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News - June 2020

News - June 2020

HS Associated With Increased Cancer Risk
Hidradenitis suppurativa (HS) was associated with a significantly increased risk for cancer, according to the findings of a recent nationwide population-based cohort study, including several specific cancers such as Hodgkin lymphoma and nonmelanoma skin cancer.

Using data from the Korean Health Insurance Review and Assessment Service database, the researchers identified 22,468 patients diagnosed with HS between January 1, 2009, and December 31, 2017, and 179,734 controls matched by age, sex, index year, and insurance type. The mean age was 33.63 years and 63.7% of patients in both groups were male.

The researchers calculated overall and specific cancer incidence rates per 100,000 person-years, as well as the risk of cancers, and compared these between the HS and matched-control cohorts.

Among patients with HS, the adjusted hazard ratio (aHR) of overall cancer was 1.28 (95% CI, 1.15-1.42), the researchers wrote. They also found patients with HS had significantly higher risk for Hodgkin lymphoma (aHR, 5.08; 95% CI, 1.21-21.36), oral cavity and pharyngeal cancer (aHR, 3.10; 95% CI, 1.60-6.02), central nervous system cancer (aHR, 2.40; 95% CI, 1.22-4.70), nonmelanoma skin cancer (HR, 2.06; 95% CI, 1.12-3.79), prostate cancer (aHR, 2.05; 95% CI, 1.30-3.24), and colorectal cancer (aHR, 1.45; 95% CI, 1.09-1.93).

“More intense cancer surveillance may be warranted in patients with HS,” the researchers concluded.

Jung JM, Lee KH, Kim Y, et al. Assessment of overall and specific cancer risks in patients with hidradenitis suppurativa. JAMA Dermatol. Published online May 27, 2020. doi:10.1001/jamadermatol.2020.1422

Satisfaction With Physician Influenced by Patients’ Mental Health
Doctor having concern with patientGreater psychological distress and depression symptoms were associated with lower satisfaction with physicians among patients with psoriasis, according to the findings of a 14-year retrospective study published in JAMA Dermatology

Associations between psoriasis and mental health comorbidities have been well documented, highlighting a need for physicians to screen, as well as refer or treat, patients with various mental conditions in addition to their skin disease.
On the flip side, how mental health is associated with patient satisfaction with physicians is rarely studied among adults with skin conditions, the researchers said.

Using data from the 2004 through 2017 Medical Expenditure Panel Survey, the researchers analyzed the association between mental health comorbidities among patients with psoriasis and their satisfaction with physicians in the United States. Mental health comorbidities were measured using the Kessler 6-Item Psychological Distress Scale and the Patient Health Questionnaire 2. They used the patient-physician communication composite score to assess patients’ satisfaction with their physician.

The researchers analyzed a total of 8,876,767 adults with psoriasis, with a mean age of 52.1 years and 54% were female (unweight total 652 patients). Of these patients, 27% had moderate to severe symptoms of psychological distress and 21% had moderate to severe symptoms of depression.

Compared with patients with no or mild symptoms of psychological distress, those with moderate to severe symptoms were less satisfied with their clinicians. Patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction compared with those with no or mild symptoms (95% CI, 1.5-4.9). Likewise, those with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction compared to patients with no or mild symptoms (95% CI, 1.1-4.7).

In addition, the researchers observed similar trends in patients with depression symptoms, where those with moderate to severe symptoms were less satisfied with their clinicians compared with those with no or mild symptoms. Compared with patients with no or mild depression symptoms, patients with moderate symptoms were 4.6 times more likely to report low patient satisfaction (95% CI 2.1-10).

“This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms,” the researchers concluded, adding, “Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.” n

Read C, Armstrong AW. Association between the mental health of patients with psoriasis and their satisfaction with physicians. JAMA Dermatol. Published online May 6, 2020. doi:10.1001/jamadermatol.2020.1054

IL-17A/IL-17F Biologic Remains Safe and Effective for Long-term Use
Bimekizumab remains safe and effective through 60 weeks of treatment, Psoriasis patientaccording to the findings of a recent study. “Dual neutralization of both IL-17A and IL-17F with the monoclonal antibody bimekizumab may have greater efficacy in psoriasis than neutralization of IL-17A alone,” the researchers said. They investigated the long-term efficacy and safety of bimekizumab for the treatment of psoriasis using data from a phase 2b extension study.

In the extension study, 217 participants with moderate to severe psoriasis who achieved a Psoriasis Area and Severity Index (PASI) 90 response after 12 weeks of treatment continued treatment with bimekizumab at a dose of 64 mg, 160 mg, or 320 mg for an additional 48 weeks. 

The researchers found that participants who achieved PASI 90 generally maintained high levels of efficacy through week 60. Overall, 80% to 100% of participants maintained their PASI 90 score, 69% to 83% of participants maintained their PASI 100 score, and 78% to 100% of participants maintained their Investigator Global Assessment score of 0/1. 

In addition, the incidence of serious treatment-emergent adverse events was 15 of 217 (6.9%). The researchers noted that no cases of inflammatory bowel disease, major adverse cardiovascular events, or suicidal ideation or behavior were reported during the study period. 

The response rates to bimekizumab were maintained through week 60, with a substantial proportion of participants achieving complete skin clearance, the researchers concluded. While the study showed bimekizumab was generally well-tolerated and effective, it was limited by the fact that most of the data reported was for week 12 PASI 90 responders only and that there was a low number of participants in the bimekizumab 64-mg group. n

Blauvelt A, Papp KA, Merola JF, et al. Bimekizumab for patients with moderate-to-severe plaque psoriasis: 60-week results from BE ABLE 2, a randomized, double-blinded, placebo-controlled phase 2b extension study. J Am Acad Dermatol. Published online May 28, 2020. doi:10.1016/j.jaad.2020.05.105

Topical Therapy Shows Promise for AD in Phase 2 Study
Findings from a recent study showed tapinarof, a topical aryl hydrocarbon receptor modulating agent, was effective for the treatment of atopic dermatitis (AD) in adolescents and adults. 

topical therapy for eczemaThe phase 2b, double-blind, vehicle-controlled study included adolescents and adults with AD. Participants were randomized to receive either tapinarof cream 0.5%, 1%, or vehicle and applied it either once or twice daily for 12 weeks, with a 4-week follow up. 

The researchers used the Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI), affected body surface area (BSA), pruritus numeric rating scale scores, subjective impression of AD and pruritus symptom severity, and Patient-Oriented Eczema Measure (POEM) scores to assess efficacy. Of the 247 participants, 191 completed the study. 

Compared with the vehicle group, IGA responses were higher in the tapinarof groups after week 12; this reached statistical significance among those treated with twice-daily tapinarof 1%. They also noted that EASI scores significantly improved in all tapinarof groups. Among participants treated with tapinarof, ≥75% and ≥90% improvements in EASI scores from baseline were significantly higher, except in the once-daily 0.5% group and twice-daily 0.5% group, respectively. In addition, tapinarof significantly reduced affected BSA in all groups, except the 0.5% twice-daily group.

Improvements in POEM scores were observed in all groups, the researchers added. They also found more participants reported AD and pruritus severity as very or moderately improved in the tapinarof groups. 

Additionally, most reported adverse events were mild or moderate.

“Tapinarof is a potential important advance in topical medicine development for AD,” the researchers concluded. n

Paller AS, Stein Gold L, Soung J, Tallman AM, Rubenstein DS, Gooderham M. Efficacy and patient-reported outcomes from a phase IIb, randomized clinical trial of tapinarof cream for the treatment of adolescents and adults with atopic dermatitis. J Am Acad Dermatol. Published online June 2, 2020. doi:10.1016/j.jaad.2020.05.135

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