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Book Details
Abstract
A brand-new title in the field of dermatology, Therapy for Severe Psoriasis provides the ultimate coverage of the treatment options available for today's most serious cases, including biologics and oral therapies. It features discussions of the newest drug therapies, recent FDA-approved biosimilars, and combination approaches to care, while an overview chapter was designed to aid those new to the field in understanding the nuances of difficult-to-treat subtypes of psoriasis. Comprehensive and focused, Therapy for Severe Psoriasis will be a welcome addition to the library of any dermatologist seeking in-depth information on the challenges of this condition.
- Each of the 16 chapters includes either an in-depth focus on a single therapy or an overview of a unique aspect of psoriasis, including: UVB therapy, methotrexate, acitretin, cyclosporine, apremilast, etanercept, infliximab, adalimumab, ustekinumab, secukinumab, and ixekizumab.
- Takes an evidence-based approach to hard-to-treat severe psoriasis.
- Discusses the newest drug therapies (such as ixekizumab), plus recent FDA-approved biosimilars, a topic unique to this particular psoriasis text.
- Presents combination approaches for instances when standard treatments are not successful.
- Includes an overview chapter to help beginners understand the nuances of the disorder.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Therapy for Severe Psoriasis | i | ||
| Therapy for Severe Psoriasis | iii | ||
| Copyright\r | iv | ||
| Contributors | vii | ||
| EDITORS | vii | ||
| AUTHORS | vii | ||
| Foreword | ix | ||
| Preface | xi | ||
| ACKNOWLEDGMENTS | xi | ||
| Contents | xiii | ||
| Therapy for Severe Psoriasis | xv | ||
| 1. Chapter 1 - Overview of Psoriasis | 1 | ||
| KEY POINTS | 1 | ||
| EPIDEMIOLOGY | 1 | ||
| AGE OF ONSET | 1 | ||
| Cause and Pathogenesis | 2 | ||
| DEVELOPMENT OF A LESION | 2 | ||
| T CELLS | 2 | ||
| MACROPHAGES AND DENDRITIC CELLS | 3 | ||
| NEUTROPHILS | 3 | ||
| UNINVOLVED PSORIATIC SKIN | 3 | ||
| CLINICAL FINDINGS | 3 | ||
| History | 3 | ||
| CUTANEOUS LESIONS | 4 | ||
| Psoriasis Vulgaris | 4 | ||
| Guttate Psoriasis | 5 | ||
| Inverse Psoriasis (Flexural Psoriasis) | 5 | ||
| Erythrodermic Psoriasis | 5 | ||
| Pustular Psoriasis | 6 | ||
| Generalized Pustular Psoriasis (von Zumbusch) | 6 | ||
| Annular Pustular Psoriasis and Impetigo Herpetiformis | 7 | ||
| Localized Pustular Psoriasis Variants | 7 | ||
| Napkin Psoriasis | 8 | ||
| Linear Psoriasis | 8 | ||
| RELATED PHYSICAL FINDINGS | 8 | ||
| Nail Findings | 8 | ||
| PSORIATIC ARTHRITIS | 8 | ||
| LABORATORY TESTS | 9 | ||
| COMPLICATIONS | 9 | ||
| MODIFYING FACTORS | 10 | ||
| TREATMENT | 10 | ||
| TOPICAL THERAPIES | 11 | ||
| CORTICOSTEROIDS | 11 | ||
| VITAMIN D3 AND ANALOGUES | 11 | ||
| TAZAROTENE | 12 | ||
| TOPICAL CALCINEURIN INHIBITORS | 12 | ||
| SALICYLIC ACID | 12 | ||
| BLAND EMOLLIENTS | 12 | ||
| PHOTOTHERAPY | 12 | ||
| ORAL AGENTS | 13 | ||
| BIOLOGIC THERAPY | 13 | ||
| REFERENCES | 13 | ||
| 2. Chapter 2 - Ultraviolet B Phototherapy | 17 | ||
| KEY POINTS | 17 | ||
| INTRODUCTION | 17 | ||
| Definition | 17 | ||
| History | 17 | ||
| Types | 17 | ||
| Broadband ultraviolet B (290–320 nm) | 17 | ||
| Narrowband ultraviolet B (311–313 nm) | 18 | ||
| TARGETED PHOTOTHERAPY | 18 | ||
| TANNING BEDS | 18 | ||
| INDICATIONS | 18 | ||
| MECHANISM OF ACTION | 18 | ||
| EFFICACY | 19 | ||
| Broadband Ultraviolet B | 19 | ||
| Narrowband Ultraviolet B | 19 | ||
| TARGETED PHOTOTHERAPY | 19 | ||
| 3. Chapter 3 - Psoralen-Ultraviolet Light A Therapy | 27 | ||
| KEY POINTS | 27 | ||
| INTRODUCTION | 27 | ||
| MECHANISM OF ACTION | 27 | ||
| EFFICACY | 29 | ||
| Combination Therapy | 29 | ||
| DOSING | 30 | ||
| SAFETY | 31 | ||
| Nonmelanoma Skin Cancer | 31 | ||
| Malignant Melanoma | 32 | ||
| PRECAUTIONS | 32 | ||
| Contraindications | 32 | ||
| Special Populations | 32 | ||
| Pregnancy and lactation | 32 | ||
| Children | 33 | ||
| MONITORING | 33 | ||
| VACCINATION | 33 | ||
| SUMMARY | 33 | ||
| REFERENCES | 33 | ||
| 4. Chapter 4 - Methotrexate | 37 | ||
| KEY POINTS | 37 | ||
| INTRODUCTION | 37 | ||
| MECHANISM OF ACTION | 38 | ||
| EFFICACY | 38 | ||
| CHAMPION | 38 | ||
| RESTORE1 | 39 | ||
| M10-255 | 39 | ||
| SMALLER STUDIES | 39 | ||
| EFFICACY IN REDUCTION OF IMMUNOGENICITY | 41 | ||
| EFFICACY IN PSORIATIC ARTHRITIS | 42 | ||
| SAFETY | 42 | ||
| CHAMPION | 42 | ||
| RESTORE1 | 43 | ||
| Toxicity | 43 | ||
| Drug and Food Interactions | 43 | ||
| PRECAUTIONS | 43 | ||
| Myelosuppression | 44 | ||
| Hepatotoxicity | 44 | ||
| Pulmonary Fibrosis | 44 | ||
| Patients with Excessive Third Space Fluids | 44 | ||
| Teratogenicity | 44 | ||
| Pediatric Use | 45 | ||
| Geriatric Use | 45 | ||
| MONITORING | 45 | ||
| Baseline Monitoring | 45 | ||
| Ongoing Monitoring | 45 | ||
| Hematologic | 45 | ||
| Renal | 45 | ||
| Liver | 46 | ||
| VACCINATIONS | 46 | ||
| SUMMARY AND RECOMMENDATIONS | 46 | ||
| REFERENCES | 46 | ||
| 5. Chapter 5 - Acitretin | 49 | ||
| KEY POINTS | 49 | ||
| INTRODUCTION | 49 | ||
| MECHANISM OF ACTION | 49 | ||
| EFFICACY | 50 | ||
| Monotherapy | 50 | ||
| Plaque psoriasis | 50 | ||
| Pustular psoriasis | 51 | ||
| Erythrodermic psoriasis | 51 | ||
| Combination Therapy | 51 | ||
| Acitretin and psoralen plus ultraviolet A | 51 | ||
| Acitretin and broadband ultraviolet B phototherapy | 54 | ||
| Acitretin and narrowband ultraviolet B phototherapy | 54 | ||
| Chemoprevention | 55 | ||
| SAFETY | 55 | ||
| Teratogenicity | 55 | ||
| Mucocutaneous | 56 | ||
| Musculoskeletal | 56 | ||
| Neurologic | 57 | ||
| Metabolic and Hepatic | 57 | ||
| Immunosuppression | 58 | ||
| Ophthalmologic | 58 | ||
| Psychiatric | 58 | ||
| PRECAUTIONS | 58 | ||
| Pregnancy Category X | 58 | ||
| Metabolic and Hepatic | 58 | ||
| Drug Interactions | 58 | ||
| MONITORING | 59 | ||
| VACCINATIONS | 59 | ||
| SUMMARY | 59 | ||
| REFERENCES | 60 | ||
| 6. Chapter 6 - Cyclosporine | 63 | ||
| KEY POINTS | 63 | ||
| INTRODUCTION | 63 | ||
| MECHANISM OF ACTION | 64 | ||
| EFFICACY | 64 | ||
| Monotherapy | 64 | ||
| Short-term therapy: for induction of remission | 64 | ||
| Intermittent short-term therapy: for maintenance and prevention of relapse | 65 | ||
| Continuous long-term therapy | 66 | ||
| Combination Therapy | 66 | ||
| Topical therapy | 66 | ||
| Systemic therapy | 67 | ||
| EFFICACY IN PSORIATIC ARTHRITIS | 67 | ||
| SAFETY | 67 | ||
| Nephrotoxicity | 67 | ||
| Hypertension | 68 | ||
| Malignancies | 68 | ||
| Additional Side Effects | 68 | ||
| PRECAUTIONS | 68 | ||
| Pregnancy Category C and Lactation | 68 | ||
| Pediatrics | 69 | ||
| Geriatrics | 69 | ||
| Drug and Food Interactions | 69 | ||
| MONITORING | 69 | ||
| Baseline Monitoring | 69 | ||
| Ongoing Monitoring | 70 | ||
| VACCINATIONS | 71 | ||
| SUMMARY AND RECOMMENDATIONS | 71 | ||
| REFERENCES | 71 | ||
| 7. Chapter 7 - Apremilast | 75 | ||
| KEY POINTS | 75 | ||
| INTRODUCTION | 75 | ||
| MECHANISM OF ACTION | 75 | ||
| EFFICACY | 76 | ||
| EFFICACY IN PSORIATIC ARTHRITIS | 78 | ||
| SAFETY | 79 | ||
| PRECAUTIONS | 79 | ||
| MONITORING | 80 | ||
| VACCINATIONS | 80 | ||
| SUMMARY AND RECOMMENDATIONS | 80 | ||
| REFERENCES | 81 | ||
| 8. Chapter 8 - Etanercept | 83 | ||
| KEY POINTS | 83 | ||
| INTRODUCTION | 83 | ||
| Mechanism of Action | 83 | ||
| EFFICACY | 84 | ||
| Pivotal Trials | 84 | ||
| US psoriasis pivotal trial | 84 | ||
| Global psoriasis pivotal trial | 85 | ||
| Efficacy in Pediatric and Geriatric Populations | 87 | ||
| Efficacy with Combination Therapy | 88 | ||
| SAFETY | 88 | ||
| Clinical Trial Safety Data | 88 | ||
| OBSERVE-5 Observational Registry Data | 89 | ||
| PRECAUTIONS | 90 | ||
| Serious Infections | 90 | ||
| Tuberculosis | 90 | ||
| Opportunistic infections | 90 | ||
| Malignancies | 91 | ||
| Lymphoproliferative malignancy | 91 | ||
| Nonmelanoma skin cancer | 91 | ||
| Heart Failure | 91 | ||
| Hepatitis B Virus Reactivation | 91 | ||
| Neurologic Events | 91 | ||
| Hematologic Events | 91 | ||
| Allergic Reactions | 91 | ||
| Autoimmunity | 91 | ||
| Granulomatosis with Polyangiitis | 92 | ||
| Severe Alcoholic Hepatitis | 92 | ||
| MONITORING | 92 | ||
| VACCINATIONS | 92 | ||
| TUMOR NECROSIS FACTOR INHIBITOR THERAPY AND CARDIOVASCULAR RISK REDUCTION | 93 | ||
| SUMMARY | 94 | ||
| REFERENCES | 94 | ||
| 9. Chapter 9 - Infliximab | 97 | ||
| KEY POINTS | 97 | ||
| INTRODUCTION | 97 | ||
| MECHANISM OF ACTION | 97 | ||
| EFFICACY | 98 | ||
| Study of Psoriasis with Infliximab Induction Therapy | 99 | ||
| European Infliximab for Psoriasis Efficacy and Safety Study I | 99 | ||
| European Infliximab for Psoriasis Efficacy and Safety Study II | 100 | ||
| EFFICACY IN PSORIATIC ARTHRITIS | 101 | ||
| SAFETY | 102 | ||
| Study of Psoriasis with Infliximab Induction Therapy | 102 | ||
| European Infliximab for Psoriasis Efficacy and Safety Study I | 102 | ||
| European Infliximab for Psoriasis Efficacy and Safety Study II | 103 | ||
| Psoriasis Longitudinal Assessment and Registry | 103 | ||
| PRECAUTIONS | 103 | ||
| Infection | 104 | ||
| Tuberculosis | 104 | ||
| Opportunistic Infections | 104 | ||
| Malignancy | 104 | ||
| Hepatitis B | 104 | ||
| Multiple Sclerosis and Demyelinating Disorders | 104 | ||
| Congestive Heart Failure | 104 | ||
| Drug-induced Lupus | 105 | ||
| Blood Dyscrasias | 105 | ||
| Hypersensitivity Reactions | 105 | ||
| MONITORING | 105 | ||
| VACCINATIONS | 106 | ||
| SUMMARY AND RECOMMENDATIONS | 107 | ||
| REFERENCES | 107 | ||
| 10. Chapter 10 - Adalimumab | 111 | ||
| KEY POINTS | 111 | ||
| INTRODUCTION | 111 | ||
| MECHANISM OF ACTION | 111 | ||
| EFFICACY | 111 | ||
| REVEAL | 112 | ||
| Open-Label Extension Study from REVEAL | 112 | ||
| Comparative Study of Adalimumab Versus Methotrexate Versus Placebo in Patients with Psoriasis | 113 | ||
| Efficacy in Psoriatic Arthritis | 115 | ||
| Expert Recommendations on Adalimumab Efficacy | 116 | ||
| SAFETY | 116 | ||
| Risk of Infection and Malignancy | 116 | ||
| ESPRIT 5-year Analysis | 117 | ||
| REVEAL | 117 | ||
| Open-Label Extension Trial | 117 | ||
| Comparative Study of Adalimumab Versus Methotrexate Versus Placebo in Patients with Psoriasis | 117 | ||
| Summary on Adalimumab Safety Concerns | 120 | ||
| PRECAUTIONS | 120 | ||
| Infection | 120 | ||
| Tuberculosis | 121 | ||
| Opportunistic infections | 121 | ||
| Malignancy | 121 | ||
| Hepatitis B | 121 | ||
| Multiple Sclerosis and Demyelinating Disorders | 121 | ||
| Congestive Heart Failure | 121 | ||
| Drug-induced Lupus | 121 | ||
| Blood Dyscrasias | 122 | ||
| Hypersensitivity Reactions | 122 | ||
| MONITORING | 122 | ||
| VACCINATIONS | 122 | ||
| TUMOR NECROSIS FACTOR INHIBITOR THERAPY AND CARDIOVASCULAR RISK REDUCTION | 123 | ||
| SUMMARY | 124 | ||
| REFERENCES | 124 | ||
| 11. Chapter 11 - Ustekinumab | 127 | ||
| KEY POINTS | 127 | ||
| INTRODUCTION | 127 | ||
| MECHANISM OF ACTION | 127 | ||
| PHARMACOKINETICS | 128 | ||
| EFFICACY | 128 | ||
| FACTORS EFFECTING DECREASED EFFICACY | 130 | ||
| EFFICACY IN PALMOPLANTAR PSORIASIS | 131 | ||
| EFFICACY IN PEDIATRIC PSORIASIS | 131 | ||
| EFFICACY IN PSORIATIC ARTHRITIS | 131 | ||
| SAFETY | 131 | ||
| MONITORING | 132 | ||
| VACCINATIONS | 134 | ||
| SUMMARY AND RECOMMENDATIONS | 134 | ||
| REFERENCES | 134 | ||
| 12. Chapter 12 - Secukinumab | 139 | ||
| KEY POINTS | 139 | ||
| INTRODUCTION | 139 | ||
| MECHANISM OF ACTION | 139 | ||
| EFFICACY | 140 | ||
| ERASURE AND FIXTURE | 140 | ||
| FEATURE AND JUNCTURE | 142 | ||
| SAFETY | 145 | ||
| PRECAUTIONS | 147 | ||
| Infections | 147 | ||
| Tuberculosis | 147 | ||
| Crohn Disease | 148 | ||
| Hypersensitivity Reactions | 148 | ||
| Pregnancy | 148 | ||
| MONITORING | 148 | ||
| VACCINATIONS | 149 | ||
| SUMMARY AND RECOMMENDATIONS | 150 | ||
| REFERENCES | 150 | ||
| 13. Chapter 13 - Ixekizumab | 153 | ||
| KEY POINTS | 153 | ||
| INTRODUCTION | 153 | ||
| MECHANISM OF ACTION | 153 | ||
| EFFICACY | 154 | ||
| Phase 2 Trial and Open-Label Extension Study | 154 | ||
| UNCOVER-2 and UNCOVER-3 Phase 3 Trials | 154 | ||
| Efficacy in Other Forms of Psoriasis | 155 | ||
| SAFETY | 157 | ||
| Phase 2 Trial and OLE Study | 157 | ||
| UNCOVER-2 and UNCOVER 3 | 158 | ||
| Summary and Additional Safety Concerns | 158 | ||
| Mucosal inflammation and inflammatory bowel disease | 158 | ||
| Neutropenia | 158 | ||
| Suicide | 159 | ||
| PRECAUTIONS | 159 | ||
| Infections | 159 | ||
| Tuberculosis | 159 | ||
| Inflammatory Bowel Disease | 159 | ||
| Hypersensitivity Reactions | 159 | ||
| Pregnancy | 159 | ||
| MONITORING | 159 | ||
| VACCINATIONS | 161 | ||
| SUMMARY | 161 | ||
| REFERENCES | 161 | ||
| 14. Chapter 14 - Biosimilars | 163 | ||
| KEY POINTS | 163 | ||
| INTRODUCTION | 163 | ||
| SMALL MOLECULE GENERIC DRUGS | 164 | ||
| CREATION OF THE BIOSIMILAR AND ANALYTICAL ASSESSMENTS | 164 | ||
| REGULATION | 165 | ||
| EXTRAPOLATION | 165 | ||
| INFLECTRA | 166 | ||
| CLINICAL TRIALS | 166 | ||
| ADDITIONAL CONSIDERATIONS AND SUMMARY | 167 | ||
| REFERENCES | 169 | ||
| 15. Chapter 15 - Combination Therapies for Psoriasis | 171 | ||
| KEY POINTS | 171 | ||
| INTRODUCTION | 171 | ||
| Methotrexate | 171 | ||
| Methotrexate and Ustekinumab | 173 | ||
| Methotrexate and Adalimumab | 173 | ||
| Methotrexate and Infliximab | 173 | ||
| Methotrexate and Etanercept | 174 | ||
| Cyclosporine | 175 | ||
| Cyclosporine and Etanercept | 175 | ||
| Cyclosporine and Adalimumab | 175 | ||
| Cyclosporine and Apremilast | 175 | ||
| Acitretin | 175 | ||
| Acitretin and Etanercept | 176 | ||
| Acitretin and Apremilast | 176 | ||
| Biologics and Phototherapy | 176 | ||
| REFERENCES | 177 | ||
| 16. Chapter 16 - Investigational Therapies for Psoriasis | 181 | ||
| KEY POINTS | 181 | ||
| INTRODUCTION | 181 | ||
| Tofacitinib | 181 | ||
| Certolizumab Pegol | 184 | ||
| ANTI-IL-17 AGENTS | 184 | ||
| Brodalumab | 184 | ||
| ANTI-IL-23 AGENTS | 185 | ||
| Guselkumab | 185 | ||
| Tildrakizumab | 185 | ||
| Risankizumab | 185 | ||
| SUMMARY | 185 | ||
| REFERENCES | 185 | ||
| Index | 187 |