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

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

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

Связь распространенности кардиометаболических заболеваний с наличием псориатического артрита у российских пациентов с псориазом

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.Псориаз ассоциирован с повышенным риском кардиометаболической патологии. Сравнительных исследований ее распространенности у пациентов с псориазом в зависимости от наличия псориатического артрита (ПcА) на репрезентативной выборке российских пациентов не проводилось.Цель исследования – сравнить распространенность кардиометаболических заболеваний у российских пациентов с псориазом в зависимости от наличия или отсутствия ПсА.Материал и методы. Проанализированы данные регистра пациентов с псориазом Российского общества дерматовенерологов и косметологов (РОДВК). Критерии включения: возраст >18 лет, наличие сведений об установленном диагнозе ПcА. Сопоставление проводили между пациентами с ПcА и двумя группами сравнения: всеми пациентами без ПcА и пациентами без ПcА с продолжительностью псориаза, превышающей установленное значение.Результаты и обсуждение. В анализ включено 920 пациентов с ПcА (группа 1) и 2325 больных псориазом без ПcА (группа 2). В группу 3 вошли 655 пациентов из группы 2.Распространенность кардиометаболических заболеваний у пациентов с ПсА была выше, чем в группе 2. При сравнении с группой 3 статистическая значимость различий отмечалась только для нарушения толерантности к глюкозе. Однако с учетом поправки на пол и возраст пациенты с ПcА имели статистически значимо более высокие, чем в группе 3, шансы развития артериальной гипертензии (АГ), ишемической болезни сердца, стенокардии, острого нарушения мозгового кровообращения, нарушения толерантности к глюкозе и сахарного диабета 2-го типа. При введении поправок на факторы риска заболеваний статистическая значимость различий сохранялась для АГ и стенокардии.Заключение. Распространенность кардиометаболических заболеваний у российских пациентов с ПсА выше, чем у пациентов с псориазом без ПcА

Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial

Background: Plaque psoriasis affecting palms and soles is disabling and often resistant to treatment. Objective: Evaluate the efficacy and safety of secukinumab, an anti-interleukin 17A antibody, in subjects with palmoplantar psoriasis. Methods: In this double-blinded, randomized controlled trial, 205 subjects were randomized 1:1:1 to secukinumab 300 mg, 150 mg, or placebo. The primary endpoint was Palmoplantar Investigator's Global Assessment (ppIGA) 0 (clear) or 1 (almost clear/minimal) response at week 16. Results: At week 16, the percentage of subjects who achieved clear or almost clear palms and soles (or ppIGA 0/1) with secukinumab 300 mg (33.3%) and 150 mg (22.1%) was superior to the percentage achieved with placebo (1.5%, . P < .001). Palmoplantar Psoriasis Area and Severity Index (ppPASI) was significantly reduced with secukinumab 300 mg (-54.5%) and 150 mg (-35.3%) compared with placebo (-4.0%, . P < .001). Dermatology Life Quality Index (DLQI) 0/1 responses from subjects in the secukinumab groups were also significantly higher compared with placebo at week 16 (P < .01) and pain and function of palms and soles was markedly improved with secukinumab as measured by the palmoplantar Quality-of-Life Instrument. Secukinumab 300 mg consistently showed the best outcomes. The safety profile was favorable and similar to previous studies. Limitations: Lack of active comparator. Conclusion: In GESTURE, the largest randomized controlled trial in palmoplantar psoriasis, secukinumab demonstrated the greatest efficacy to date for treating difficult-to-treat psoriasis

Syphilis epidemiology in 1994–2013, molecular epidemiological strain typing and determination of macrolide resistance in Treponema pallidum in 2013–2014 in Tuva Republic, Russia

© 2016 APMIS. Published by John Wiley & Sons LtdThe incidence of syphilis in the Tuva Republic (geographical centre of Asia), Russia has been exceedingly high historically. No detailed examinations and no molecular investigations of Treponema pallidum strains transmitted in the Tuva Republic, or in general, in Russia, were published internationally. We examined the syphilis epidemiology in 1994–2013, and the molecular epidemiology and macrolide resistance in T. pallidum strains in 2013–2014 in the Tuva Republic. Among 95 mainly primary or secondary syphilis patients, the arp, tpr, tp0548 and 23S rRNA genes in 85 polA gene-positive genital ulcer specimens were characterized. The syphilis incidence in Tuva Republic peaked in 1998 (1562), however declined to 177 in 2013. Among the 70 (82%) completely genotyped specimens, six molecular strain types were found. Strain type 14d/f accounted for 91%, but also 14c/f, 14d/g, 14b/f, 14i/f, 9d/f, and 4d/f were identified. Two (2.4%) specimens contained the 23S rRNA A2058G macrolide resistance mutation. This is the first internationally published typing study regarding T. pallidum in Russia, performed in the Tuva Republic with the highest syphilis incidence in Russia. The two molecular strain types 4d/f and 9d/f have previously been described only in Eastern and Northern China and for the first time, macrolide-resistant syphilis was described in Russia

Pathogenetic substantiation of combination therapy for rosacea

Rosacea is a chronic inflammatory dermatosis predominantly damage to the skin of the face, which has a significant negative impact on the quality patients’ lives. The main goal of treatment is to achieve the most complete remission. However, due to the fact that the pathogenesis of the disease is not fully understood, the search for new methods of treatment is especially relevant. Combined use pulsed dye laser and ivermectin drug is presented as alternative pathogenetically substantiated method of therapy. The purpose of the study is to characterize immune disorders and the role of cytokines in the pathogenesis of rosacea, as well as the possibilities of combination therapy based on literature data. An analysis of literature sources from the MedLine, Pubmed, eLibrary databases for the period from 2002 to 2022 was carried out, using the keywords “ivermectin”, “pulsed dye laser”, “rosacea”, “cytokines”, “ivermectin” , “Pulsed Dye Laser”, “rosacea”, “cytokines”

Search for predictors of psoriatic arthritis in patients with psoriasis

Background. Psoriatic arthritis is a chronic inflammatory disease of the joints, spine and entheses that can occur in patients with psoriasis. The prevalence of psoriatic arthritis is 19.7%. In 70% of cases, psoriasis precedes the development of arthritis. It has been proven that a delay in the diagnosis of psoriatic arthritis even by 6 months is associated with a deterioration in long-term radiological and functional results, leading to disability. The problem of early diagnosis of joint damage can be solved by identifying predictors of the risk of developing psoriatic arthritis in patients with psoriasis. Aims. To determine possible predictors for the development of psoriatic arthritis in patients with psoriasis. Methods. The open, uncontrolled, prospective study enrolled 250 patients. The main group consisted of 190 patients diagnosed with plaque psoriasis. The control group consisted of 60 patients with psoriatic arthritis. In order to identify associations of clinical and genetic (HLA-B27 carriage) parameters with the development of psoriatic arthritis, we compared the frequency of occurrence of these parameters in patients with psoriatic arthritis and without. Results. Among 190 patients with plaque psoriasis 128 (67.4%) men, 62 (32.6%) women, aged 18 to 84 years (40.30 ± 15.56), the average duration of psoriasis was 10.09 ± 11.08 years (0–57). Among 60 patients with psoriatic arthritis 39 (65%) men, 21 (35%) women aged 18 to 86 years (44.43 ± 14.15), the average duration of psoriasis was 20.47 ± 13.22 years (2–57), the average duration of psoriatic arthritis was 7.97 ± 9.95 years (0–47). Сlinical predictors for the development of psoriatic arthritis in patients with psoriasis: nail psoriasis (OR = 2.244 [95% CI: 1.245–4.045]); severe psoriasis (PASI ≥ 20) (OR = 2.148 [95% CI: 1.161–3.975]); arterial hypertension (OR = 1.982 [95% CI: 1.031–3.812]); duration of psoriasis over 25 years (OR = 3.365 [95% CI: 1.676–6.756]), р 0,05. Conclusions. The joint consideration of informative predictors will allow us to develop an original multi-parameter mathematical model for calculating the risk of developing psoriatic arthritis in patients with psoriasis