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Biomedical subjects

Steven R Feldman

Publications and source records attributed to Steven R Feldman.

At least 19 recordsLinked to original sources
PubMed2006

Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a common problem for which topical agents are the primary treatment. When topical medications fail, further therapy may include systemic agents with the potential for greater toxicity. Adherence to topical treatment of atopic dermatitis has not been well characterized. Poor adherence to topical medication could account for failure of topical therapy. PURPOSE: To determine adherence to topical treatment in patients with atopic dermatitis. METHODS: Thirty-seven children were given 0.1% triamcinolone ointment and were counseled to use it twice daily. They were told to return in 4 weeks, at which time they were told to continue treatment for another 4 weeks. Electronic monitors were used to measure adherence over the entire 8 week study. Patients were not informed of the compliance monitoring until the end of the study. RESULTS: Twenty-six patients completed 8 weeks of treatment. Mean adherence from the baseline to the end of the study was 32%. Adherence was higher on or near office visit days and subsequently decreased rapidly. LIMITATIONS: This study was limited by the large number of subjects who failed to return for follow-up appointments or withdrew from the study. CONCLUSIONS: Adherence to topical medications is very poor in a clinic population of children with atopic dermatitis. Office visits are one means to increase adherence. If adherence to topical treatment can be improved, exposure to more costly and potentially toxic systemic agents may be avoidable.

Administration, Topical↗
PubMed2006

A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis.

BACKGROUND: Previous studies of infliximab in psoriasis have demonstrated rapid improvement with induction therapy and sustained response with regularly administered maintenance therapy. OBJECTIVE: The efficacy and safety of continuous (every-8-week) and intermittent (as-needed) maintenance regimens were compared. METHODS: Patients with moderate-to-severe psoriasis (n = 835) were randomized to induction therapy (weeks 0, 2, and 6) with infliximab 3 mg/kg or 5 mg/kg or placebo. Infliximab-treated patients were randomized again at week 14 to continuous or intermittent maintenance regimens at their induction dose. RESULTS: At week 10, 75.5% and 70.3% of patients in the infliximab 5 mg/kg and 3 mg/kg groups, respectively, achieved PASI 75; 45.2% and 37.1% achieved PASI 90 (vs 1.9% [PASI 75] and 0.5% [PASI 90] for placebo; P < .001). Through week 50, PASI responses were better maintained with continuous compared with intermittent therapy within each dose, and with 5 mg/kg compared with 3 mg/kg continuous therapy. LIMITATIONS: Longer term (>1 year) maintenance therapy and further study of infliximab serum concentrations over this period, in both PASI 75 responders and non-responders, would be preferable. CONCLUSIONS: Through week 50, response was best maintained with continuous infliximab therapy. Infliximab was generally well-tolerated in most patients.

Adult↗
PubMed2006

Adapting electronic adherence monitors to standard packages of topical medications.

Adherence to topical medications is poorly characterized. Electronic monitors can provide objective adherence data, but these monitors are not designed to work with tubes of medications. We sought to adapt standard electronic monitors to commonly used medication tubes. An adapter was created to fit over standard medication tubes. Screw threads on the adapter were designed to fit standard electronic monitors. Adapters and monitors were tested with tubes of gel, ointment, and cream over an 8-week test period during which the adapters were opened and closed twice daily. The adapters were easily mated to both plastic and aluminum topical medication tubes. The bond between the adapter and the tube was maintained throughout the study. Electronic monitors were 100% accurate at identifying medication events over the study period. We conclude that adapting existing electronic monitors to medication tubes should facilitate a much better understanding of adherence to topical treatment.

Administration, Topical↗
PubMed2006

Quality of life in patients with psoriasis.

Psoriasis is one of the prevalent skin conditions in the United States. This chronic condition has a significant negative impact on patients' quality of life. Psoriasis has been linked to the depression and suicidal tendencies in the patients. The costs associated with decrements in quality of life, lost productivity, and work absenteeism may be enormous, increasing overall costs associated with the disease management. This review attempts to outline different quality of life measures available for psoriasis and describes their use in studies examining patient reported outcomes associated with pharmacological interventions for psoriasis. Factors associated with quality of life in psoriasis patients are described. It further describes physician's role in the psoriasis management to improve patients' overall well-being.

Absenteeism↗
PubMed2006

Low-dose acitretin is associated with fewer adverse events than high-dose acitretin in the treatment of psoriasis.

OBJECTIVE: In practice, lower dose acitretin therapy (25 mg/d) seems to be better tolerated and associated with fewer abnormalities found after laboratory testing. Here we revisit the original phase 3 trials for acitretin to evaluate the evidence for low-dose therapy producing fewer adverse effects than the 50 mg/d dosage. DESIGN: We retrospectively analyzed pooled data from 2 large pivotal trials, each including a randomized, placebo-controlled, 8-week double-blind phase followed by a 16-week open-label phase. SETTING: Multicenter pivotal trial of subjects in referral centers and private practice. PARTICIPANTS: Subjects with severe psoriasis requiring systemic therapy were recruited according to inclusion/exclusion criteria. INTERVENTION: During the double-blind phase, subjects received placebo or one of several fixed acitretin doses. Dose adjustment was allowed during the open-label phase, during which high-dose treatment was defined as a mean dosage of 50 mg/d and low-dose treatment was defined as a mean dosage of 25 mg/d. MAIN OUTCOME MEASURES: The frequency of anomalies found after laboratory testing and clinical adverse events were the outcomes of interest. RESULTS: Common adverse effects (dry skin, alopecia, rhinitis, etc) were 2 to 3 times more frequent in subjects receiving 50-mg/d acitretin than in those receiving 25 mg/d. Increases in hepatic enzymes and triglycerides in subjects receiving low-dose therapy were minimal compared with levels in those receiving high-dose therapy. CONCLUSIONS: We have shown low-dose therapy (25 mg/d) to be an effective strategy for substantially reducing acitretin-associated adverse effects. Many adverse effects associated with acitretin therapy are dose dependent and can limit the usefulness of this potentially beneficial therapy.

Acitretin↗
PubMed2006

Latino farmworker perceptions of the risk factors for occupational skin disease.

BACKGROUND: Farmworkers in the US constitute a medically underserved population at substantial risk for numerous environmental and occupational health problems. Most US farmworkers are Latino. Skin disease is one health problem to which farmworkers are particularly vulnerable. Interventions to reduce skin disease must be adapted to farmworkers' understanding of such disease, including their beliefs or knowledge of risk factors for skin disease. METHODS: Structured by the Explanatory Models of Illness framework, this analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (6 females, 24 males) to determine beliefs and perceptions of the causes of common occupational skin diseases in this population. Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. RESULTS: Skin disease is a major concern among farmworkers because it affects work, social interaction, and other aspects of their lives. Farmworker beliefs and perceptions of skin disease causation can be integrated into a general model in which perceived risk factors include sun and heat, chemicals, plants, insects, moisture, hygiene, and contagion. Each of these factors is moderated by the individual's personal susceptibility to that cause. The interaction or combination of two or more factors is thought to amplify their individual effects. CONCLUSIONS: The farmworker model of skin disease causation suggests important content for health education to reduce skin disease among farmworkers.

Adolescent↗
PubMed2006

Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners.

Frequent tanning has reinforcing properties. We tested whether opioid antagonism blocks potential reinforcing effect of indoor tanning in 8 frequent tanners and 8 infrequent tanner control subjects. Opioid blockade reduced ultraviolet preference in frequent tanners. Four of 8 frequent tanners, but no infrequent tanners, exhibited withdrawal-like symptoms with naltrexone administration. A limitation of this study is its small size.

Adolescent↗
PubMed2006

The negative impact of psoriasis on the workplace.

BACKGROUND: The health-related quality of life and economic impact of psoriasis has been documented. However, the negative impact of psoriasis on the workplace is poorly understood. AIM/METHODS: Through anonymous surveys from 30 subjects of each of three psoriasis severity groups we aim to quantify the workplace impact experienced by psoriasis patients and factors that may contribute to this impact. Data were collected using several previously validated measures including the Work Productivity Assessment Index (WPAI), SF-8, Hospital Anxiety and Depression (HADS) and past medical/psoriasis history. RESULTS: Psoriasis patients experienced negative impact at work as measured by the WPAI; this impact is directly associated with disease severity. The other instruments confirmed the negative impact of psoriasis though the degree of impact did not always correlate with disease severity or work impact. Owing to the relatively small numbers, the significance of these findings is not certain. CONCLUSIONS: This preliminary study finds that psoriasis is associated with a reduction in work productivity and social functioning; this may explain the relatively high cost of this disease on both a macro- and microeconomic level. As there was a lack of significant trends in this study, formal inferences are limited and further investigation is warranted.

Adult↗
PubMed2006

Novel combination regimens: biologics and acitretin for the treatment of psoriasis-- a case series.

Combination therapy has long been a mainstay of psoriasis treatment, particularly for those that suffer from moderate-to-severe disease. The biologics represent a new and exciting approach to psoriasis treatment though their use in combination regimens has not been adequately examined. This brief series reports on the combination of biologics with acitretin in the treatment of psoriasis.

Acitretin↗
PubMed2006

The cost-effectiveness and cost of treatment failures associated with systemic psoriasis therapies.

BACKGROUND: Psoriasis is difficult at times to treat and treatment failures are not uncommon regardless of approach. With the advent of expensive biologic therapies for psoriasis there is increasing discussion on the cost efficacy of a given systemic or biologic agent. An alternative and overlooked aspect of cost efficacy is the cost that accrues from treatment failures. METHODS: We review the literature and develop a model to analyze the cost-effectiveness and the cost of treatment failures per success for various systemic psoriasis agents using a 12-week treatment period. RESULTS: For continuous-dose agents, the cost-effectiveness results are: methotrexate $623, acitretin $2729, cyclosporine $2969, nUVB $3692, PUVA $4668, etanercept $16 312, and efalizumab $17 196. The cost of expected treatment failures to achieve one success for the same agents were: methotrexate $187, cyclosporine $505, PUVA $767, nUVB $1034, acitretin $1310, etanercept $8319, and efalizumab $12 897. CONCLUSIONS: Methotrexate appears to be the most cost-effective agent for the treatment of severe psoriasis. However, greater efficacy can be achieved with cyclosporine and PUVA, albeit at a greater cost. Because of the high cost of treatment failures, access to a wide array of therapies and combination regimens should not be discouraged by physicians or insurers.

Cost-Benefit Analysis↗
PubMed2006

New treatments for psoriasis: which biologic is best?

Psoriasis is a chronic, debilitating disease affecting not only the skin, but also having a significant impact on a patient's quality of life. The treatment of severe psoriasis is quite challenging due to the chronic, relapsing nature of the disease and the difficulties inherent in treatment planning. Though the biologics are perhaps the most promising of available psoriasis treatments, the decision to institute a given therapy may be fraught with complexity for the clinician. Patients now hear of these promising new treatments for psoriasis via print, television and radio advertising; they frequently come to their physician asking if they are eligible for any of these agents and, if so, 'which biologic is best?'. This paper attempts to determine the ideal biologic agent based upon several parameters: FDA- and EU-approved indications, therapeutic efficacy, impact on quality of life, cost-effectiveness, and safety profile. Certainly the physician is central to medical decision-making, though ultimately patient preference may play the largest role in determining the 'best' biologic agent. There is no single ideal biologic for all patients and a physician's job is to educate patients on the relative advantages and disadvantages of each agent. Through informed discussion, the clinician can help each individual patient decide which biologic agent is ideal for them.

Adalimumab↗
PubMed2006

Adherence in dermatology: a review of the last 20 years.

BACKGROUND: Adherence has been studied in many areas of medicine; however, there are few published articles pertaining to adherence and dermatology. OBJECTIVE: The purpose of this review is to summarize the current literature on medical adherence as it specifically applies to dermatology. METHODS: We conducted a PUBMED search between the years of 1985 and 2005 using the following terms: 1-[adherence AND dermatology] and 2-[dermatology AND treatment]. The search was limited to articles in English and human subjects. RESULTS: The literature search yielded 57 articles. Seventeen of these articles met the inclusion criteria and were reviewed in order to define, measure, quantify, validate, and understand adherence in dermatology. CONCLUSIONS: Adherence to topical therapy among dermatology patients is difficult to measure reliably, hence the few articles available on this topic. A small number of studies using new electronic monitoring technology have shown that dermatology patients have low adherence rates to treatment regimens. There are socioeconomic, cognitive, and psychological factors that contribute to non-adherence among patients. Improving patient knowledge and the doctor-patient relationship are ways to improve patient adherence.

Communication↗