Cyclosporine vs. dupilumab vs. methotrexate for patients with AD
A study published in the British Journal of Dermatology assessed outcomes in 488 adult and pediatric patients with atopic dermatitis (AD) receiving treatment with cyclosporine, dupilumab, or methotrexate. Treatment with cyclosporine resulted in Eczema Area and Severity Index (EASI)–50, EASI-75, and EASI-90 more rapidly than treatment with dupilumab, which resulted in the achievement of these three outcomes more rapidly than treatment with methotrexate.
The reduction in the EASI, Patient-Oriented Eczema Measure, Peak Pruritus Numerical Rating Scale, and Dermatology Life Quality Index was significantly greater among patients treated with dupilumab and cyclosporine than among those treated with methotrexate. According to the authors, the study showed that dupilumab is consistently more effective than methotrexate in treating patients with AD and that cyclosporine is the most effective option for treating those with severe disease.
What is the path forward for treating children with severe atopic dermatitis with dupilumab? Read more.
DermWorld Insights and Inquiries: The expanding horizon of anti-IL-36 therapy
We last explored the relationship between IL-36 and generalized pustular psoriasis (GPP) and the use of spesolimab (SPEVIGO an IL-36 receptor antagonist) six months prior to its September 2022 FDA approval for GPP. Subsequent studies have affirmed that the IL-36 signaling pathway is the key driver in the pathogenesis of GPP. The role of IL-36 in the pathogenesis of other dermatoses is an area of active inquiry. Dramatic examples of off-label spesolimab have been reported in severe cases of pyoderma gangrenosum. IL-36 has recently been associated with disease mechanisms in atopic dermatitis, hidradenitis suppurativa, neutrophilic dermatoses, autoimmune blistering disease, and Netherton syndrome. Additional trials evaluating the long-term efficacy and safety data are required before spesolimab becomes a major player in the treatment of GPP and other inflammatory skin diseases. Keep reading!
FDA approves new treatment for immune-mediated vasculitis
The FDA approved the asthma drug benralizumab as a new therapy for adults with eosinophilic granulomatosis with polyangiitis (EGPA). EGPA, formerly known as Churg-Strauss syndrome, is caused by inflammation of blood vessels that can damage multiple organs and be fatal if left untreated. Approval for the drug was based on the MANDARA trial, which compared patients with relapsing or refractory EGPA with those taking mepolizumab atop standard therapy, including oral corticosteroids and other immunosuppressants.
The study demonstrated benralizumab’s noninferiority, with 59% of patients receiving remission versus 56% of those taking mepolizumab. More patients treated with benralizumab were able to fully taper off oral corticosteroids during the trial (41% vs. 26% with mepolizumab).
Factors associated with residual tumor at time of Mohs micrographic surgery for BCC, SCC
Authors of a study published in JAAD investigated the percentage of cases in which residual tumor was histologically present at the time of Mohs micrographic surgery (MMS) for basal cell carcinomas (BCC) and squamous cell carcinomas (SCC). Residual tumor was identified in 83.3% of BCC and 66.8% of SCC at the time of MMS. In patients clinically appearing tumor-free following biopsy, residual histologic tumor was identified in 68.2% of BCC and 41.5% of SCC. Residual tumor was significantly more likely in men, high-risk sites, small biopsy sizes, and larger preoperative sizes.
[Metformin mania: Is it an adequate chemopreventive agent for skin cancer? Read more.]
Authors of a study published in the Journal of the European Academy of Dermatology and Venereology evaluated the long-term efficacy of risankizumab for the treatment of high-impact disease manifestations (nail, scalp and palmoplantar psoriasis) through 256 weeks of continuous treatment. Patients with moderate-to-severe plaque psoriasis were randomized to risankizumab 150 mg during two double-blind, phase 3, 52-week base studies. Subgroup assessments included the proportion of patients who achieved 90-100% improvement according to the Psoriasis Area and Severity Index (PASI).
A similar proportion of patients achieved PASI 90/100 through week 256 regardless of age, sex, body mass index, weight, PASI, or psoriatic arthritis status. Patients with nail, scalp, or palmoplantar psoriasis experienced substantial improvements (>81%, >94% and >97% improvement, respectively, from baseline to week 256). In patients with all three manifestations, 44.6% achieved complete clearance. According to the study authors, risankizumab displayed high clinical response rates regardless of patient demographics and disease manifestations.
MIPS EUC reweighting requests deadline extended due to Change Healthcare cyberattack
Due to the Change Healthcare cyberattack, clinicians and groups who missed the April 15, 2024, deadline for the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception Application for performance year 2023 can now submit a request for reweighting one or more MIPS performance categories. This exception is available from now through Oct. 11, 2024, at 8 p.m. ET.
CMS will only approve applications citing this cyberattack as the basis for requesting reweighting under the MIPS EUC Exception policies. Any applications submitted for reasons outside of the Change Healthcare cyberattack will be denied. For more information, visit the 2023 MIPS EUC Reweighting Requests Guide.
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