Background: Leaving against medical advice (LAMA) can be defined broadly as a patient’s insistence upon leaving the hospital against the treating team has expressed advice, which is both a challenge ...and concern for physicians, as these patients lost to follow-up, and their outcomes remain unknown. There is no previous study conducted to find the prevalence and causes of LAMA in brain tumors patients in the Middle East to the best of our knowledge. Methods: Patients studied in this research are those who were diagnosed with any type of brain tumors and were admitted to the Neurosurgical Department in Khoula Hospital (KH) but signed LAMA in the two years between January 2017 to December 2018 by going through the electronic medical records. Data obtained from the health information system includes socioeconomic characteristics, health status-related data, diagnosis-related data, and the reasons for LAMA. Results: A total number of 302 patients with brain tumors included in this study. Twenty-eight patients (9.2%) signed LAMA with a majority of those who signed LAMA were in the young adult’s group (3-39 years) and represented 18 (64%). Eight patients (28.57%) among the LAMA group and 43 patients (15.69%) in the non-LAMA group have tumors in the frontal lobe, which has found to be the most familiar location (29%). There was a significant relationship between the reason for LAMA and gender (P=0.020). Conclusion: Younger patients, male, Omani, newly diagnosed tumors, and tumors in the frontal lobe were all risk factors for LAMA. Education and awareness about LAMA recommended in order to avoid readmission and loss of follow up.
Abstract
Biological drugs have revolutionized the treatment of immune-mediated inflammatory diseases. Clinical experience and evidence suggest that biosimilars can be used as safely and effectively ...as their originator. However, patients’ perceptions of biosimilars are that they are inferior to the originator. Currently, few studies have assessed the tolerability and efficacy of switching from the adalimumab originator to a biosimilar in patients with well-controlled moderate-to-severe psoriasis. Our objective was to describe the clinical experience of switching patients from the adalimumab originator to a biosimilar and that of switching back to the originator for those intolerant to biosimilars. A single-centre, retrospective cohort study was conducted to identify patients with moderate-to-severe psoriasis who had switched from the adalimumab originator (Humira®) to a biosimilar (Amgevita® or Imraldi®) from 2018 to 2022. Patient data were obtained from a combination of patient records and databases, including the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) and the National High Tech Prescribing Hub. Patients were excluded from the study if their treatment duration on an adalimumab biosimilar was < 16 weeks or if they were being treated for an indication other than psoriasis. From 2018 to 2022, 100 patients who switched from the adalimumab originator to a biosimilar were identified. At week 16, 81 patients (81%) maintained their initial switch from the adalimumab originator to biosimilar. Nineteen (19%) patients who were switched to an adalimumab biosimilar were switched back to the originator secondary to adverse events. Maintenance or improvement in baseline Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) was observed in 91% and 90%, respectively, in patients who remained on a biosimilar. For those intolerant to biosimilars, maintenance or improvement in baseline PASI and DLQI was still observed although in fewer patients: 63% and 47%, respectively. Our study demonstrates that drug efficacy was recaptured and adverse events were ameliorated for all patients switched from an adalimumab biosimilar back to the originator. For patients who did not tolerate biosimilar switch, reasons for switching back to the originator mirrored those reported in the literature. All patients who switched back to the originator from a biosimilar recovered from loss of efficiency and the adverse events they had reported. Physicians should be confident in switching patients with well-controlled psoriasis to adalimumab biosimilars. For the small proportion of patients who experienced loss of efficacy or adverse events, all were recaptured by either switching to an alternative adalimumab biosimilar or switching back to the adalimumab originator.
Our three year retrospective cohort study demonstrated that the vast majority of patients tolerated the switch from adalimumab originator to adalimumab biosimilar, with a 19% switchback rate. All ...patients who switched back to originator from biosimilar recovered from loss of efficiency and reported adverse events.
Physicians therefore should be confident in switching patients with well controlled psoriasis to adalimumab biosimilars.
Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by recurrent inflammatory nodules and abscesses thought to develop via follicular occlusion, a disrupted ...microbiome and subsequent inflammation and follicular rupture. A 50-year-old man with no prior history of skin disease was referred from hepatology with a 3-month history of recurrent inflammatory nodules of the axillae and bilateral groin. He had been diagnosed with advanced metastatic segment II/III hepatocellular carcinoma and portal vein thrombosis on a background of cirrhosis 7 months previously. He received palliative radiotherapy for T12/L1 spinal metastases and endoscopic banding of grade 2 oesophageal varices. Concomitant treatment with the programmed cell death ligand (PDL)-1 inhibitor atezolizumab and bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, was commenced 1 month postdiagnosis. After 2 months of combination immunotherapy, the patient reported the development of recurrent inflammatory nodules and abscesses. Examination was consistent with HS Hurley stage II. Of note, the patient had no other risk factors for HS including smoking, sex, family history, comorbidities or raised body mass index. Immune checkpoint inhibitors are associated with a myriad of cutaneous toxicities. Anti-PDL-1-induced HS has been described with nivolumab with an upregulation of the interleukin-17 axis postulated as a mechanism Ayoubi N, Gerhardt AC, Hennessy K et al. Hidradenitis suppurativa secondary to nivolumab. J Am Acad Dermatol 2022; 87 (Suppl.): AB171. The occurrence of new-onset HS in patients on checkpoint inhibitors supports the concept of HS as a primary inflammatory disease. Cases of HS have also been reported with sunitinib, a VEGF inhibitor (Montero-Vilchez T, Bueno-Rodriguez A, Salvador-Rodriguez L et al. Could vascular endothelial growth factor inhibitors induce hidradenitis suppurativa? Report of three patients with renal cancer treated with sunitinib. Dermatol Ther 2020; 33: e13306). Although the exact culprit drug in this patient’s case cannot be definitively stated, given the effect that HS has on quality of life, the association of HS with both PDL-1 and VEGF inhibition should be noted along with prompt referral to a dermatologist and initiation of appropriate treatment.
Use of Phototherapy in Children Eustace, Karen; Dolman, Sophie; Alsharqi, Ali ...
Pediatric dermatology,
March/April 2017, 2017-Mar, 2017-03-00, 20170301, Volume:
34, Issue:
2
Journal Article
Peer reviewed
Background
Phototherapy is a well‐recognized treatment in adults and children. Previous articles have reported success in treating recalcitrant skin disorders such as atopic dermatitis (AD), ...psoriasis, pityriasis lichenoides chronica, and vitiligo in children.
Methods
This was a retrospective review over an 18‐month period from June 2012 to December 2013 of all children receiving phototherapy in a tertiary pediatric dermatology center.
Results
Seventy‐five patients 3 to 17 years of age (mean 10.6 years; 35 male, 40 female) were included. Forty‐eight (64%) patients had AD and 21 (28%) had psoriasis. Seventy received narrowband ultraviolet B (NBUVB) treatment and five received hand and foot psoralen and ultraviolet A (PUVA) treatment. All patients with AD were treated with NBUVB and four (8.3%) were also treated with hand PUVA. After phototherapy, 76% had documented clear to almost clear skin. At the 12‐month follow‐up, 52% of the patients with AD remained clear. All 21 patients with psoriasis underwent NBUVB phototherapy. The clearance rate after phototherapy was 86%. At the 12‐month follow‐up, 43% of the patients with psoriasis remained clear.
Conclusion
Phototherapy can reduce disease burden in individuals with severe AD and psoriasis and should be considered as a second‐line therapy if standard topical regimens are unsuccessful.
Biologic therapies can be highly effective for the treatment of severe psoriasis, but response for individual patients can vary according to drug. Predictive biomarkers to guide treatment selection ...could improve patient outcomes and treatment cost-effectiveness.
We sought to test whether HLA-C*06:02, the primary genetic susceptibility allele for psoriasis, predisposes patients to respond differently to the 2 most commonly prescribed biologics for psoriasis: adalimumab (anti–TNF-α) and ustekinumab (anti–IL-12/23).
This study uses a national psoriasis registry that includes longitudinal treatment and response observations and detailed clinical data. HLA alleles were imputed from genome-wide genotype data for 1326 patients for whom 90% reduction in Psoriasis Area and Severity Index score (PASI90) response status was observed after 3, 6, or 12 months of treatment. We developed regression models of PASI90 response, examining the interaction between HLA-C*06:02 and drug type (adalimumab or ustekinumab) while accounting for potentially confounding clinical variables.
HLA-C*06:02–negative patients were significantly more likely to respond to adalimumab than ustekinumab at all time points (most strongly at 6 months: odds ratio OR, 2.95; P = 5.85 × 10−7), and the difference was greater in HLA-C*06:02–negative patients with psoriatic arthritis (OR, 5.98; P = 6.89 × 10−5). Biologic-naive patients who were HLA-C*06:02 positive and psoriatic arthritis negative demonstrated significantly poorer response to adalimumab at 12 months (OR, 0.31; P = 3.42 × 10−4). Results from HLA-wide analyses were consistent with HLA-C*06:02 itself being the primary effect allele. We found no evidence for genetic interaction between HLA-C*06:02 and ERAP1.
This large observational study suggests that reference to HLA-C*06:02 status could offer substantial clinical benefit when selecting treatments for severe psoriasis.
Background/Objectives
The simplified psoriasis index (SPI) is a three‐part multidimensional tool incorporating disease severity, psychosocial impact and historical course completed by the health‐care ...professional (professional SPI, proSPI) or the patient (self‐assessment SPI, saSPI). We aimed to assess the validity and response distribution of proSPI and saSPI in patients with psoriasis undergoing phototherapy.
Methods
The validity and response distribution of SPI was assessed by recording saSPI and proSPI in patients with psoriasis before and after a course of phototherapy. Recruitment ended once 100 complete data sets were available for analysis.
Results
Altogether 52 of the 100 patients evaluated were male and most (93) underwent narrowband UVB phototherapy. There was a close correlation between the proSPI‐current severity score (proSPI‐s) with the psoriasis area and severity index (PASI) score (r = 0.76, r = 0.86) before and after treatment, respectively. Although pretreatment correlation between the saSPI‐current severity score (saSPI‐s) and PASI was weak (r = 0.39), a more close correlation was noted at the end of treatment (r = 0.50). A moderate correlation was observed between the SPI‐psychosocial impact score (SPI‐p) and the dermatology life quality index (DLQI), both before and after phototherapy (r = 0.64, r = 0.73). The SPI had wide response distributions in all three domains.
Conclusions
Both versions of SPI demonstrated wide response distributions and the proSPI‐s in particular was shown to have good validity with PASI.
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