai...Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impaired in the different CSDs,andprovide comparative references to estimate better the real impact of the different CSDs. Patients and methods: A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. Results: After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The ’ physical discomfort’ dimension was more degraded in AD and CU than in PSO (P < 0.001), and ’ leisure activities’ more in PSO than in CU (P < 0.001). ‘ Self-perception’ and ‘ reatment-induced restrictions’ dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the ‘ daily living activities’ dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. Conclusions. The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.展开更多
An open-label study of alefacept plus ultravioletB light as combination therapy for chronic plaque psoriasis<Author>Ortonne J.P./Khemis A./Koo J./Choi J. [J.P.Ort-onne, l’ Archet II, 15, R. de S. Antoine de Gin...An open-label study of alefacept plus ultravioletB light as combination therapy for chronic plaque psoriasis<Author>Ortonne J.P./Khemis A./Koo J./Choi J. [J.P.Ort-onne, l’ Archet II, 15, R. de S. Antoine de Ginestiere, Nice, Cé dex 03, France]Background: Alefacept, a fully human LFA-3/IgG1 fusion protein, is a selective biological agent approved in theUnited States for the treatment of chronic plaque psoriasis. In phase 3 trials, clinical improvement and prolonged off-treatment remission of psoriasis correlated with reductions in circulating memory T cells. Reductions in pathogenic epidermal T cells in psoriatic lesions also have been noted following phototherapy with ultraviolet B (UVB) light. Because alefacept and UVB target T cells in different ways, combination therapy with these two agents may lead to greater efficacy. Objectives: To determine the safety, tolerability, and efficacy trends of combination therapy with alefacept plus UVB light in patients with chronic plaque psoriasis. Methods: In an open-label, parallel-group study conducted at two sites, one in France and one in the United States, patients with chronic plaque psoriasis who were candidates for phototherapy received 12-weekly intramuscular injections of alefacept, 15 mg. In addition, patients were randomized to one of three treatment arms: no UVB treatment, 6-week UVB treatment, and 12-week UVB treatment. UVB treatment consisted of narrowband (NB) UVB at the site in France and broadband (BB) UVB at the site in the United States. The 12-week treatment period was followed by a 12-week follow-up period. Clinic visits occurred weekly during treatment and every 2-4 weeks during follow-up. Results: A total of 60 patients (n =30/site)were enrolled in the study. Alefacept was well tolerated when administered in combination with UVB treatment and as monotherapy. There was no evidence of increased phototoxicity or photosensitivity with the combination. At each study site, alefacept/UVB provided a higher overall response rate and led to a more rapid onset of response compared with alefacept monotherapy. Of patients who achieved ≥ 50% reduction from baseline Psoriasis Area Severity Index (PASI 50) at 2 weeks after the last dose of alefacept, 75-100% in the combination therapy groups maintained this response throughout followup in the absence of further psoriasis therapy. Conclusions: In patients with chronic plaque psoriasis, combination therapy with alefacept plus short-term (6-12 weeks) UVB treatment is well tolerated with a trend toward greater and more rapid efficacy than alefacept alone.<Keywords>展开更多
文摘Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impaired in the different CSDs,andprovide comparative references to estimate better the real impact of the different CSDs. Patients and methods: A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. Results: After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The ’ physical discomfort’ dimension was more degraded in AD and CU than in PSO (P < 0.001), and ’ leisure activities’ more in PSO than in CU (P < 0.001). ‘ Self-perception’ and ‘ reatment-induced restrictions’ dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the ‘ daily living activities’ dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. Conclusions. The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.
文摘An open-label study of alefacept plus ultravioletB light as combination therapy for chronic plaque psoriasis<Author>Ortonne J.P./Khemis A./Koo J./Choi J. [J.P.Ort-onne, l’ Archet II, 15, R. de S. Antoine de Ginestiere, Nice, Cé dex 03, France]Background: Alefacept, a fully human LFA-3/IgG1 fusion protein, is a selective biological agent approved in theUnited States for the treatment of chronic plaque psoriasis. In phase 3 trials, clinical improvement and prolonged off-treatment remission of psoriasis correlated with reductions in circulating memory T cells. Reductions in pathogenic epidermal T cells in psoriatic lesions also have been noted following phototherapy with ultraviolet B (UVB) light. Because alefacept and UVB target T cells in different ways, combination therapy with these two agents may lead to greater efficacy. Objectives: To determine the safety, tolerability, and efficacy trends of combination therapy with alefacept plus UVB light in patients with chronic plaque psoriasis. Methods: In an open-label, parallel-group study conducted at two sites, one in France and one in the United States, patients with chronic plaque psoriasis who were candidates for phototherapy received 12-weekly intramuscular injections of alefacept, 15 mg. In addition, patients were randomized to one of three treatment arms: no UVB treatment, 6-week UVB treatment, and 12-week UVB treatment. UVB treatment consisted of narrowband (NB) UVB at the site in France and broadband (BB) UVB at the site in the United States. The 12-week treatment period was followed by a 12-week follow-up period. Clinic visits occurred weekly during treatment and every 2-4 weeks during follow-up. Results: A total of 60 patients (n =30/site)were enrolled in the study. Alefacept was well tolerated when administered in combination with UVB treatment and as monotherapy. There was no evidence of increased phototoxicity or photosensitivity with the combination. At each study site, alefacept/UVB provided a higher overall response rate and led to a more rapid onset of response compared with alefacept monotherapy. Of patients who achieved ≥ 50% reduction from baseline Psoriasis Area Severity Index (PASI 50) at 2 weeks after the last dose of alefacept, 75-100% in the combination therapy groups maintained this response throughout followup in the absence of further psoriasis therapy. Conclusions: In patients with chronic plaque psoriasis, combination therapy with alefacept plus short-term (6-12 weeks) UVB treatment is well tolerated with a trend toward greater and more rapid efficacy than alefacept alone.<Keywords>
