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Evaluate the use of widefield radiation therapy (RT) in the management of extensive skin field cancerization (ESFC) with/without keratinocyte cancer (KC). The National Dermatology Radiation Oncology Registry is a multidisciplinary collaboration (dermatologists and radiation oncologists). It captures disease description, prior therapies, radiation prescription, clinical effect, skin cosmesis scores, and toxicity data. This analysis included 12-month follow-up data on 89 treated fields from a subset of 83 patients. Clinical success (>90% field clearance) was 96% (ESFC, n = 63) and 88% (ESFC with KC, n = 26). Complete lesion response was seen in 96% of evaluable (n = 25) ESFC with KC. Recurrence (4/89 [5%]) and appearance of new lesions (10/89 [11%]) were minimal. Cosmetic outcome was excellent/good in 98% ESFC and 96% ESFC with KC. Grade 1–2 acute radiation dermatitis occurred in up to 80% of treated fields. The frequency of Grade 3 acute skin toxicities was low. Registry data demonstrate the potential for widefield RT to treat patients with significant skin pathology who have exhausted other therapies and require durable, minimally invasive treatment options. At 12 months, observed clinical success rates were higher than those reported for topical interventions for ESFC. Ongoing follow-up is required to determine longer term outcomes. [ABSTRACT FROM AUTHOR]

Factors beyond the Psoriasis Area and Severity Index (PASI) contribute to disease severity in psoriasis and potentially affect treatment responses. This subset analysis of data from two phase 3 clinical studies assessed baseline parameters in patients with different degrees of psoriasis severity in order to determine treatment responses to ixekizumab and safety outcomes. This study used integrated data from the UNCOVER-2 and -3 trials involving 2709 patients with chronic plaque psoriasis to assess the efficacy and safety of ixekizumab in three subgroups of patients, defined by PASI > 15 (group 1), PASI > 15 and history of ≥3 non-biologic systemic therapies (group 2), or PASI = 12-15 (group 3). In groups 1 and 2, additional baseline features were identified that could influence treatment responses, including age at disease onset, Dermatology Life Quality Index, and work productivity. Irrespective of subgroup, ixekizumab demonstrated high PASI responses at weeks 12 and 60, which were evident as early as week 2. Adverse events did not differ across subgroups. Our data support the efficacy, early onset of action, and maintained response of ixekizumab as observed in previous trials, and highlight the complexity of comprehensively defining disease severity in psoriasis. [ABSTRACT FROM AUTHOR]

Ciclosporin (CsA) is a systemic immunosuppressive agent indicated for use in the treatment of patients with recalcitrant atopic dermatitis (AD). Studies demonstrate reasonable evidence of benefit compared with placebo. However as biologic agents are under development for use in AD, an assessment of the use, attitude to and safety of CsA is essential in understanding unmet needs in severe AD. We present the results of a survey asking questions relating to initial dose, duration of prescription, precautions and monitoring undertaken during treatment, adverse events seen, and hierarchy of use for systemic agents. This survey was distributed at the annual meeting of the Australasian College of Dermatologists. Twenty-two percent of respondents never prescribe CsA, and 50% prescribe it only 1–2 times per month. When prescribed, the most frequently recommended duration was 6–12 months (24%). Of prescribers, 56% start with a low dose of <3.5 mg/kg daily, and when stratified according to years of experience, a higher proportion of more junior dermatologists commenced with lower doses (p=.028). Regarding side effects, 95% of respondents expressed concern about nephrotoxicity, 37% about hypertension, and 17% infection. The results suggest that although most dermatologists consider CsA to be effective, there are concerns regarding the safety profile. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of guselkumab on work productivity, including absenteeism and presenteeism, in psoriasis patients with and without depression/anxiety. Methods: VOYAGE 2 is a randomized, double-blind, placebo-controlled, and comparator-controlled, phase 3 trial that compared guselkumab with adalimumab in patients with moderate-to-severe psoriasis. Absenteeism was evaluated among patients who reported that their skin prevented work/study based on the Dermatology Life Quality Index (DLQI) work/study domain (score = 3) at baseline. Presenteeism was assessed by summarizing mean changes in four Work Limitations Questionnaire (WLQ) domain scores at week 24. Analyses were compared between treatments and stratified by depression/anxiety status at baseline. Results: At week 24, 82.1% and 50.0% in the guselkumab and adalimumab groups, respectively, reported a DLQI work/study score = 0 (no effect of skin on work/study) (p <.001). Mean changes (improvements) were greater in guselkumab-treated versus adalimumab-treated patients in the work limitations domains of Physical Demands (−6.9 vs. −3.3, p <.05), Mental-Interpersonal (−6.3 vs. −3.2, p <.06), and Output Demands (−6.2 vs. −2.2, p <.05). Improvements were consistent in patients with and without depression/anxiety. Conclusions: Psoriasis patients treated with guselkumab had significantly better improvements in absenteeism and presenteeism compared with those treated with adalimumab, regardless of depression/anxiety status. [ABSTRACT FROM AUTHOR]

Background: Calcipotriol 50 µg/g and betamethasone 0.5 mg/g dipropionate (Cal/BD) aerosol foam formulation provides greater effectiveness and improved patient preference compared with traditional Cal/BD formulations for the topical treatment of plaque psoriasis.Objective: To determine the cost-effectiveness of Cal/BD foam compared with Cal/BD gel from the Australian perspective.Methods: A Markov model was developed to evaluate the cost-effectiveness of topical Cal/BD foam and gel for the treatment of people with plaque psoriasis. Treatment effectiveness, safety, and utilities were based on a randomized control trial, resource use was informed by expert opinion, and unit costs were obtained from public sources. Outcomes were reported in terms of 1-year costs, quality-adjusted life years, and incremental cost-effectiveness ratios. All costs were reported in 2017 Australian Dollars.Results: The model showed that patients using Cal/BD foam had more QALYs and higher costs over 1 year compared with patients using Cal/BD gel, resulting in a cost of $13,609 per QALY gained at 4-weeks. When 4 weeks of Cal/BD foam was compared with 8 weeks of Cal/BD gel treatment, Cal/BD foam was $8 less expensive and resulted in 0.006 more QALYs gained. Sensitivity analyses showed that, compared with Cal/BD ointment, Cal/BD foam was associated with an incremental cost of $15,091 per QALY gained.Conclusion: Cal/BD foam is the most cost-effective Cal/BD formulation for the topical treatment of patients with plaque psoriasis. [ABSTRACT FROM AUTHOR]

Background/Objectives:Psoriasis is a chronic condition that may require long-term treatment for disease control. This analysis utilizes data from the Australasian Psoriasis Registry with particular attention to the impact of biologic therapy on DLQI, and the differences between the biologics in terms of DLQI score change. Methods:A retrospective review of patients enrolled in the Australasian Psoriasis Registry from April 2008 to August 2016 was conducted. All subjects from the registry that had DLQI and Psoriasis Assessment Severity Index (PASI) scores recorded at a baseline time point of treatment commencement, in addition to week 12 and 24 post commencement were included in the study. A window of ±3 weeks was permitted at these time points. Multivariate linear regression analysis was undertaken to identify significant predictors associated with change in DLQI. Results:Significant predictors of reduction in DLQI and PASI score from baseline to week 24 include use of adalimumab, infliximab, secukinumab and ustekinumab. Other therapies, including etanercept and oral systemic agents did not show significant change. Each class of biologic showed significant reductions in DLQI score, with IL-12/23 blockade showing the greatest reduction. Significant predictors of lack of reduction in DLQI score include a baseline PASI score <16, and history of diabetes, alcoholism or uveitis. Conclusions:Patients with moderate to severe chronic plaque psoriasis who are treated with biologics show the greatest reduction in DLQI score, compared with other treatments. Australian dermatologists are prescribing biologics when patients qualify for them in keeping with current guidelines. [ABSTRACT FROM AUTHOR]

Background:Actinic keratosis (AK) is a common skin condition, for which topical therapies are frequently prescribed. This review summarises current understanding of patient adherence and persistence to topical AK treatment by identifying literature relating to measures of adherence and persistence and influencing factors. Methods:A multi-database literature search was conducted (2004–2015) using key search terms. Supplementary searches of pivotal clinical trials and reference lists of eligible papers were also conducted. Results:Non-adherence and non-persistence rates varied between real-world studies (10–63% and 23–31%, respectively), with combined non-adherence and non-persistence reported as high as 88%. Methods to calculate adherence and persistence differed between studies. Adherence and persistence were generally higher in clinical trials than clinical practice. Key contributing factors to non-adherence and non-persistence to AK treatment were identified as: treatment duration, severity and persistence of local skin responses and patient confusion over treatment regimens. Conclusion:The review highlighted a significant evidence gap regarding adherence and persistence to topical AK therapies. Combined, non-adherence and non-persistence may be as high as 88% in clinical practice, highlighting the importance of incorporating contributing factors to patient non-adherence into treatment decisions. [ABSTRACT FROM PUBLISHER]

Geographically weighted spatial statistical methods are a family of spatial statistical methods developed to address the presence of non-stationarity in geographical processes, the so-called spatial heterogeneity. While these methods have recently become popular for analysis of spatial data, one of their characteristics is that they produce outputs that in themselves form complex multi-dimensional spatial data sets. Interpretation of these outputs is therefore not easy, but is of high importance, since spatial and non-spatial patterns in the results of these methods contain clues to causes of underlying non-stationarity. In this article, we focus on one of the geographically weighted methods, the geographically weighted discriminant analysis (GWDA), which is a method for prediction and analysis of categorical spatial data. It is an extension of linear discriminant analysis (LDA) that allows the relationship between the predictor variables and the categories to vary spatially. This produces a very complex data set of GWDA results, which include on top of the already complex discriminant analysis outputs (e.g. classifications and posterior probabilities) also spatially varying outputs (e.g. classification function parameters). In this article, we suggest using geovisual analytics to visualise results from LDA and GWDA to facilitate comparison between the global and local method results. For this, we develop a bespoke visual methodology that allows us to examine the performance of global and local classification method in terms of quality of classification. Furthermore, we are also interested in identifying the presence (or absence) of non-stationarity through comparison of the outputs of both methods. We do this in two ways. First, we visually explore spatial autocorrelation in both LDA and GWDA misclassifications. Second, we focus on relationships between the classification result and the independent variables and how they vary over space. We describe our visual analytic system for exploration of LDA and GWDA outputs and demonstrate our approach on a case study using a data set linking election results with a selection of socio-economic variables. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented commenting on the link between IgA nephropathy, an immune complex mediated mesangio-proliferative glomerulonephritis, and cutaneous T cell lymphoma.