Fertility Counseling Pattern over Time in Young Patients with Breast Cancer: A Retrospective Analysis at a Large Comprehensive Cancer Center

Background: One main issue to be considered in young patients diagnosed with early breast cancer (BC) is the impact of oncological treatments on fertility and future chances of conception. Current guidelines recommend a comprehensive addressing of oncofertility as part of the management of premenopausal BC patients, including counselling on available assisted reproduction technologies and fertility preservation (FP) strategies. The COVID-19 pandemic represented a potential hurdle to the integration of these procedures into clinical practice. This study aims to describe the time-related evolution in addressing oncofertility issues. Methods: This retrospective mono-institutional observational study considered 206 patients who received neoadjuvant chemotherapy, adjuvant chemotherapy (CT) or adjuvant endocrine therapy (ET), diagnosed with breast cancer at the age of 40 or younger in the years 2014-2015 and 2020-2021. Timerelated evolution in addressing oncofertility during oncological consultations and adoption of a fertility or ovarian function preservation (OFP) method were analyzed comparing the two different timeframes. Results: Comparing the two cohorts 2014-2015 and 2020-2021, we found a significant difference in the presence of fertility discussion records (37.4% vs 57.9%, p < 0.01), and in the application of OFP/FP techniques (54.5 vs 78.5%, p < 0.01). In the two cohorts there was a significant difference in OFP (57.6% vs 70%, p = 0.03) and FP techniques application rates (5.1% vs 19.6%, p < 0.01). In the study population, age at diagnosis resulted to influence clinicians' approach towards counseling and/or OFP/FP strategies (87.3% in patients <35 years old (yo) vs 56.7% in older patients, p < 0.01). In the 2020-2021 cohort, age resulted less influential in the choice of using an OFP/FP strategy (87% vs 72.1%, p = 0.18). A higher rate of documented fertility discussion and/or OFP/FP techniques application was recorder in patients who had not had children before BC diagnosis (80.6% vs 64.5%, p = 0.02). When considering only the 2020-2021 timeframe, parity no longer significantly affected the prescription of an OFP/FP strategy (80.4% vs 78.3%, p = 0.93). Conclusions: This study on real world data demonstrates the progressive evolution in the way clinicians approach oncofertility issues, showing a greater attention across years, with more BC patients receiving a dedicated counseling, despite the COVID-19 pandemic

Immune characterization of breast cancer metastases: prognostic implications.

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) evaluated in primary breast cancer (BC) convey prognostic information. Limited data in the metastatic setting are available. METHODS: Secondary lesions from 94 BC patients, 43 triple-negative (TN) and 51 HER2-positive, were evaluated for TILs and expression of CD8, FOXP3, and PD-L1 by immunohistochemistry. RESULTS: TILs levels on metastasis were generally low (median 5%) and did not differ between TN and HER2+ tumors. Younger patients showed significantly lower TILs (p\u2009=\u20090.002). In HER2+ patients, TILs were higher in lung metastases as compared to other sites (p\u2009=\u20090.038). TILs composition was different across metastatic sites: skin metastases presented higher FOXP3 (p =\u20090.002) and lower CD8/FOXP3 ratio (p\u2009=\u20090.032). Patients treated for metastatic BC prior to biopsy had lower CD8 (overall: p\u2009=\u20090.005, HER2+: p\u2009=\u20090.011, TN: p\u2009=\u20090.075). In TN patients, median overall survival (OS) was 11.8 and 62.9 months for patients with low and high TILs, respectively (HR 0.29, 95%CI 0.11-0.76, log-rank p\u2009=\u20090.008). CD8/FOXP3 ratio was also prognostic in TN patients (median OS 8.0, 13.2, and 54.0 months in 1st, 2nd and 3th tertile, log-rank p\u2009=\u20090.019). Both TILs and CD8/FOXP3 ratio were independent factors at multivariate analysis. Counterintuitively, in HER2+ BC, low TILs tumors showed better prognosis (median OS 53.7 vs 39.9 months in TILs low and TILs high, not statistically significant). CONCLUSIONS: Our findings indicate the relevance of TILs as prognostic biomarker for TNBC even in the advanced setting and provide novel hypothesis-generating data on potential sources of immune heterogeneity of metastatic BC

A MULTICENTER OPEN-LABEL EXPERIENCE ON THE RESPONSE OF PSORIASIS TO ADALIMUMAB AND EFFECT OF DOSE ESCALATION IN NON-RESPONDERS: THE APHRODITE PROJECT

There is much evidence to show the efficacy of adalimumab, a human monoclonal antibody targeting tumour necrosis factor-alpha, in the treatment of plaque psoriasis. In this open-label experience, 147 high-need patients suffering from plaque psoriasis, with a mean Psoriasis Area and Severity Index (PASI) of 18.8, and concomitant psoriatic arthritis (PsA) received subcutaneous injections of 40 mg of adalimumab every other week (EOW). This was actually the dosage regimen recommended for PsA, as the drug had not then been approved for psoriasis at the time of the patients' enrolment. At week 12, an improvement of at least 50% of the PASI (PASI-50) was observed in 111 (77%) patients. Continuation of treatment in responders with adalimumab 40 mg EOW led to a sustained response, with the PASI-50 achieved by 97% of patients in the as-treated analysis at week 24 (PASI-75 in 82% and PASI-90 in 45% out of 109 patients who received EOW injections up to week 24). Thirty subjects who failed to attain the PASI-50 response at week 12 were treated with adalimumab 40 mg every week for a further 12 weeks. At week 24, 80% of these patients obtained a PASI-50 response after dose escalation. Tolerability was good in the majority of patients. Only two patients discontinued treatment because of an adverse event (repeated flu-like episodes and a pleuropericarditis of unknown origin, respectively)

A Multicenter Open Study on the Tolerability and Efficacy of a Cosmetic Treatment in Mild Acne Vulgaris during the Summer Months

The improvement of acne vulgaris (AV) during summer months is a general opinion which is not universally accepted as some patients experience no change or even an aggravation of their AV during hot months. Therapeutic management of AV in summer is often difficult; in fact, most traditional anti-acne treatments are contraindicated or poorly tolerated during summer months. In this study we evaluated the tolerability and effectiveness of a cosmetic anti-acne treatment performed for 12 summer weeks in 347 patients (mean age, 19.4 yrs) with mild AV of the face. The study product (Exfoliac®) contained a mixture of alpha hydroxy acids and substances with moisturizing and/or lenitive effects. In the first 4 weeks, Exfoliac® 10 cream was applied twice a day (b.i.d.). The treatment in the following 8 weeks was decided on the basis of dermatologist's assessment of the clinical response and could consist in Exfoliac® 10 cream or Exfoliac® 15 cream, once daily (o.d.) or b.i.d. During the study period, patients used Exfoliac® cleansing gel. The cumulative results indicate a significant improvement of AV lesions and seborrhoea, irrespectively of sun exposure, and a good tolerability, even in sunbathed patients. Adverse reactions, mostly of mild severity, appeared to be independent of sunbathing or use of sunscreens and were observed in a small proportion of cases (6.8% in the first 4 weeks and 5.6% in the last 8 weeks). Our results suggest that this type of treatment is an effective and safe approach to patients with mild AV who require treatment in the summertime

Evaluation of “Steroid-Sparing” Effects of Xanthena® Cream in Patients with Mild to Moderate Atopic Dermatitis

Emollients play an important role in the management of atopic dermatitis (AD). The aim of this study was to evaluate the efficacy and the “steroid-sparing” activity of an emollient cream (Xanthena® cream) in patients with mild to moderate AD. Patients were asked to apply twice a day for 7 days a cream containing hydrocortisone butyrate on the lesionai skin and then to apply Xanthena® cream only on the left side of affected areas. During the 2-month study period, the use of the corticosteroid cream was resumed in case of flare-up in any side. The results obtained show significant differences of both the total severity score and the intensity of each symptom and sign of AD between the skin areas treated with Xanthena® cream and the control areas (P<0.05); a relevant reduction of steroid requirement was also noted in correlation with the use of this emollient cream (P<0.05). A significant improvement was observed even after the first month of therapy for most symptoms, except for excoriations/fissuring, oozing/crusting and burning which improved only at 2 months. Treatment was well-tolerated by the majority of patients; adverse local reactions, mostly transient and of mild intensity, were observed in 7% of cases

Treatment of Psoriasis Vulgaris with Calcipotriol Betamethasone Dipropionate Combination Followed by Calcipotriol and Assessment of the Adjuvant Basic Use of Urea-Based Emollients

A new combination product containing betamethasone dipropionate and calcipotriol (Dovobet® ointment) has been proven very effective and well tolerated in patients with psoriasis vulgaris. Emollients are adjunctive modalities commonly used in psoriasis; however, their actual role in combination with topical drugs as well as well as their compatibility with these drugs have not been well elucidated. In 313 adult patients with psoriasis vulgaris, we studied the efficacy and tolerability of treatment with Dovobet® ointment combined with urea-based emollients (Excipial U®) for 4 weeks, followed by treatment with calcipotriol (Daivonex®) either alone (group A) or combined with urea-containing emollients (Excipial U®, group B) for 8 weeks. Clinical evaluations were performed at baseline, at 4 and 12 weeks, assessing the clinical score for erythema, scaling, infiltration and pruritus, graded on the basis of a 5-point scale. After the initial 4-week treatment, a significant improvement of all clinical parameters was observed (p<0.05). Overall, clinical results improved further during the maintenance treatment phase; significant changes (p<0.05) were observed in each group. Most patients considered treatment efficacy positively at both 4 weeks and 12 weeks. Interestingly, at the end of the study, a greater percentage of patients in group B than in group A judged the efficacy as excellent. Treatment was very well tolerated. Only two patients complained of mild and transient burning sensation during the first days of treatment. The results of this study confirm the great efficacy and tolerability of sequential treatment with Dovobet®, and Daivonex® in psoriasis vulgaris and show the enhanced acceptability of this treatment associated with urea-based emollients

Pruritus characteristics in a large Italian cohort of psoriatic patients

none368nononeDamiani, G.; Cazzaniga, S.; Conic, R.R.Z.; Naldi, L.; Griseta, V.; Miracapillo, A.; Azzini, M.; Mocci, L.; Michelini, M.; Offidani, A.; Bernardini, L.; Campanati, A.; Ricotti, G.; Giacchetti, A.; Norat, M.; Gualco, F.; Castelli, A.; Cuccia, A.; Diana, A.; Roncarolo, G.; Belli, M.A.; Baldassarre, M.A.; Santoro, G.; Vena, G.A.; Lo Console, F.; Filotico, R.; Mastrandrea, V.; Brunetti, B.; Musumeci, F.; Carrabba, E.; Dal Mas, P.; Annicchiarico, F.; Benvegn_u, B.; Spaziani, G.; Cusano, F.; Saletta Iannazzone, S.; Galluccio, A.; Pezza, M.; Marchesi, L.; Imberti, G.; Reseghetti, A.; Barbera, C.; Reggiani, M.; Lanzoni, A.; Patrizi, A.; Bardazzi, F.; Antonucci, A.; De Tommaso, S.; Wallnofer, W.; Ingannamorte, F.; Calzavara-Pinton, P.; Iannazzi, S.; Zane, C.; Capezzera, R.; Bassisi, S.; Rossi, M.T.; Altamura, V.; Vigl, W.; Nobile, C.; Aste, N.; Murgia, S.; Mugheddu, C.; Scuderi, G.; Baglieri, F.; Di Dio, C.; Cilioni Grilli, E.; Mastronardi, C.; Agnusdei, C.P.; Antrilli, A.; Aulisa, L.; Raimondo, U.; Scotto di Luzio, G.; Battarra, V.C.; Farro, P.; Plaitano, R.; Micali, G.; Musumeci, M.L.; Massimino, D.; Li Calzi, M.; La Greca, S.; Pettinato, M.; Sapienza, G.; Valenti, G.; De Giacomo, P.F.; Amico, .; Arcangeli, F.; Brunelli, D.; Ghetti, E.; Tulli, A.; Assi, G.; Amerio, P.; Laria, G.; Prestinari, F.; Spadafora, S.; Coppola, M.; Caresana, G.; Pezzarossa, E.; Felisi, C.; Donato, L.; Bertero, M.; Musso, L.; Pa lazzini, S.; Bruscino, P.; Agozzino, U.C.; Ottaviani, M.; Simoncini, C.; Virgili, A.; Osti, F.; Fabbri, P.; Volpi, W.; Caproni, M.; Lotti, T.; Prignano, F.; Buggiani, G.; Troiano, M.; Fenizi, G.; Altobella, A.; Amoruso, A.; Condello, M.; Goffredo, A.; Righini, M.G.; Alessandrini, F.; Satolli, F.; Zampetti, M.; Bertani, E.; Fossati, S.; Parodi, A.; Burlando, M.; Fiorucci, C.; Nigro, A.; Ghigliotti, G.; Massone, L.; Moise, G.M.; Serrai, M.; Cannata, G.; Campagnoli, A.M.; Daly, M.; Leporati, C.; Peila, R.; Filosa, G.; Bugatti, L.; Nicolini, M.; Nazzari, G.; Cestari, R.; Anastasio, F.; Larussa, F.M.; Pollice, N.; De Francesco, F.; Mazzocchetti, G.; Peris, K.; Fargnoli, M.C.; Di Cesare, A.; De Angelis, L.; Flati, G.; Biamonte, A.S.; Quarta, G.; Congedo, M.; Carcaterra, A.; Strippoli, D.; Fideli, D.; Marsili, F.; Celli, M.; Ceccarini, M.; Bachini, L.; D'Oria, M.; Schirripa, V.; De Filippi, C.; Martini, P.; Lapucci, E.; Mazzatenta, C.; Ghilardi, A.; Simonacci, M.; Bettacchi, A.; Gasco, R.; Zanca, A.; Battistini, S.; Dattola, S.; Vernaci, R.; Postorino, F.; Zampieri, P.F.; Padovan, C.; Gonz_alez Intchaurraga, M.A.; Ladurner, J.; Guarneri, B.; Cannav_o, S.; Manfr_e, C.; Borgia, F.; Puglisi Guerra, A.; Cattaneo, A.; Carrera, C.; Fracchiolla, C.; Mozzanica, N.; Prezzemolo, L.; Menni, S.; Lodi, A.; Martino, P.; Monti, M.; Mancini, L.; Sacrini, F.; Altomare, G.F.; Taglioni, M.; Lovati, C.; Mercuri, S.R.; Schiesari, G.; Giannetti, A.; Conti, A.; Lasagni, C.; Greco, M.; Ronsini, G.; Schianchi, S.; Fiorentini, C.; Niglietta, S.; Maglietta, R.; Padalino, C.; Crippa, D.; Pini, M.; Rossi, E.; Tosi, D.; Armas, M.; Ruocco, V.; Ayala, F.; Balato, N.; Gaudiello, F.; Cimmino, G.F.; Monfrecola, G.; Gallo, L.; Argenziano, G.; Fulgione, E.; Berruti, G.; Ceparano, S.; De Michele, I.; Giorgiano, D.; Leigheb, G.; Deledda, S.; Peserico, A.; Alaibac, M.; Piaserico, S.; Schiesari, L.; Dan, G.; Mattei, I.; Oro, E.; Aric_o, M.; Bongiorno, M.R.; Angileri, R.; Amato, S.; Todaro, F.; Milioto, M.; Bellastro, R.; Di Nuzzo, S.; De Panfilis, G.; Zanni, M.; Borroni, G.; Cananzi, R.; Brazzelli, V.; Lisi, P.; Stingeni, L.; Hansel, K.; Pierfelice, V.; Donelli, S.; Rastelli, D.; Gasperini, M.; Barachini, P.; Cecchi, R.; Bartoli, L.; Pavesi, M.; De Paola, S.; Corradin, M.T.; Ricciuti, F.; Piccirillo, A.; Viola, L.; Tataranni, M.; Mautone, M.G.; Lo Scocco, G.; Niccoli, M.C.; Brunasso Vernetti, A.M.G.; Gaddoni, G.; Resta, F.; Casadio, M.C.; Arcidiaco, M.C.; Luvar_a, M.C.; Albertini, G.; Di Lernia, V.; Guareschi, E.; Catrani, S.; Morri, M.; Amerio, P.; De Simone, C.; D'Agostino, M.; Agostino, I.; Calvieri, S.; Cantoresi, F.; Richetta, A.; Sorgi, P.; Carnevale, C.; Nicolucci, F.; Berardesca, E.; Ardig_o, M.; De Felice, C.; Gubinelli, E.; Talamonti, M.; Camplone, G.; Cruciani, G.; Riccardi, F.; Barbati, R.; Zumiani, G.; Pagani, W.; Malagoli, P.G.; Pellicano, R.; Donadio, D.; Di Vito, C.; Cottoni, F.; Montesu, M.A.; Pirodda, C.; Addis, G.; Marongiu, P.; Farris, A.; Cacciapuoti, M.; Verrini, A.; Desirello, G.; Gnone, M.; Fimiani, M.; Pellegrino, M.; Castelli, G.; Zappal_a, L.; Sesana, G.; Ingordo, V.; Vozza, E.; Di Giuseppe, D.; Fasciocco, D.; Nespoli, P.; Papini, M.; Cicoletti, M.; Bernengo, M.G.; Ortoncelli, M.; Bonvicino, A.; Capella, G.; Doveil, G.C.; Forte, M.; Peroni, A.; Salomone, B.; Savoia, P.; Pippione, M.; Zichichi, L.; Frazzitta, M.; De Luca, G.; Zumiani, G.; Tasin, L.; Simonetto, D.; Ros, S.; Trevisan, G.; Patamia, M.; Miertusova, S.; Patrone, P.; Frattasio, A.; Piccirillo, F.; La Spina, S.; Di Gaetano, L.; Marzocchi, V.; Motolese, A.; Venturi, C.; Gai, F.; Pasquinucci, S.; Bellazzi, R.M.; Silvestri, T.; Girolomoni, G.; Gisondi, P.; Veller Fornasa, C.; Trevisan, G.P.Damiani, Giulia; Cazzaniga, S.; Conic, R. R. Z.; Naldi, L.; Griseta, V.; Miracapillo, A.; Azzini, M.; Mocci, L.; Michelini, M.; Offidani, A.; Bernardini, L.; Campanati, A.; Ricotti, G.; Giacchetti, A.; Norat, M.; Gualco, F.; Castelli, A.; Cuccia, A.; Diana, A.; Roncarolo, G.; Belli, M. A.; Baldassarre, M. A.; Santoro, G.; Vena, G. A.; Lo Console, F.; Filotico, R.; Mastrandrea, V.; Brunetti, B.; Musumeci, F.; Carrabba, E.; Dal Mas, P.; Annicchiarico, F.; Benvegn_u, B.; Spaziani, G.; Cusano, F.; Saletta Iannazzone, S.; Galluccio, A.; Pezza, M.; Marchesi, L.; Imberti, G.; Reseghetti, A.; Barbera, C.; Reggiani, M.; Lanzoni, A.; Patrizi, A.; Bardazzi, F.; Antonucci, DIEGO ADRIAN; De Tommaso, S.; Wallnofer, W.; Ingannamorte, F.; Calzavara-Pinton, P.; Iannazzi, S.; Zane, C.; Capezzera, R.; Bassisi, S.; Rossi, M. T.; Altamura, V.; Vigl, W.; Nobile, C.; Aste, N.; Murgia, S.; Mugheddu, C.; Scuderi, Gianluca; Baglieri, F.; Di Dio, C.; Cilioni Grilli, E.; Mastronardi, C.; Agnusdei, C. P.; Antrilli, A.; Aulisa, L.; Raimondo, U.; Scotto di Luzio, G.; Battarra, V. C.; Farro, P.; Plaitano, R.; Micali, G.; Musumeci, M. L.; Massimino, D.; LI CALZI, Marco; La Greca, S.; Pettinato, M.; Sapienza, G.; Valenti, G.; De Giacomo, P. F.; Amico, .; Arcangeli, F.; Brunelli, Donatella; Ghetti, E.; Tulli, A.; Assi, G.; Amerio, P.; Laria, G.; Prestinari, F.; Spadafora, S.; Coppola, M.; Caresana, G.; Pezzarossa, E.; Felisi, C.; DI DONATO, Luca; Bertero, M.; Musso, L.; Pa lazzini, S.; Bruscino, P.; Agozzino, U. C.; Ottaviani, M.; Simoncini, Claudia; Virgili, A.; Osti, F.; Fabbri, Paolo; Volpi, W.; Caproni, M.; Lotti, T.; Prignano, F.; Buggiani, G.; Troiano, M.; Fenizi, G.; Altobella, A.; Amoruso, A.; Condello, M.; Goffredo, A.; Righini, M. G.; Alessandrini, F.; Satolli, F.; Zampetti, M.; Bertani, E.; Fossati, S.; Parodi, A.; Burlando, M.; Fiorucci, C.; Nigro, A.; Ghigliotti, G.; Massone, L.; Moise, G. M.; Serrai, M.; Cannata, G.; Campagnoli, A. M.; Daly, M.; Leporati, C.; Peila, R.; Filosa, G.; Bugatti, L.; Nicolini, M.; Nazzari, G.; Cestari, R.; Anastasio, F.; Larussa, F. M.; Pollice, N.; De Francesco, F.; Mazzocchetti, Gabriele; Peris, K.; Fargnoli, M. C.; Di Cesare, A.; DE ANGELIS, Luca; Flati, G.; Biamonte, A. S.; Quarta, G.; Congedo, M.; Carcaterra, A.; Strippoli, D.; Fideli, D.; Marsili, F.; Celli, Maria; Ceccarini, M.; Bachini, L.; D'Oria, M.; Schirripa, V.; De Filippi, C.; Martini, P.; Lapucci, E.; Mazzatenta, C.; Ghilardi, A.; Simonacci, M.; Bettacchi, A.; Gasco, R.; Zanca, A.; Battistini, S.; Dattola, S.; Vernaci, R.; Postorino, F.; Zampieri, P. F.; Padovan, C.; Gonz_alez Intchaurraga, M. A.; Ladurner, J.; Guarneri, B.; Cannav_o, S.; Manfr_e, C.; Borgia, F.; Puglisi Guerra, A.; Cattaneo, A.; Carrera, C.; Fracchiolla, C.; Mozzanica, N.; Prezzemolo, L.; Menni, S.; Lodi, A.; Martino, P.; Monti, Marina; Mancini, L.; Sacrini, F.; Altomare, G. F.; Taglioni, M.; Lovati, C.; Mercuri, S. R.; Schiesari, G.; Giannetti, Anna; Conti, A.; Lasagni, C.; Greco, M.; Ronsini, G.; Schianchi, S.; Fiorentini, C.; Niglietta, S.; Maglietta, R.; Padalino, C.; Crippa, D.; Pini, M.; Rossi, E.; Tosi, D.; Armas, M.; Ruocco, V.; Ayala, F.; Balato, N.; Gaudiello, F.; Cimmino, G. F.; Monfrecola, G.; Gallo, L.; Argenziano, G.; Fulgione, E.; Berruti, G.; Ceparano, S.; De Michele, I.; Giorgiano, D.; Leigheb, G.; Deledda, S.; Peserico, A.; Alaibac, M.; Piaserico, S.; Schiesari, L.; Dan, G.; Mattei, I.; Oro, E.; Aric_o, M.; Bongiorno, M. R.; Angileri, R.; D'Amato, Sonia; Todaro, F.; Milioto, M.; Bellastro, R.; Di Nuzzo, S.; De Panfilis, G.; Zanni, M.; Borroni, Giovanni Marco; Cananzi, R.; Brazzelli, V.; Lisi, P.; Stingeni, L.; Hansel, K.; Pierfelice, V.; Donelli, S.; Rastelli, D.; Gasperini, M.; Barachini, P.; Cecchi, R.; Bartoli, L.; Pavesi, M.; De Paola, S.; Corradin, M. T.; Ricciuti, F.; Piccirillo, A.; Viola, L.; Tataranni, M.; Mautone, M. G.; Lo Scocco, G.; Niccoli, M. C.; Brunasso Vernetti, A. M. G.; Gaddoni, G.; Resta, F.; Casadio, M. C.; Arcidiaco, M. C.; Luvar_a, M. C.; Albertini, G.; Di Lernia, V.; Guareschi, E.; Catrani, S.; Morri, M.; Amerio, P.; De Simone, C.; D'Agostino, M.; Agostino, I.; Calvieri, S.; Cantoresi, F.; Richetta, A.; Sorgi, P.; Carnevale, C.; Nicolucci, F.; Berardesca, E.; Ardig_o, M.; De Felice, C.; Gubinelli, E.; Talamonti, Marco Claudio; Camplone, G.; Cruciani, G.; Riccardi, F.; Barbati, R.; Zumiani, G.; Pagani, W.; Malagoli, P. G.; Pellicano, R.; Donadio, D.; Di Vito, C.; Cottoni, F.; Montesu, M. A.; Pirodda, C.; Addis, G.; Marongiu, P.; Farris, A.; Cacciapuoti, M.; Verrini, A.; Desirello, G.; Gnone, M.; Fimiani, M.; Pellegrino, M.; Castelli, G.; Zappal_a, L.; Sesana, G.; Ingordo, V.; Vozza, E.; Di Giuseppe, D.; Fasciocco, D.; Nespoli, P.; Papini, M.; Cicoletti, M.; Bernengo, M. G.; Ortoncelli, M.; Bonvicino, A.; Capella, G.; Doveil, G. C.; Forte, M.; Peroni, A.; Salomone, B.; Savoia, P.; Pippione, M.; Zichichi, L.; Frazzitta, M.; De Luca, G.; Zumiani, G.; Tasin, L.; Simonetto, D.; Ros, S.; Trevisan, G.; Patamia, M.; Miertusova, S.; Patrone, P.; Frattasio, A.; Piccirillo, F.; La Spina, S.; Di Gaetano, L.; Marzocchi, V.; Motolese, Alfonso; Venturi, C.; Gai, F.; Pasquinucci, S.; Bellazzi, R. M.; Silvestri, T.; Girolomoni, G.; Gisondi, P.; Veller Fornasa, C.; Trevisan, G. P

Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: Results from the Italian Psocare Registry

Background Some studies have shown that switching patients from one tumor necrosis factor (TNF)-alfa inhibitor to another may be beneficial when they have an inadequate response or an adverse event. Objective We sought to assess the variables predicting the efficacy of the second TNF-alfa inhibitor in patients discontinuing the first TNF-alfa inhibitor. Methods Data from all 5423 consecutive patients starting TNF-alfa inhibitor therapy for psoriasis between September 2005 and September 2010 who were included in the Italian Psocare registry were analyzed. Results In 105 patients who switched to a second TNF-alfa inhibitor who had complete follow-up data, 75% improvement in the Psoriasis Area Severity Index score (PASI 75) was reached by 29% after 16 weeks and by 45.6% after 24 weeks. Patients who switched because of secondary loss of efficacy (loss of initial PASI 75 response) or adverse events/intolerance were more likely to reach PASI 75 than those who switched as a result of primary inefficacy (PASI 75 never achieved) (hazard ratio 2.7, 95% confidence interval 1.3-5.5 vs hazard ratio 2.0, 95% confidence interval 1.0-3.9 and 1, respectively). Limitations There was a small number of patients with complete follow-up data. Conclusion PASI 75 response in patients who switched from one anti-TNF-alfa agent to another was significantly reduced in patients who showed primary inefficacy of the first anti-TNF-alfa. © 2013 by the American Academy of Dermatology, Inc

Latent tuberculosis infection in patients with chronic plaque psoriasis: Evidence from the Italian Psocare Registry

Background The nationwide prevalence of latent tuberculosis infection (LTBI) in Italian patients with psoriasis has never been investigated.Objectives To estimate the nationwide prevalence of LTBI in Italian patients with psoriasis who are candidates for systemic treatment.Methods Data were obtained from the Psocare Registry on those patients (n = 4946) with age &gt; 18 years, systemic treatment at entry specified and tuberculin skin test (TST) performed according to the Mantoux method. LTBI diagnosis was based on a positive TST result in the absence of any clinical, radiological or microbiological evidence of active tuberculosis.Results Latent tuberculosis infection was diagnosed in 8.3% of patients with psoriasis (409 of 4946). The prevalence of LTBI was lower in patients on biologics than in those on conventional systemic treatments, ranging from 4.3% (19 of 444) of patients on adalimumab to 31% (eight of 26) of those on psoralenultraviolet A (P &lt; 0.05). Independent factors associated with LTBI were male sex [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.04-1.62; P = 0.02], age over 55 years (OR 2.93, 95% CI 2.18-3.93; P &lt; 0.001) and being entered into a conventional treatment (OR 3.83, 95% CI 3.10-4.74; P &lt; 0.001). Positive history of tuberculosis was seen in 1% of patients (n = 49).Conclusions The nationwide prevalence of LTBI in Italian patients with psoriasis candidate to systemic treatment is high, and screening is recommended prior to biological treatment