Cost per responder for ixekizumab and other biologic drugs approved for the treatment of moderate-to-severe plaque psoriasis in Italy

This analysis was aimed at estimating the cost per responder as measured by number needed to treat of ixekizumab as compared with other biologic drugs approved in Italy for the treatment of moderate-to-severe plaque psoriasis. The clinical efficacy was assessed in terms of number needed to treat, based on a network meta-analysis of published efficacy data as measured by Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) for relevant biologic comparators. The cost was based on the number of administrations dispensed in the first (induction plus maintenance period) and the second (maintenance period only) year of treatment and the ex-factory price net of discounts of each biologic drug. The cost per responder was adopted as a cost-effectiveness indicator. Independent of the Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) used and the year of treatment considered, the cost per number needed to treat for ixekizumab appeared consistently to be the lowest. For example, considering first-year costs and PASI75, the cost per responder for ixekizumab was €16,388, compared to adalimumab (€22,574), etanercept (branded original: €32,420; biosimilar: €21,432), secukinumab (€17,937), and ustekinumab (€20,014). The differences in the cost per responder between ixekizumab and the comparators increased when higher Psoriasis Area and Severity Index response levels were considered. This economic assessment confirmed that ixekizumab is a cost-efficient option from the perspective of the Italian National Health Service for the treatment of moderate-to-severe plaque psoriasis

Cone-beam CT evaluation of morphology, location, and course of mandibular incisive canal: Considerations for implant treatment

Objectives: The purpose of the present study was to assess the presence and course of the incisive canal (IC) in the mental interforaminal region according to dental status, age, and sex using cone-beam computed tomography(CBCT). Methods: The right and left sides were retrospectively studied in 356 patients (n = 712). Axial, sagittal, crosssectional,and panoramic images were evaluated, and threedimensional images were reconstructed and evaluated as necessary. The morphology, course, and length of mandibular ICs and the inner and outer diameters of the canals were measured. The reliability and reproducibility of measurements were examined using the intraclass correlation coefficient and the coefficient of variation. Results: The IC was found on 91 % of images, and its mean length anterior to the mental foramen was approximately 12.4 mm. The mean distance of the IC from the lower mandibular border was 10.5 mm, and its course was closer to the buccal border at the starting point; it deviated lingually through the anterior mandible. Statistically significant differences in the course and localization of the IC were found in edentulous and older patients (p<0.05).Conclusion: A high proportion of mandibular canals can be detected by CBCT imaging. Clinicians should be careful during implant or bone surgery procedures to avoid possible complications, with special emphasis on patient age and dental status, using this imaging modality that minimizes radiation exposure. © Japanese Society for Oral and Maxillofacial Radiology and Springer Japan 2013

Bilateral nipple necrosis in a breastfeeding woman with Behcet's disease

Behcet's disease is a chronic, multisystem disorder. A 23-year-old female patient diagnosed with Behcet's disease 3 years earlier was admitted with deep ulcers on both areolas caused by detachment of the nipples following breastfeeding since spontaneous delivery of her baby. Physical examination revealed a necrotic ulcer crater 2 cm in diameter on each breast, with the lactiferous ducts draining into these. Incisional biopsy sample from the areola ulcer border on the left breast showed leukocytoclastic vasculitis. Breastfeeding was stopped, and local wound care and systemic corticosteroid therapy were started. After 4 weeks, epithelization tissue filled the ulcers, leveling the crater base with the areola. Bilateral nipple necrosis in a breastfeeding woman is a rare entity. It is thought that in the present case minor trauma caused by breastfeeding accompanied by neutrophilic infiltration resulting from amplified inflammatory response and leukocytoclastic vasculitis attributable to Behcet's disease was responsible for the necrosis. (C) 2002 Elsevier Science Ltd. All rights reserved