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Daniel J Pearce

Publications and source records attributed to Daniel J Pearce.

32 records · Page 2Linked to original sources
PubMed2005

Infliximab for inpatient psoriasis management--is there a role?

BACKGROUND: While outpatient management is a realistic goal for most psoriasis patients, inpatient hospitalization may be required for severe acute exacerbations. The paradigm of inpatient psoriasis treatment has changed as reflected in an overall decline in admissions as well as the introduction of several new agents for patients with moderate to severe disease. With these changes as well as the changes in inpatient health care delivery, the costs of inpatient psoriasis therapy need to be re-examined. PURPOSE: To determine the mean charges and length of stay associated with inpatient admissions for psoriasis and compare these with the potential charges for infliximab administration in the inpatient setting. METHODS: Inpatient psoriasis admissions were identified from the State of Maryland Health Services Cost Review Commission (HSCRC) non-confidential database from 1994 to 2003. The mean length of stay and total charges associated with psoriasis admissions were determined and adjusted to current values based upon the hospital costs component of the Consumer Price Index (CPI). The potential charges for infliximab administration were then estimated according to a presumed treatment paradigm and based on median Medicare reimbursement rates. RESULTS: The mean length of stay for an inpatient psoriasis patient was 4.9 days, and the mean CPI adjusted total charges from 1994 to 2003 were $6736. In 2003, the mean total charges for a psoriasis admission were $7578. The total estimated charges for a 2-day inpatient hospitalization with infliximab administration were $6256. CONCLUSIONS: Although infliximab therapy is not currently approved for psoriasis therapy it does have efficacy and may be a first-line therapy for inpatient treatment. Additionally, the high cost of infliximab may be offset by a decreased overall length of stay and its use is therefore potentially justified.

Antibodies, Monoclonal↗
PubMed2005

The comorbid state of psoriasis patients in a university dermatology practice.

BACKGROUND: Psoriasis treatment is frequently complicated by the various types and severities of disease as well as the large number of therapies available. Another critical consideration in treatment planning is the presence of comorbid diseases. PURPOSE: The purpose of this study was to evaluate the relative prevalence of major comorbid disease states in patients with psoriasis and to identify significant predictors of these concurrent diseases in such patients. METHODS: A retrospective chart review of 753 patients from an academic dermatology practice was performed. The patients were identified by ICD-9 code for psoriasis in billing records of patients seen between 1997 and 2000. Data on comorbidities were compiled from review of electronic chart notes from all physician visits in the university practice. RESULTS: Comorbid diagnoses were listed in 551 out of 753 (73%) charts. As would be expected, hypertension, dyslipidaemia, diabetes and heart disease were the most common comorbidities; renal failure and hepatitis were least likely. Hepatitis was associated with use of systemic therapies (odds ratio = 2.19) and non-white race. When compared with national prevalence estimates, psoriasis patients had increased heart disease, hypertension, diabetes and emphysema; however, these findings must be interpreted with some caution. CONCLUSIONS: Comorbid diseases are common in psoriasis patients and should be taken into account during treatment planning and surveillance; they may pose unique challenges in caring for patients with psoriasis, particularly those requiring systemic therapy.

Academic Medical Centers↗
PubMed2005

The role of commercial tanning beds and ultraviolet A light in the treatment of psoriasis.

BACKGROUND: Phototherapy is an effective, safe psoriasis treatment administered via office-based units or home devices. There is controversy over the use of commercial tanning beds; ultraviolet B (UVB) has documented efficacy although commercial beds emit largely UVA. OBJECTIVE: To determine the efficacy of UVA and the role of commercial tanning beds in treating psoriasis. METHODS: A literature search of UVA and commercial tanning was performed. RESULTS: UVA can be effective for psoriasis, but achieving the high doses required may not be practical. Tanning beds do emit UVB although amounts are variable. Because of variability in UVA and UVB output in different tanning bulbs, it is difficult to predict response rates using commercial tanning beds. CONCLUSIONS: UVA can be used to treat psoriasis but may not be practical. Commercial tanning beds, emitting both UVA and UVB, have a role in treating psoriasis as an alternative to office-based therapy.

Heliotherapy↗
PubMed2005

A reappraisal of the concept of suppressive versus remittive psoriasis treatments.

Among the ways to characterize the many treatments for psoriasis is to distinguish suppressive from remittive therapies. Remittive therapies are thought to be treatments that result in a prolonged period of disease remission even after stopping the drug, while suppressive treatments are thought to work only during the treatment period. However, apparent differences in remittive and suppressive properties may be due to the remitting and relapsing nature of psoriasis and the order in which treatments are used in patients. Few clinical trials have compared the suppressive versus remittive properties of different treatments. Given the adverse events and expense associated with many psoriasis therapies, a major implication is that psoriasis patients who have cleared on therapy should probably be tested at intervals to see if they can be tapered off their medication without loss of control of their disease.

Humans↗
PubMed2005

Biologic therapy for psoriasis: telephone triage.

The past 15 years have been a time of remarkable achievement in the treatment of psoriasis. New topical medications with efficacy and safety have been introduced. At the same time, there has been resurgence in the use of traditional agents such as methotrexate and cyclosporine. An enlightened understanding of psoriasis as an immune-mediated disease has led to the development of unique injectable medications called biologics. All of these developments have occurred in part as we have gained a better understanding of the powerful impact that psoriasis has on patients. The biologics represent a new and exciting class of medications for treating psoriasis. Their novelty is reflected by both excitement and uncertainty. Efficacy rates of the biologics in treating psoriasis are unparalleled and safety data over the short term is promising. However, long-term safety data does not exist. Furthermore, as with any new class of medication, specifically an injectable preparation costing approximately $18,000 to $30,000 annually, concern on the part of patients is expected. Despite any uncertainty, the biologics are drastically altering the arena of psoriasis care. Clinicians have an entirely new class of medications to recommend to patients who have either failed or are not eligible for traditional agents. At the same time, due to the expense of these agents, the relationship between the patient, clinician, and insurer is changing. Certainly the introduction of biologics has created a need for educating clinic staff regarding these therapies. There are barriers to the effective and safe use of the biologics; often, these barriers lie at the level of the patient and depend on his comfort level and understanding of the treatment. This being said, it is the charge of the dermatology community, especially those on the front lines such as nurses, to lead efforts in patient education to ensure the best care for those suffering from psoriasis.

Drug Storage↗
PubMed2004

A Simplified Psoriasis Area Severity Index (SPASI) for rating psoriasis severity in clinic patients.

INTRODUCTION: The Psoriasis Area and Severity Index (PASI) is the most widely used tool to assess psoriasis disease severity in clinical trials, although it can be exceedingly cumbersome for use in daily clinical practice. Because clinical trials rely on the PASI for inclusion criteria, having a PASI score on a clinic patient may be useful for determining if the patient has a level of disease severity similar to that of patients treated in clinical trials. PURPOSE: The purpose of this study is to assess a simplified measure of psoriasis disease severity that is more conducive to use in general dermatology practice, the simplified PASI (SPASI). METHODS: We evaluate an area-weighted assessment of lesion severity composed of the sum of the average redness, thickness, and scaliness of all the psoriasis lesions multiplied by an estimate of total body surface area involved. The SPASI is mathematically derived from the PASI. The SPASI and PASI are not identical because of the categorical nature of area estimates used in the PASI. We use existing psoriasis-population data regarding the anatomical distribution of psoriasis lesions to create a simulated patient database. Monte Carlo analysis is then performed to determine the relation between the PASI and SPASI. RESULTS: For a sample population with a mean PASI score of 12.8, the mean SPASI was 14.2. Correlation between the PASI and the SPASI was high (r = 0.90). Bland-Altman analysis showed no consistent bias between the PASI and the SPASI. When attempting to identify simulated patients with a PASI score of 12 (an inclusion criterion for many clinical trials for severe psoriasis), SPASI was 97 percent sensitive and 66 percent specific. DISCUSSION: The SPASI is much less onerous than the PASI, requiring estimation of only four rather than sixteen independent variables. It provides a quick and practical estimate of disease severity similar to the PASI and can be used to communicate that patients have a level of disease severity similar or dissimilar to that of patients studied in clinical trials.

Dermatology↗
PubMed2004

The cost of psoriasis therapies: considerations for therapy selection.

PURPOSE: The purpose of this article is to provide a review of the cost of psoriasis therapies from two sources as well as compare the average wholesale price (AWP), as listed in the 2003 Drug Topics Red Book to that of a popular Internet pharmacy. METHODS: Prices of therapies were obtained two ways: the AWP was recorded from the 2003 Drug Topics Red Book. A range and average price per gram (or mL) were calculated based on the smallest size or quantity available. In addition, a price comparison was made to values as they were reported online at drugstore.com. Monthly cost estimates were based on average systemic dosing and for topicals, 18 g/month (for 1% body surface area [BSA] involvement). RESULTS: The prices of psoriatic treatment medications vary considerably--from the relatively inexpensive topical corticosteroids to the more costly biologic therapies. In the category of corticosteroids, a trend was evident between the overall price per gram of each class and the potency of each class. Class I and VI corticosteroids had an average price per gram (or mL) of dollars 2.08 (dollars 37/month/1% BSA) and dollars 0.86 (dollars 15/month/1% BSA), respectively. Nonsteroidal topical treatments had an average price per gram (or mL) dollars 2.18 (dollars 39/month/1% BSA). Systemic therapies have a wide range of costs. The total monthly expense, based on estimated average dosing, was calculated for methotrexate, acitretin, and cyclosporine and were dollars 78.60, dollars 400.50, and dollars 735.00, respectively. Biologic therapies designed for continuous use cost roughly dollars 1,300/month. DISCUSSION: There are numerous treatment options for psoriasis with a wide range of costs. In addition to significant challenges from a scientific perspective, psoriasis treatment is further complicated by the cost of the numerous medications. Prices reported in the AWP were similar in many instances to those listed at an Internet pharmacy. Many considerations should go into therapy selection for psoriasis and a comprehensive approach that includes cost will likely provide the best patient care.

Anti-Inflammatory Agents↗
PubMed2003

Multiparameter analysis of murine bone marrow side population cells.

We describe the multiparameter flow cytometric analysis of the relationship between side population (SP) formation and well-characterized, antigen-defined stem cell subsets. We also compared the competitive repopulation ability of subsets defined by the SP profile to those identified by antigenic markers. The vast majority of SP cells possessed a primitive cell phenotype (c-kit+, SCA-1+, Thy-1+, CD31+, CD135neg, lineage neg), but only a minority of antigen-defined subsets were SP cells. Hence, although SP cells are identified independently of antigenic markers, they are not distinct from established stem cell phenotypes, but are a small subset of them. Approximately half of SP cells expressed CD34 at readily detectable levels, and one-third of SP cells possessed the primitive c-kit+, SCA-1+, lineage neg, CD34neg cell phenotype. Since most SP cells are a subset of c-kit+, Thy-1+, lineage neg, SCA-1+ cells (KTLS), we determined whether the SP cell subset represents a further enrichment in long-term repopulating cell content. The SP+ subset of KTLS+ cells was more enriched for competitive repopulation units than the SP- fraction of KTLS+ cells. Hence, the SP cell fraction highlights a subset of the long-term repopulating cells found within the already highly purified KTLS fraction.

Animals↗
PubMedDate not supplied

The frequent use of oral retinoids in combination with other treatments for psoriasis: a retrospective analysis.

BACKGROUND: Combination treatment in psoriasis may be common, logical, and appropriate, even if not well tested or well documented by clinical trials. While oral retinoids such as acitretin can be used as monotherapy, efficacy can be further augmented by combination use with other agents. Similarly, because of its safety profile, acitretin can be added in low doses to help patients who have not achieved adequate control with other psoriasis treatments. OBJECTIVE: The purpose of this study was to assess how oral retinoids are used in combination with other drugs to treat psoriasis. METHODS: We assessed the use of acitretin and other oral retinoids for the treatment of psoriasis using two sources of information: nationally representative survey data from the National Ambulatory Medical Care Survey (NAMCS) and local data obtained by chart review of 518 patients seen in a university dermatology clinic. RESULTS: In the NAMCS, oral retinoids were prescribed with other psoriasis medications at 71% of visits. In the chart review, combination use was even more frequent (96% of subjects were on combination treatment) and included combinations of acitretin with topicals, phototherapy, and other systemic treatments. Adverse events were reported in 53% of patients treated with acitretin, although none were severe. CONCLUSION: Use of acitretin in combination with many other psoriasis treatments is a common practice. Mucocutaneous side effects of oral retinoids are common but with appropriate dosing are generally mild.

Acitretin↗
PubMedDate not supplied

Characterization of cells with a high aldehyde dehydrogenase activity from cord blood and acute myeloid leukemia samples.

Aldehyde dehydrogenase (ALDH) is a cytosolic enzyme that is responsible for the oxidation of intracellular aldehydes. Elevated levels of ALDH have been demonstrated in murine and human progenitor cells compared with other hematopoietic cells, and this is thought to be important in chemoresistance. A method for the assessment of ALDH activity in viable cells recently has been developed and made commercially available in a kit format. In this study, we confirmed the use of the ALDH substrate kit to identify cord blood stem/progenitor cells. Via multicolor flow cytometry of cord blood ALDH+ cells, we have expanded on their phenotypic analysis. We then assessed the incidence, morphology, phenotype, and nonobese diabetic/ severe combined immunodeficiency engraftment ability of ALDH+ cells from acute myeloid leukemia (AML) samples. AML samples had no ALDH+ cells at all, an extremely rare nonmalignant stem/progenitor cell population, or a less rare, leukemic stem cell population. Hence, in addition to identifying nonmalignant stem cells within some AML samples, a high ALDH activity also identifies some patients' CD34+/ CD38- leukemic stem cells. The incidence of normal or leukemic stem cells with an extremely high ALDH activity may have important implications for resistance to chemotherapy. Identification and isolation of leukemic cells on the basis of ALDH activity provides a tool for their isolation and further analysis.

ADP-ribosyl Cyclase↗
PubMedDate not supplied

Tazarotene cream (0.1%) in combination with betamethasone valerate foam (0.12%) for plaque-type psoriasis.

A combination of multiple agents is often required to achieve treatment success for plaque-type psoriasis. We report a case series of 10 patients that were treated with betamethasone valerate foam (0.12%) in the morning and topical tazarotene cream (0.1%) in the evening for a total of 12 weeks or until plaques cleared. Erythema, scale, and thickness along with an aggregate severity score were determined at weeks 4, 8, and 12. One patient was lost to follow-up. Eight of the other 9 patients experienced improvement in their disease by week 12. Two patients were clear of their psoriasis at week 4 and 4 were clear at week 8. No adverse events, including irritation were reported; the use of the corticosteroid foam may protect against potential local irritation reported with tazarotene. The combination of tazarotene cream and betamethasone valerate foam is an effective combination approach to treating localized plaque-type psoriasis.

Betamethasone Valerate↗
PubMedDate not supplied

Inpatient management of severe psoriasis.

Historically, severe psoriasis frequently required inpatient hospitalization for several weeks to reduce symptoms and prevent morbidity and mortality, Despite declining hospitalization rates there remain patients who undergo severe, acute psoriasis exacerbations requiring inpatient care. The majority of the literature describes the treatment of psoriasis in the outpatient setting. We review the inherent differences between the inpatient and outpatient management of psoriasis along several dimensions and discuss an approach to the inpatient treatment of severe psoriasis based upon therapeutic rate of onset, efficacy, and safety. The inpatient setting benefits from and lends itself to use of rapid acting, highly effective agents. Given the acute nature of psoriasis inpatient episodes, the risks associated with long-term use of a treatment are far less important in inpatient setting treatment planning than they are in the outpatient setting.

Biological Therapy↗
PubMedDate not supplied

Factors affecting prescription of ultra-high potency topical corticosteroids in skin disease: an analysis of US national practice data.

Of the topical preparations available, the ultra-high potency corticosteroids have an important role in treating psoriasis. However, the use of these agents in many other conditions and patient populations may not be appropriate. This study examines the prescribing patterns of Class I topical corticosteroids in patients with skin disease by analyzing data from the National Ambulatory Medical Care Survey (1990-2000). Of the nearly 718 million visits for skin disease, Class I topical corticosteroids were prescribed in nearly 3% of all skin disease-related visits, with prescription rates being highest in psoriasis (22%). The study found greater prescription rates of Class I topical steroids by dermatologists compared to non-dermatologists [Odds Ratio (OR) = 4.39 (95% CI: 2.15, 8.99)]. However, there were also a large number of questionable prescriptions for other conditions, which could be construed as misuse of these medications. Despite limitations and the potential dubious use seen here, Class I topical corticosteroid use is relatively commonplace. Education efforts and novel preparations of Class I agents will help to ensure the best possible care for patients suffering from significant skin diseases like psoriasis.

Administration, Cutaneous↗