Resolution of the Council of Russian Experts: Apremilast, a phosphodiesterase 4 inhibitor, as a representative of a new class of small molecule compounds: Its place in the treatment of moderate or severe psoriasis and psoriatic arthritis

On November 26, 2016, Moscow hosted an Interdisciplinary Council of Russian Experts in Dermatology and Rheumatology, which discussed the unsolved problems and new possibilities of therapy for psoriasis (Ps) and psoriatic arthritis (PsA). The meeting was attended by leading experts in rheumatology and dermatology. The experts analyzed data, including the foreign guidelines relating to the new representative of a class of small molecule compounds, apremilast (registered in the Russian Federation in 2016) in order to determine the place of the drug in algorithms for treatment of moderate and severe Ps and PsA. They came to the following conclusions: the use of apremilast extends the existing possibilities for treating Ps and PsA; the drug can be administered to patients with moderate-to-severe plaque Ps or active PsA in case of the insufficiently efficiency or intolerance of previous therapy with disease-modifying antirheumatic drugs or contraindications to their use. Apremilast may be recommended in patients with concomitant diseases; it is appropriate to carry out a pharmaco-economic analysis and to get experience with apremilast in the healthcare facilities of the Russian Federation

Influence of age of onset of psoriasis on prevalence and clinical characteristics of psoriatic arthritis (according to the registry of patients with psoriasis)

Сlinical, immunological and genetic differences between patients with early and late onset psoriasis are reported. Comparative studies of clinical characteristics of psoriatic arthritis according to age of psoriasis onset (skin manifestation) are lacking.Aim – to compare the prevalence and clinical characteristics of psoriatic arthritis depending on age of psoriasis onset (skin manifestation) in patients included to the psoriasis patient registry of Russian Society of Dermatovenereologists and Cosmetologists.Materials and methods. Prevalence of psoriatic arthritis in 3,227 patients with psoriasis aged 18 years and older was calculated. Comparison of the clinical characteristics of psoriatic arthritis according to the age of onset of psoriasis was performed on 916 patients with psoriasis and psoriatic arthritis.The U-test was used to compare quantitative variables. To identify the association between qualitative variables, the χ2 test was used; odds ratio and 95% confidence interval were calculated, unadjusted and adjusted for other independent variables.Results. In the majority of patients (73%), psoriasis manifested before the age of 40. Psoriatic arthritis at the time of inclusion to the registry was diagnosed in 31.7% of patients with early onset psoriasis and in 19.5% of patients with late onset psoriasis (p=0.0005).The odds of having psoriatic arthritis were almost two times lower in patients with late onset psoriasis (p=0.0005). When adjusted for sex and age, the odds of having psoriatic arthritis among patients with late onset psoriasis became 4 times lower than in patients with early onset psoriasis (p=0.0005). However, when adjusted for sex and duration of psoriasis, the odds ratio lost its statistical significance.The axial involvement (32.1% vs 20.5%; p=0.003) and the involvement of foot joints (59.7% vs 51.5%; p=0.048) was more likely in patients with early onset psoriasis. The odds ratio for axial involvement was still statistically significant when adjusted for other independent variables.Conclusions. Age of onset of psoriasis before 40 years of age is associated with more frequent axial involvement in psoriatic arthritis

Резолюция Совета российских экспертов: «Апремиласт, ингибитор фосфодиэстеразы 4 , как представитель нового класса малых молекул : место в лечении среднетяжелого , тяжелого псориаза и псориатического артрита»

On November 26, 2016, Moscow hosted an Interdisciplinary Council of Russian Experts in Dermatology and Rheumatology, which discussed the unsolved problems and new possibilities of therapy for psoriasis (Ps) and psoriatic arthritis (PsA). The meeting was attended by leading experts in rheumatology and dermatology. The experts analyzed data, including the foreign guidelines relating to the new representative of a class of small molecule compounds, apremilast (registered in the Russian Federation in 2016) in order to determine the place of the drug in algorithms for treatment of moderate and severe Ps and PsA. They came to the following conclusions: the use of apremilast extends the existing possibilities for treating Ps and PsA; the drug can be administered to patients with moderate-to-severe plaque Ps or active PsA in case of the insufficiently efficiency or intolerance of previous therapy with disease-modifying antirheumatic drugs or contraindications to their use. Apremilast may be recommended in patients with concomitant diseases; it is appropriate to carry out a pharmaco-economic analysis and to get experience with apremilast in the healthcare facilities of the Russian Federation.26 ноября 2016 г. в Москве состоялся междисциплинарный Совет российских экспертов в области дерматологии и ревматологии, на котором обсуждались нерешенные вопросы и новые возможности терапии псориаза (Пс) и псориатического артрита (ПсА). В совещании приняли участие ведущие эксперты в области ревматологии и дерматологии. Были проанализированы данные, в том числе и зарубежные рекомендации, касающиеся нового представителя класса малых молекул – апремиласта (зарегистрирован в Российской Федерации в 2016 г.), с целью определить место препарата в алгоритмах лечения среднетяжелого и тяжелого Пс и ПсА. Эксперты пришли к следующим выводам: применение апремиласта расширяет существующие возможности лечения Пс и ПсА; препарат можно назначать пациентам с бляшечным Пс среднетяжелой и тяжелой степени, активным ПсА при недостаточной эффективности или непереносимости предшествующей терапии базисными противовоспалительными препаратами или наличии противопоказаний к ним. Апремиласт можно рекомендовать пациентам с сопутствующими заболеваниями; целесообразно проведение фармакоэкономического анализа и получение опыта использования апремиласта в медицинских учреждениях Российской Федерации

Relationship between the prevalence of cardiometabolic diseases and the presence of psoriatic arthritis in Russian patients with psoriasis

Psoriasis is associated with an increased risk of cardiometabolic pathology. Comparative studies of this pathology’s prevalence in patients with psoriasis depending on the presence of psoriatic arthritis (PsA) in a representative sample of Russian patients have not been conducted.Objective:to compare the prevalence of cardiometabolic diseases in Russian patients with psoriasis depending on the presence or absence of PsA.Material and methods. The data of the register of patients with psoriasis of the Russian Society of dermatovenerologists and Cosmetologists (RODVK) were analyzed. Inclusion criteria: age >18 years, information about the established diagnosis of PsA. A comparison was made between patients with PsA and two comparison groups: all patients without PsA and patients without PsA with a duration of psoriasis exceeding the established value.Results and discussion. The analysis included 920 patients with PsA (group 1) and 2325 patients with psoriasis without PsA (group 2). Group 3 included 655 patients from group 2.The prevalence of cardiometabolic diseases in patients with PsA was higher than in group 2. When compared to group 3, the statistically significant differences were noted only for impaired glucose tolerance. However, adjusted for gender and age, patients with PsA had statistically significant higher chances of developing arterial hypertension (AH), coronary heart disease, angina pectoris, acute cerebrovascular accident, impaired glucose tolerance and diabetes mellitus than patients in group 3. When adjusting for disease risk factors, the statistical significance of differences remained for hypertension and angina pectoris.Conclusion. The prevalence of cardiometabolic diseases in Russian patients with PsA is higher than in patients with psoriasis without PsA

Changes in the hair growth cycle in women with non-scarring alopecia

One of the key elements in the pathophysiological process of androgenetic alopecia and telogen hair loss is the change of hair cycle. Growth factors controlling the development and cycle of the hair follicle have thus far been established. However, the role of growth factors in the pathogenesis of alopecia remains to be revealed.Objective. This study was aimed at investigating the expression of the VEGF, KGF, EGF and TGF-01 growth factors in women with androgenetic alopecia and telogen hair loss, as well as their role in the development of alopecia.Materials and methods. 60 female patients diagnosed with telogen hair loss (30 women) and androgenetic alopecia (30 women) were observed. In order to investigate the expression of the VEGF, KGF, EGF and TGF-01 growth factors, we conducted an immunofluorescent analysis of skin samples obtained by punch biopsy (4 mm) from the frontoparietal scalp area of patients with androgenetic alopecia and telogen hair loss. 15 samples obtained from healthy people were used as a reference group.Results. A change in the expression of the VEGF, KGF and TGF-01 growth factors in women with androgenetic alopecia and telogen hair loss was established in comparison with healthy individuals. A correlation was found between the expression of the growth factors under study, age (p ≤ 0.05), as well as the character and duration of the disease (p ≤ 0.05) in women with non-scarring alopecia. The expression of the growth factors is found to be dependent on the clinical form of alopecia (p < 0.001).Conclusion. The VEGF growth factor is established to have the most significant effect on the development of androgenetic alopecia in women, with the KGF, TGF-01 and EGF factors being less significant as the predictors of this disorder. The VEGF growth factor is shown to affect telogen hair loss to a greater extent compared to the EGF factor. Our study confirms differences in the pathogenesis of androgenetic alopecia and telogen hair loss in women. The findings suggest that the VEGF and KGF growth factors, as well as TGF-01 inhibitors may be used as potential pharmacological agents for treating patients suffering from androgenetic alopecia and telogen hair loss

Key objectives of dermatovenerological assistance to the Russian Federation population for the period up to 2024. Results of the activities of medical organizations in providing dermatovenerological assistance to the Russian Federation population in 2017

This article analyses the epidemiological situation concerned with sexually transmitted infections and dermatoses, as well as the dynamics of syphilis incidence, incidence of syphilis among migrants, incidence of dermatoses in the Russian Federation during the 2013-2017 period

Clinical and economic analysis of biologic drugs in treatment of psoriasis

Purpose. To evaluate the cost effectiveness of use of ustekinumab (Stelara®), infliximab (Remicade®) and adalimumab (Humira®) for treatment of moderate and severe psoriasis. Methods. A cost-effectiveness analysis and budget impact analysis have been conducted. Clinical efficacy was evaluated by reduction in PASI scores by 50, 75 and 90%. The efficacy and safety of compared anti-psoriasis agents were derived from a meta-analysis of efficacy of biologic agents in treatment of moderate and severe plague psoriasis containing all compared drugs. The expenses counted includes costs of anti-psoriasis therapy, cost of drug administration and associated medical services. Results. Ustekinumab (Stelara®) was shown to be the most cost-effective biologic agent with respect to the cost per patient achieving PASI50, PASI75 and PASI90 scores. Total direct medical costs associated with use of ustekinumab for treatment of psoriasis turned to be 2 824 rub. (0.2%) per patient per year less than total cost of treatment associated with adalimumab and 444 315 rub. (27.3%) per patient per year less than total costs associated with infliximab. Thus, treatment of patient with moderate and severe psoriasis with ustekinumab results in optimal health care resource utilization. Conclusion. Prescribing of ustekinumab (Stelara®) was demonstrated to be dominating strategy of treatment of moderate and severe psoriasis being the most effective and less costly strategy among those based on other biologic agents