Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists

Paul, C.; Gallini, Adeline; Maza, A.; Montaudié, Henri; Sbidian, É.; Aractingi, S.; Aubin, F.; Bachelez, Hervé; Cribier, B.; Joly, P.; Jullien, D.; Maître, Michel; Miséry, Laurent; Richard, M.‐A.; Jp, Ortonne

doi:10.1111/j.1468-3083.2011.03990.x

Cited by 73 publications

(62 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although these results are at odds with the substantially higher incidence of cirrhosis reported in a few early studies, [14][15][16] 34 Thus, it is likely that the higher incidence of MTX-related cirrhosis in older studies was related to greater prevalence of intake of hepatotoxins such as alcohol, vitamin A and arsenic, and/ or use of daily or high cumulative dosing regimens. Moreover, implementation of more recent recommendations to co-administer folic acid 8,62,63 may have protected against hepatotoxicity. 64 Lastly, it is conceivable that an indolent disease course even among biopsy-proven cirrhotics, as suggested by histological improvement on drug withdrawal and absence of decompensation despite continuation at low dose, 59, 65 could have contributed to a lower requirement for transplantation in this series.…”

Section: Discussionmentioning

confidence: 99%

End‐stage methotrexate‐related liver disease is rare and associated with features of the metabolic syndrome

Dawwas

Aithal

2014

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundMethotrexate (MTX) is one of the most frequently prescribed drugs in contemporary medicine with a well‐recognised hepatotoxic potential, for which stringent laboratory and histological surveillance has long been advocated.AimTo estimate the population burden of end‐stage methotrexate‐related liver disease (MTX‐LD) in the United States and identify independent host risk factors for this disease entity.MethodsWe analysed the records of all individuals who had been listed for, and/or received, liver transplantation in the United States, as reported to the Organ Procurement and Transplantation Network between 1 October 1987 and 31 December 2011, and identified those whose liver disease was attributed, wholly or partly, to MTX therapy. We also compared the demographic and clinical characteristics of adult individuals with MTX‐LD with those listed and/or transplanted for alcoholic liver disease (ALD, n = 43 285), non‐alcoholic steatohepatitis (NASH, n = 7569) and primary sclerosing cholangitis (PSC, n = 8526) using the adjusted odds ratios (AORs) derived from multi‐variable logistic regression models.ResultsOf 158 904 adults who had been listed for, and/or received, liver transplantation during the study period, only 117 (0.07%) had MTX‐LD. Compared with individuals with ALD and PSC, those with MTX‐LD were more likely to be older (AORs per 5‐year increase: 1.27, P < 0.001 and 1.33, P < 0.001 respectively); female (AORs: 1.78, P = 0.003 and 3.87, P < 0.001); Caucasian (AORs: 3.03, P = 0.001 and 2.05, P = 0.04); and diabetic (AORs: 2.76, P < 0.001 and 4.12, P < 0.001). With the exception of Caucasian ethnicity (AOR: 1.94, P = 0.05), the odds of these characteristics did not differ from individuals with NASH. The odds of elevated body mass index among MTX‐LD individuals were higher than those with PSC (AOR per 5 kg/m2: 1.51, P < 0.001); similar to those with ALD (AOR per 5 kg/m2:1.15, P = 0.1); and lower than those with NASH (AOR per 5 kg/m2: 0.66, P < 0.001).ConclusionsThe United States population burden of end‐stage methotrexate‐related liver disease is likely to be exceedingly small, suggesting the need for reappraisal of current hepatotoxicity surveillance guidelines. The risk factor profile of methotrexate‐related liver disease supports the notion that it may share a common pathogenesis with NASH.

show abstract

Section: Discussionmentioning

confidence: 99%

End‐stage methotrexate‐related liver disease is rare and associated with features of the metabolic syndrome

Dawwas

Aithal

2014

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Second, recommendations for daily clinical practice were formulated by a group of dermatologists with a special interest in psoriasis. 1,7,8 In November 2011, the 10 psoriasis experts (CP, SA, FA, BC, PJ, DJ, MLM, LM, MAR, JPO) from the scientific committee selected clinically relevant questions addressing three major domains relevant to psoriasis comorbidities: risk of cardiovascular events, risk of cancer, alcohol consumption in psoriasis. A Delphi voting process was initiated to select the most clinically relevant questions as described before (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Mean agreement (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) Is there an increased risk of cardiovascular morbidity and mortality in psoriasis patients? Can subgroups at higher risk be identified to adapt their disease management?…”

Section: Recommendationsmentioning

confidence: 99%

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

Richard

Barnetche²,

Horreau

et al. 2013

Acad Dermatol Venereol

View full text Add to dashboard Cite

The relationship between psoriasis, chronic inflammation, cardiovascular risk and risk of cancer has long been debated.In addition, it has been suggested that alcohol consumption may be a risk factor for psoriasis onset and severity.The aim of this study was to develop evidence-based recommendations on the risk of comorbidities and its management for daily clinical use, focusing on cardiovascular risk, risk of cancer and alcohol use in psoriasis.A scientific committee identified and selected through the Delphi method clinically relevant questions about cardiovascular risk, risk of cancer and alcohol use in psoriasis. To address these questions, a systematic literature search was performed in Medline, Embase and the Cochrane Library databases. Systematic literature reviews including meta-analysis whenever possible were performed. Subsequently, an Expert board meeting involving 39 dermatologists took place to analyse the evidence and to elaborate recommendations on the selected questions. Recommendations were graded according to the Oxford level of evidence grading system. The degree of agreement of these recommendations was assessed on a 10-point scale, as well as their potential impact on daily clinical practice.A total of 3242 articles were identified through the systematic literature searches, among which 110 were included in the systematic reviews. Overall, 12 recommendations were elaborated regarding comorbidities management in psoriasis patients. A moderate increased risk of cardiovascular diseases (CVD), mainly myocardial infarction (MI) [meta-analysis of cohort studies: OR = 1.25 (95% CI 1.03-1.52) and of cross-sectional studies: OR = 1.57 (95% CI 1.08-2.27)], and coronary artery disease (CAD) [meta-analysis of cross-sectional: OR = 1.19 (95% CI 1.14-1.24), of cohort studies: OR = 1.20 (95% CI 1.13-1.27) and of case-control studies: OR = 1.84 (95% CI 1.09-3.09)] was acknowledged. This increased cardiovascular risk requires appropriate prevention measures. There was a lack of substantial evidence that conventional systemic treatment has any effect on cardiovascular risk although methotrexate might be cardioprotective. An increased risk of solid cancer potentially associated with smoking and alcohol use was identified. The role of systemic treatment on cancer risk could not be assessed thoroughly due to limited long-term follow-up data. A higher risk of non-melanoma skin cancers especially squamous cell carcinoma was shown, mainly due to previous exposure to oral 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. No firm conclusion could be drawn regarding alcohol and psoriasis due to high variability in alcohol usage assessment in studies. Clinical experience suggests higher alcohol consumption among psoriasis patients compared to the general population. The mean expert participants' level of agreement on these recommendations varied from 6.8 to 9.4. These 12 recommendations are evidence based and supported by a panel of expert dermatologists. The next step is now to dis...

show abstract

“…52 It is recommended that the Modification of Diet in Renal Disease formula rather than the Cockcroft-Gault equation be used for overweight patients and those Ͼ50 years old. 18 After checking fasting serum lipids at the initiation of therapy, these levels can be tested at least every 6 months for evidence of hypercholesterolemia or hypertriglyc-eridemia. 52 Because of the monthly monitoring or laboratory tests and examinations, obtaining a CsA level is generally not necessary.…”

Section: Monitoringmentioning

confidence: 99%

Psoriasis Vulgaris: An Evidence-Based Guide for Primary Care

Kupetsky

Keller

2013

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists

Cited by 73 publications

References 76 publications

End‐stage methotrexate‐related liver disease is rare and associated with features of the metabolic syndrome

End‐stage methotrexate‐related liver disease is rare and associated with features of the metabolic syndrome

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

Psoriasis Vulgaris: An Evidence-Based Guide for Primary Care

Contact Info

Product

Resources

About