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Psoriasis: HELP
Articles from Nijmegen
Based on 206 articles published since 2008
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These are the 206 published articles about Psoriasis that originated from Nijmegen during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Guideline European S3-Guideline on the systemic treatment of psoriasis vulgaris - Update Apremilast and Secukinumab - EDF in cooperation with EADV and IPC. 2017

Nast, A / Spuls, P I / van der Kraaij, G / Gisondi, P / Paul, C / Ormerod, A D / Saiag, P / Smith, C H / Dauden, E / de Jong, E M / Feist, E / Jobling, R / Maccarone, M / Mrowietz, U / Papp, K A / Reich, K / Rosumeck, S / Talme, T / Thio, H B / van de Kerkhof, P / Werner, R N / Dressler, C. ·Division of Evidence-Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands. · Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy. · Department of Dermatology, Paul Sabatier University, Toulouse, France. · Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK. · Service de Dermatologie, Hôpital Ambroise Paré Université Paris V, Boulogne, France. · St Johns Institute of Dermatology, Guys and St Thomas' Hospital Foundation Trust, London, UK. · Hospital Universitario de la Princesa, Madrid, Spain. · Radboud University medical center and Radboud University, Nijmegen, The Netherlands. · Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Cambridge, UK. · Roma, Italy. · Department of Dermatology, Psoriasis-Center University Medical Center Schleswig Holstein, Kiel, Germany. · Waterloo, Canada. · Dermatologikum Hamburg, Hamburg, Germany. · Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. ·J Eur Acad Dermatol Venereol · Pubmed #28895202.

ABSTRACT: -- No abstract --

2 Guideline European S3-Guidelines on the systemic treatment of psoriasis vulgaris--Update 2015--Short version--EDF in cooperation with EADV and IPC. 2015

Nast, A / Gisondi, P / Ormerod, A D / Saiag, P / Smith, C / Spuls, P I / Arenberger, P / Bachelez, H / Barker, J / Dauden, E / de Jong, E M / Feist, E / Jacobs, A / Jobling, R / Kemény, L / Maccarone, M / Mrowietz, U / Papp, K A / Paul, C / Reich, K / Rosumeck, S / Talme, T / Thio, H B / van de Kerkhof, P / Werner, R N / Yawalkar, N. ·Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy. · Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK. · Service de Dermatologie, Hôpital Ambroise Paré Université Paris V, Boulogne, France. · Clinical Lead for Dermatology, St Johns Institute of Dermatology, St Thomas' Hospital, London, UK. · Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands. · Third Faculty of Medicine, Department of Dermatology, Charles University, Prague, Czech Republic. · Department of Dermatology, Hôpital Saint-Louis, Paris, France. · St. Johns Institute of Dermatology, St. Thomas' Hospital, London, UK. · Hospital Universitario de la Princesa, Madrid, Spain. · University Medical Center Nijmegen St Radboud, Nijmegen, The Netherlands. · Medizinische Klinik mit Schwerpunkt Rheumatologie u. klinische Immonologie, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Cambridge, UK. · SZTE Borgyogyaszati Klinika, Szeged, Hungary. · Roma, Italy. · Department of Dermatology, Psoriasis-Center University Medical Center Schleswig Holstein, Kiel, Germany. · Waterloo, Canada. · Department of Dermatology, Paul Sabatier University, Toulouse, France. · Dermatologikum Hamburg, Hamburg, Germany. · Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Department of Dermatology, Erasmus University, Rotterdam, The Netherlands. · Department of Dermatology, University Hospital Nijmegen, Nijmegen, The Netherlands. · Department of Dermatology, Inselspital, Universitätsklinik für Dermatologie, Bern, Switzerland. ·J Eur Acad Dermatol Venereol · Pubmed #26481193.

ABSTRACT: -- No abstract --

3 Guideline Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology. 2014

Zweegers, J / de Jong, E M G J / Nijsten, T E C / de Bes, J / te Booij, M / Borgonjen, R J / van Cranenburgh, O D / van Deutekom, H / van Everdingen, J J E / de Groot, M / Van Hees, C L M / Hulshuizen, H / Koek, M B G / de Korte, W J A / de Korte, J / Lecluse, L L A / Pasch, M C / Poblete-Gutiérrez, P A / Prens, E P / Seyger, M M B / Thio, H B / Torcque, L A / de Vries, A C Q / van de Kerkhof, P C M / Spuls, Ph I. ·Dutch Society of Dermatology and Venereology. j.zweegers@derma.umcn.nl. ·Dermatol Online J · Pubmed #24656281.

ABSTRACT: This document provides a summary of the Dutch S3-guidelines on the treatment of psoriasis. These guidelines were finalized in December 2011 and contain unique chapters on the treatment of psoriasis of the face and flexures, childhood psoriasis as well as the patient's perspective on treatment. They also cover the topical treatment of psoriasis, photo(chemo)therapy, conventional systemic therapy and biological therapy.

4 Review Prevalence of genital psoriasis in patients with psoriasis. 2018

Meeuwis, Kim A P / Potts Bleakman, Alison / van de Kerkhof, Peter C M / Dutronc, Yves / Henneges, Carsten / Kornberg, Lori J / Menter, Alan. ·a Department of Dermatology , Radboud University Nijmegen Medical Center , Nijmegen , Netherlands. · b Eli Lilly and Company , Indianapolis , IN , USA. · c Lilly France , Neuilly sur Seine , France. · d Lilly Deutschland GmbH , Bad Homburg , Germany. · e Syneos Health , Raleigh , NC , USA. · f Baylor University Medical Center , Dallas , TX , USA. ·J Dermatolog Treat · Pubmed #29565190.

ABSTRACT: BACKGROUND: Psoriatic lesions in the genital area (GenPs) can cause considerable physical and emotional distress. To increase physician awareness, we estimated the GenPs prevalence among patients with psoriasis. METHODS: An English language literature search was performed. Articles reporting GenPs prevalence met the search criteria and were included. Because GenPs is rarely reported in demographics of prospective clinical trials, GenPs prevalence and baseline demographics of patients with and without GenPs in two prospective randomized phase 3b trials (NCT02561806 and NCT02634801) involving patients with moderate-to-severe psoriasis are reported. RESULTS: Overall, 600 references were screened. Eighteen articles met the search criteria. Patient populations were highly heterogeneous across articles. Broadly, the presence of GenPs was either physician-reported (physical examinations) or patient-reported (questionnaires). In the literature, GenPs prevalence at the time of reporting ranged from 7% to 42% and the prevalence of GenPs at any time during the course of psoriasis ranged from 33% to 63%. In the two prospective clinical trials, the prevalence of GenPs at the time of enrollment was 35-42%. CONCLUSION: A substantial proportion of patients experience genital lesions at some time during the course of psoriasis. Increased awareness of GenPs prevalence may drive improved assessment and treatment.

5 Review Past, present and future of in vitro 3D reconstructed inflammatory skin models to study psoriasis. 2018

Niehues, Hanna / van den Bogaard, Ellen H. ·Department of Dermatology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands. ·Exp Dermatol · Pubmed #29502346.

ABSTRACT: Psoriasis is a common chronic inflammatory skin disease with a significant socio-economic impact that can greatly affect the patients' quality of life. The prevailing dogma in the aetiology and pathophysiology of this complex disease is that skin cells, immune cells and environmental factors contribute to psoriatic skin inflammation. For a better understanding of the disease pathogenesis, models are required that mimic the disease and which can be used to develop therapeutics. Over the last decades, in vitro human reconstructed skin models have been widely used in dermatological research and have also been developed to mimic psoriatic skin. This viewpoint summarizes the most commonly used in vitro models and the latest accomplishments for the combination of the dermal and epidermal compartments with other cell types and factors that are important players in the psoriatic skin environment. We aim to critically list the most complete and best-validated models that include major psoriasis hallmarks with regard to gene and protein expression profile and epidermal morphology, but also discuss the shortcoming of the current models. This viewpoint intends to guide the development of in vitro 3D skin models that faithfully mimic all features of psoriatic skin. Such model will enable fundamental biological studies for a better understanding of the aetiology and pathophysiology of psoriasis and aid in novel therapeutic target identification and drug development studies.

6 Review Secukinumab for rheumatology: development and its potential place in therapy. 2016

Koenders, Marije I / van den Berg, Wim B. ·Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands. ·Drug Des Devel Ther · Pubmed #27445458.

ABSTRACT: Rheumatic disease is not a single disorder, but a group of more than 100 diseases that affect joints, connective tissues, and/or internal organs. Although rheumatic diseases like rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis (AS) differ in their pathogenesis and clinical presentation, the treatment of these inflammatory disorders overlaps. Non-steroid anti-inflammatory drugs are used to reduce pain and inflammation. Additional disease-modifying anti-rheumatic drugs are prescribed to slowdown disease progression, and is in RA more frequently and effectively applied than in AS. Biologicals are a relatively new class of treatments that specifically target cytokines or cells of the immune system, like tumor necrosis factor alpha inhibitors or B-cell blockers. A new kid on the block is the interleukin-17 (IL-17) inhibitor secukinumab, which has been recently approved by the US Food and Drug Administration for moderate-to-severe plaque psoriasis, psoriatic arthritis, and AS. IL-17 is a proinflammatory cytokine that has an important role in host defense, but its proinflammatory and destructive effects have also been linked to pathogenic processes in autoimmune diseases like RA and psoriasis. Animal models have greatly contributed to further insights in the potential of IL-17 blockade in autoimmune and autoinflammatory diseases, and have resulted in the development of various potential drugs targeting the IL-17 pathway. Secukinumab (AIN457) is a fully human monoclonal antibody that selectively binds to IL-17A and recently entered the market under the brand name Cosentyx(®). By binding to IL-17A, secukinumab prevents it from binding to its receptor and inhibits its ability to trigger inflammatory responses that play a role in the development of various autoimmune diseases. With secukinumab being the first in class to receive Food and Drug Administration approval, this article will further focus on this new biologic agent and review the milestones in its development and marketing.

7 Review Nail Psoriasis: A Review of Treatment Options. 2016

Pasch, Marcel C. ·Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen (370), The Netherlands. marcel.pasch@radboudumc.nl. ·Drugs · Pubmed #27041288.

ABSTRACT: Nail involvement affects 80-90 % of patients with plaque psoriasis, and is even more prevalent in patients with psoriatic arthritis. This review is the result of a systemic approach to the literature and covers topical, intralesional, conventional systemic, and biologic systemic treatments, as well as non-pharmacological treatment options for nail psoriasis. The available evidence suggests that all anti-tumor necrosis factor-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies which are available for plaque psoriasis and psoriatic arthritis are highly effective treatments for nail psoriasis. Conventional systemic treatments, including methotrexate, cyclosporine, acitretin, and apremilast, as well as intralesional corticosteroids, can also be effective treatments for nail psoriasis. Topical treatments, including corticosteroids, calcipotriol, tacrolimus, and tazarotene, have also been shown to have a position in the treatment of nail psoriasis, particularly in mild cases. Finally, non-pharmacological treatment options, including phototherapy, photodynamic therapy, laser therapy, and several radiotherapeutic options, are also reviewed but cannot be advised as first-line treatment options. Another conclusion of this review is that the lack of a reliable core set of outcomes measures for trials in nail psoriasis hinders the interpretation of results, and is urgently needed.

8 Review Effectiveness of Biologic and Conventional Systemic Therapies in Adults with Chronic Plaque Psoriasis in Daily Practice: A Systematic Review. 2016

Zweegers, Jeffrey / Otero, Marisol E / van den Reek, Juul M P A / van Lümig, Paula P / Driessen, Rieke J / Kievit, Wietske / Seyger, Marieke M B / van de Kerkhof, Peter C M / de Jong, Elke M G J. ·Department of Dermatology 370, Radboud University Medical Centre, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands. jeffrey_zweegers@hotmail.com. ·Acta Derm Venereol · Pubmed #26537336.

ABSTRACT: The efficacy of biologic or conventional systemic therapies for psoriasis has been shown in randomized controlled trials. Effectiveness, however, has been studied in daily practice cohorts, and no aggregation of effectiveness data is available. This systematic review searched PubMed and EMBASE and summarized the real-world evidence on effectiveness of biologics (adalimumab, etanercept, infliximab and ustekinumab) and conventional systemic therapies (acitretin, cyclosporine, fumarates and methotrexate) for the treatment of plaque psoriasis in adults. Thirty-two studies were included. Few data were available on infliximab, ustekinumab and conventional systemics. Results show that biologics and conventional systemics were effective in real-life treatment of psoriasis, with large ranges in the percentage of patients reaching 75% improvement in psoriasis area and severity index score compared with baseline, especially for etanercept and adalimumab treatment. Combination therapies of biologics with conventional systemics, and dose adjustments of biologics were frequently applied strategies and may explain the large range in improvements between cohorts.

9 Review Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities. 2015

Bronckers, I M G J / Paller, A S / van Geel, M J / van de Kerkhof, P C M / Seyger, M M B. ·Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. inge.bronckers@radboudumc.nl. · Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. ·Paediatr Drugs · Pubmed #26072040.

ABSTRACT: Psoriasis is a common chronic immune-mediated inflammatory skin disorder and begins in childhood in almost one-third of the cases. Although children present with the same clinical subtypes of psoriasis seen in adults, lesions may differ in distribution and morphology, and their clinical symptoms at presentation may vary from those reported by adult patients. Nevertheless, diagnosis of psoriasis is primarily based on clinical features. Pediatric psoriasis can have a profound long-term impact on the psychological health of affected children. Additionally, pediatric psoriasis has been associated with certain comorbidities, such as obesity, hypertension, hyperlipidemia, diabetes mellitus and rheumatoid arthritis, making early diagnosis and management essential. As guidelines are lacking and most (systemic) treatments are not approved for use in children, treatment of pediatric psoriasis remains a challenge. A prospective, multicenter, international registry is needed to evaluate these treatments in a standardized manner and ultimately to develop international guidelines on pediatric psoriasis. This article reviews current concepts in pediatric psoriasis including epidemiology, clinical features, diagnosis, the role of topical and systemic agents and the association with other morbidities in childhood.

10 Review Drug Survival Studies in Dermatology:Principles, Purposes, and Pitfalls. 2015

van den Reek, Juul M P A / Kievit, Wietske / Gniadecki, Robert / Goeman, Jelle J / Zweegers, Jeffrey / van de Kerkhof, Peter C M / Seyger, Marieke M B / de Jong, Elke M G J. ·Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Juul.vandenReek@Radboudumc.nl. · Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Dermatology, Bispebjerg Hospital, Bispebjerg, Denmark. · Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. ·J Invest Dermatol · Pubmed #26066896.

ABSTRACT: -- No abstract --

11 Review Placebo effects on itch: a meta-analysis of clinical trials of patients with dermatological conditions. 2015

van Laarhoven, Antoinette I M / van der Sman-Mauriks, Ineke M / Donders, A Rogier T / Pronk, Mathilde C / van de Kerkhof, Peter C M / Evers, Andrea W M. ·Unit Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: A.vanlaarhoven@fsw.leidenuniv.nl. · Unit Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands. · Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. · Unit Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands. ·J Invest Dermatol · Pubmed #25609025.

ABSTRACT: Although placebo contributes to the effects of treatment for various symptoms and conditions, its effect on itch has rarely been investigated. In this meta-analysis, the magnitude of the placebo effect on itch was systematically investigated in clinical trials including patients with chronic itch due to atopic dermatitis, psoriasis, or chronic idiopathic urticaria. From searches in four databases, 34 articles were included in the quantitative analyses. Placebo treatment significantly decreased itch (1.3 out of 10, 95% confidence interval 1.02-1.61) compared with baseline itch (effect size 0.55), indicating that placebo effects have a considerable role in these patients' treatment.

12 Review An update on topical therapies for mild-moderate psoriasis. 2015

van de Kerkhof, Peter C M. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500HB, The Netherlands. Electronic address: Peter.vandekerkhof@radboudumc.nl. ·Dermatol Clin · Pubmed #25412784.

ABSTRACT: Topical therapies are the mainstream treatment of psoriasis because most patients have mild disease. First-line treatments are vitamin D derivatives and corticosteroids. These treatments are usually given in combination schedules. For topical treatments the selection of the most appropriate vehicle is of major importance, thus improving adherence to the treatment, which frequently is impaired by the complexities of topical therapeutic choices. Evidence for efficacy and safety of topical treatments is readily available for vitamin D treatments and short-term treatment with corticosteroids. However, the scientific evidence for longer-term treatments is limited. Multiple new small molecules are in various stages of development and are reviewed.

13 Review The value of in vivo reflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. 2015

Hoogedoorn, L / Peppelman, M / van de Kerkhof, P C M / van Erp, P E J / Gerritsen, M J P. ·Department of Dermatology, Radboud University Medical Center, PO Box 9101, NL 6500 HB, Nijmegen, the Netherlands. ·Br J Dermatol · Pubmed #25355622.

ABSTRACT: In vivo examination of the skin by reflectance confocal microscopy (RCM) has been performed for about 20 years, leading to a broad spectrum of imaged infectious and inflammatory skin diseases (ISD) with many described RCM features. We systematically reviewed all available literature concerning ISD evaluated by RCM. Furthermore, we assessed the accuracy of the features and defined recommendations for future studies after indicating the limitations in the current published literature. PubMed, Embase, Cochrane Library and Web of Science databases were searched for literature. All studies on RCM and ISD were reviewed and quality assessment was determined by using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. The literature search revealed 77 eligible studies for inclusion. Different RCM features in a broad spectrum of ISD have been described. Further, RCM has been used for monitoring treatment and evolution of ISD, as well as for diagnostic purposes. This systematic review provides an overview of the broad spectrum of ISD imaged by RCM. Although RCM seems to be a promising monitoring and diagnostic tool for ISD, studies with appropriate methodological quality are necessary to create adequate guidelines and protocols for further implementation of RCM in clinical practice.

14 Review Systemic treatments in paediatric psoriasis: a systematic evidence-based update. 2015

van Geel, M J / Mul, K / de Jager, M E A / van de Kerkhof, P C M / de Jong, E M G J / Seyger, M M B. ·Department of Dermatology, Radboud university medical center, Nijmegen, the Netherlands. ·J Eur Acad Dermatol Venereol · Pubmed #25346019.

ABSTRACT: In 2008, a systematic review revealed that evidence-based data on efficacy and safety of treatments in paediatric psoriasis are scarce and with low level of evidence. In recent years, publications on this topic have increased exponentially. To present a systematic, evidence-based update on the efficacy and safety of systemic treatments in paediatric psoriasis and to provide treatment recommendations, an update of the previous review was performed. PubMed, EMBASE and the Cochrane Controlled Clinical Trial Register were searched between January 2007 and March 2014 for all available literature on efficacy and safety of all systemic treatments in paediatric psoriasis. The levels of evidence were determined on the Oxford Centre for Evidence-based Medicine Levels of Evidence. The newly retrieved evidence was combined with the evidence available in the former review. Fifty-two studies were included: 36 from the former review, plus 16 new articles. New evidence on induction therapy was mainly available on fumaric acid esters (FAEs), which are shown to be effective in a subgroup of patients. Long-term (96 weeks) safety and efficacy data on etanercept were found. Prospective studies are scarce. Most conclusions are formulated on studies with low level of evidence. Of the conventional systemic treatments, methotrexate still has the most evidence albeit in a low number of patients and with a low level of evidence. FAEs seem to be effective in a subgroup of patients, with gastro-intestinal complaints, flushes and temporary shifts in leucocyte counts and liver enzymes being the main side-effects. Etanercept has still accumulated most evidence of the available systematic treatments, with a large efficacy and reassuring safety profile in a 96-week follow-up.

15 Review Combined use of systemic agents for psoriasis: a systematic review. 2014

Busard, Celine / Zweegers, Jeffrey / Limpens, Jacqueline / Langendam, Miranda / Spuls, Phyllis I. ·Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. · Medical Library, Academic Medical Center, Amsterdam, the Netherlands. · Dutch Cochrane Centre, Academic Medical Center, Amsterdam, the Netherlands. ·JAMA Dermatol · Pubmed #25188393.

ABSTRACT: IMPORTANCE: Combined use of systemic agents may be necessary to achieve disease control in therapy-resistant patients. However, to our knowledge, an overview of evidence, including quality assessments, is not yet available, and no guidance on monitoring, contraindications, and interactions exists. OBJECTIVES: To summarize and critically appraise the evidence on efficacy and safety of combination therapy with systemic agents in plaque-type psoriasis. EVIDENCE REVIEW: Through March 2013, an electronic search limited to randomized clinical trials was performed in MEDLINE, EMBASE, The Cochrane Library, and ongoing trial registers. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. FINDINGS: The initial search retrieved 2583 records, of which 17 met the inclusion criteria. Most studies favored combination therapy, albeit with low significance and low quality of evidence. Etanercept plus methotrexate was the only combination therapy investigated with an adequate sample size (n = 478). In the short term, this combination had superior efficacy with a moderate quality of evidence compared with etanercept monotherapy (Psoriasis Area and Severity Index, 75; relative risk, 1.28; 95% CI, 1.14-1.45). Although this finding coincided with an increase in adverse events (relative risk, 1.25; 95% CI, 1.10-1.42), the overall safety profile remained acceptable. CONCLUSIONS AND RELEVANCE: This systematic review provides a comprehensive overview on the validity of different systemic combination therapies. For most combinations, insufficient evidence is available. Initial results indicate that combined therapy with etanercept plus methotrexate may be beneficial in patients that are therapy resistant under intensive follow-up. Dose reductions should be taken into account to minimize adverse effects.

16 Review Unmet needs in the treatment of psoriasis. 2014

Kragballe, Knud / van de Kerkhof, Peter C M / Gordon, Kenneth B. ·Dept of Dermatology, Århus University Hospital, Århus Sygehus, P.P. Ørums Gade 11, 8000 Århus, Denmark. · Dept of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. · Dept of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. ·Eur J Dermatol · Pubmed #25115238.

ABSTRACT: Biologics have greatly improved the treatment of moderate-to-severe plaque psoriasis, as most patients are now able to achieve an initial improvement of 75% in the Psoriasis Area and Severity Index. However, only ∼20%-57% reach a 90% improvement in this measurement and responses may be lost over time. In addition, there are potential safety issues as TNF-inhibitor biologics have been associated with infections or non-melanoma skin malignancies. Here we review unmet needs with current therapies for psoriasis. We researched the medical literature to discuss new therapies in development and assess their potential to meet these needs. Several new classes of anti-psoriatic drugs are currently undergoing clinical development and potential improvements with these new therapies include attaining earlier and higher-level responses that are durable, more specific targeting of cytokines involved directly in psoriatic inflammation, and new therapies offering convenient administration. Additionally, based on results from clinical trials evaluating these new agents, it may be possible to find predictive markers that identify patients best treated with certain drug classes, those prone to lose treatment responses and patients who can discontinue treatment and remain in remission. It remains to be determined whether the promising results seen in early studies of therapies in development for psoriasis will translate into actual improvements over currently available treatment options.

17 Review Cellular sources of IL-17 in psoriasis: a paradigm shift? 2014

Keijsers, Romy R M C / Joosten, Irma / van Erp, Piet E J / Koenen, Hans J P M / van de Kerkhof, Peter C M. ·Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands; Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud university medical center, Nijmegen, The Netherlands. ·Exp Dermatol · Pubmed #25039885.

ABSTRACT: Psoriasis is a common chronic inflammatory skin disease that results from interplay between the immune system and the epithelium. In the light of very successful anticytokine therapies for psoriasis, the focus has been directed towards the adaptive immune system. Expression studies, genetic studies and treatments specifically targeting players of the IL-23/IL-17 pathway, point at an important role for IL-17 in the pathogenesis of psoriasis. IL-17 stimulates the keratinocytes to produce psoriasis-associated molecules, eventually leading to chronic skin inflammation. The current opinion is that IL-17 is mainly produced by T cells, so-called T-helper 17 (Th17) cells, in psoriasis. However, evidence is accumulating that cells of the innate immune system, like neutrophils, mast cells, γδ T cells and innate lymphoid cells are the main source of IL-17 in psoriasis, rather than T cells. The paradigm in this field of research is shifting. With this viewpoint article, we will address this novel concept by critically summarizing the current literature on this subject. In psoriatic arthritis and atherosclerosis, important conditions related to psoriasis, it was also found that the majority of IL-17 is associated with cells of the innate immune system. This new concept changes our view of IL-17. Blocking IL-17 with targeted treatments might be more far-reaching than previously thought; not only IL-17 production by T cells but also by innate immune cells is blocked. Furthermore, therapies specifically targeting IL-17 may not only improve psoriasis, but also comorbidity that is associated with the IL-17 pathway, hereby preventing serious complications on the long term.

18 Review The prevalence of onychomycosis in psoriatic patients: a systematic review. 2014

Klaassen, K M G / Dulak, M G / van de Kerkhof, P C M / Pasch, M C. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. ·J Eur Acad Dermatol Venereol · Pubmed #24033871.

ABSTRACT: We systematically reviewed all available literature concerning the prevalence of onychomycosis in patients with nail psoriasis and the distribution of pathogens causing onychomycosis in this specific group of patients. Databases searched were Pubmed, EMBASE and the Cochrane Controlled Clinical Trial Register. All studies reporting on the prevalence of onychomycosis in nail psoriasis were obtained, and quality assessment was determined by the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Literature search revealed 720 studies, of which 10 studies met the inclusion criteria. The major limitation of the review was the heterogeneity of the included studies, which prevented the possibility to conduct a meta analysis. However, the average prevalence of 18.0% of onychomycosis in psoriatic patients seems to be increased when compared with control groups and literature on healthy population, even though the ultimate evidence remains lacking. As in the literature hypothesized shift in causative agents from dermatophytes to yeasts and/or moulds could not be confirmed. The clinical consequence of the relatively high prevalence of onychomycosis in psoriasis may be a general advice to rule out onychomycosis or concomitant onychomycosis in these patients with (suspected) nail psoriasis. This advice is stressed by the relative simplicity of treating the contribution of onychomycosis in the nail dystrophy but also the fact that nail psoriasis mostly is treated by immunosuppressive drugs, like steroids, methotrexate or biologics which may aggravate mycotic nail infections.

19 Review Th17 cells and IL-17 a--focus on immunopathogenesis and immunotherapeutics. 2013

van den Berg, Wim B / McInnes, Iain B. ·Rheumatology Research and Advanced Therapeutics, Department of Rheumatology, Radboud University Nijmegen Medical Center, Geert Grooteplein 26, 6525 GA Nijmegen, The Netherlands. Electronic address: w.vandenberg@reuma.umcn.nl. ·Semin Arthritis Rheum · Pubmed #24157091.

ABSTRACT: IMPORTANCE: Accumulating evidence suggests that IL-17 A has broad pathogenic roles in multiple autoimmune and immune-mediated inflammatory diseases, including psoriasis and rheumatoid arthritis (RA). The development of new therapies that inhibit IL-17 pathway signaling is of clinical significance. OBJECTIVES: This review aims to summarize the current preclinical evidence on the role of Th17 cells and IL-17 and related cytokines in immune-mediated disease pathophysiology, with a focus on psoriasis and rheumatoid arthritis, as well as to summarize recent clinical trials in these indications with newly developed IL-17 pathway inhibitors. METHODS: A systematic literature search was conducted of PubMed using relevant keywords. Studies were assessed according to recent relevance to IL-17-mediated pathophysiology and clinical IL-17 inhibition. Experimental animal models of autoimmune disease and clinical studies that focused on IL-17 pathway inhibitors were included. RESULTS: Preclinical studies suggest that IL-17A is an attractive therapeutic target. Several IL-17A inhibitors have advanced into clinical trials, including the anti-IL-17A monoclonal antibodies, secukinumab and ixekizumab, and the anti-17RA monoclonal antibody brodalumab. Each has shown variable and sometimes favorable results in proof-of-concept and phase II clinical trials and is currently undergoing further clinical evaluation in a range of immune-mediated diseases. CONCLUSION: Targeting the IL-17 pathway shows promise as strategy to treat immune-mediated diseases ranging from skin to joints.

20 Review Efficacy and safety of combinations of first-line topical treatments in chronic plaque psoriasis: a systematic literature review. 2013

Hendriks, A G M / Keijsers, R R M C / de Jong, E M G J / Seyger, M M B / van de Kerkhof, P C M. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. a.hendriks@derma.umcn.nl ·J Eur Acad Dermatol Venereol · Pubmed #23279069.

ABSTRACT: BACKGROUND: Most psoriasis patients suffering from mild to moderate disease are treated with first-line topical treatments, including corticosteroids, vitamin D analogues, topical retinoids and calcineurin inhibitors. Although evidence-based guidelines on combinations are lacking, the majority of patients will be treated with combinations of these popular topicals at some point during their life-long treatment. OBJECTIVES: We intended to systematically review all available literature on the efficacy and safety of combinations of first-line topicals in chronic plaque psoriasis, and ultimately, to propose recommendations for combined regimens concerning first-line treatments. METHODS: Databases used as data sources were PubMed, EMBASE and the Cochrane Controlled Clinical Trial Register. According to standardized procedures, literature searches were performed and a level of evidence was determined. RESULTS: In total, 2918 publications on topical combination therapy were revealed, of which 45 articles on first-line combinations were included. The combination of potent and superpotent corticosteroids with vitamin D analogues provides an improvement of psoriasis within 2 weeks, reaching a maximal improvement after 4 weeks in the majority of patients. The two-compound product permits once-daily treatment and therefore is a good solution for chronic plaque psoriasis including scalp psoriasis. Combinations of corticosteroids, with tazarotene or with calcineurin inhibitors do not provide an advantage above corticosteroid monotherapy. CONCLUSION: The combination of potent corticosteroids with calcipotriol has been studied most extensively and should be regarded as an efficacious and safe treatment option with the two-compound products as the most practical solution.

21 Review Combinations of classical time-honoured topicals in plaque psoriasis: a systematic review. 2013

Hendriks, A G M / Keijsers, R R M C / de Jong, E M G J / Seyger, M M B / van de Kerkhof, P C M. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. a.hendriks@derma.umcn.nl ·J Eur Acad Dermatol Venereol · Pubmed #22779910.

ABSTRACT: BACKGROUND: Despite the availability of newer topical treatments, classical topical treatments for chronic plaque psoriasis still have an important position for selected patient populations. The vast majority of patients are treated with a combination of topicals. The question arises: what is the evidence behind these approaches? OBJECTIVES: To systematically review all available literature on efficacy and safety of combinations of classical topical treatments in chronic plaque psoriasis, including all combinations with dithranol, coal tar and penetration enhancers, and ultimately, to propose recommendations for combination treatment. METHODS: Standardized literature searches in PubMed, EMBASE and the Cochrane Controlled Clinical Trial Register, and allocation of the degree of evidence was carried out. RESULTS: In total 2918 publications on topical combination therapy were revealed, of which 48 articles on combinations of classical treatments. In this article, the results concerning the 19 included publications are stated. The majority of combination regimens is at least as effective as monotherapies, and is generally well tolerated. CONCLUSIONS: Methods of classical treatments are not standardized and different protocols in different treatment settings are used. Therefore the interpretation of study results cannot be generalized. Most evidence was found to recommend the use of a combination regimen of topical corticosteroids and salicylic acid, above monotherapy with either component. Also, the combinations of dithranol with superpotent corticosteroids or with coal tar may be preferred above both monotherapies. In case first-line treatments and systemic therapies are not effective or contraindicated, combinations of classical topicals may provide an important opportunity.

22 Review Factors impacting the combination of topical corticosteroid therapies for psoriasis: perspectives from the International Psoriasis Council. 2011

van de Kerkhof, P C M / Kragballe, K / Segaert, S / Lebwohl, M / Anonymous2050694. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. p.vandekerkhof@derma.umcn.nl ·J Eur Acad Dermatol Venereol · Pubmed #21564329.

ABSTRACT: Corticosteroids are the mainstay of topical therapies for the treatment of mild to moderate psoriasis. Selection of vehicle, concentrations of corticosteroid and coadministered medications, and frequency of administration are critical factors that enhance bioavailability of topical corticosteroids. Topical corticosteroids are commonly used as polytherapy and combination therapy with other agents, such as salicylic acid, vitamin D analogues and tazarotene. Combinations are selected for the ability to enhance efficacy while minimizing corticosteroid-related side-effects, such as cutaneous atrophy. New, innovative products such as sprays, foams and nail lacquers provide opportunities to tailor treatment for individuals, which promotes patient adherence to medications. This review covers features of topical corticosteroid formulations that affect bioavailability, efficacy and safety when used as monotherapy and in combination with other agents for the treatment of mild to moderate psoriasis.

23 Review Mixed treatment comparison of a two-compound formulation (TCF) product containing calcipotriol and betamethasone dipropionate with other topical treatments in psoriasis vulgaris. 2011

van de Kerkhof, Peter / de Peuter, Ria / Ryttov, Jacob / Jansen, Jeroen P. ·University Hospital Nijmegen, The Netherlands. ·Curr Med Res Opin · Pubmed #21142833.

ABSTRACT: OBJECTIVE: The efficacy of the two-compound formulation (TCF) product containing calcipotriol and betamethasone dipropionate applied once daily in psoriasis has been demonstrated in phase III trials but no randomised clinical trial comparing all commonly used topical treatments exists. The aim of the study was to compare the efficacy of once-daily use of the TCF product relative to other commonly used topical agents in plaque psoriasis. RESEARCH DESIGN AND METHODS: Data on change in Psoriasis Area and Severity Index (PASI) score from baseline and PASI 75 (percentage of patients achieving a 75% reduction in PASI score), after 4 weeks of treatment were obtained by means of a systematic literature review of randomised controlled trials and synthesised with a Bayesian mixed treatment comparison meta-analysis. RESULTS: Relative to all active interventions, except for the unlicensed twice-daily application of the TCF product, the TCF once daily showed a greater efficacy based on PASI 75 response (relative risk ranging from 1.22 to 3.18) and improvement in PASI score from baseline (difference in % CFB PASI between TCF once daily and other active interventions ranged from 4.01 to 49.68). CONCLUSION: Among topical therapies evaluated, TCF once daily can be considered the most efficacious treatment for plaque psoriasis.

24 Review Genital psoriasis: A systematic literature review on this hidden skin disease. 2011

Meeuwis, Kim A P / de Hullu, Joanne A / Massuger, Leon F A G / van de Kerkhof, Peter C M / van Rossum, Michelle M. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, The Netherlands. k.meeuwis@derma.umcn.nl ·Acta Derm Venereol · Pubmed #20927490.

ABSTRACT: It is well known that the genital skin may be affected by psoriasis. However, little is known about the prevalence and clinical appearance of genital psoriasis, and genital skin is often neglected in the treatment of psoriatic patients. We performed an extensive systematic literature search for evidence-based data on genital psoriasis with respect to epidemiology, aetiology, clinical and histopathological presentation, diagnosis and treatment. Three bibliographical databases (PubMed, EMBASE and the Cochrane Library) were used as data sources. Fifty-nine articles on genital psoriasis were included. The results show that psoriasis frequently affects the genital skin, but that evidence-based data with respect to the efficacy and safety of treatments for genital psoriasis are extremely limited. An advised treatment paradigm for genital psoriasis, based on the levels of evidence, is: first-line: (weak) topical corticosteroids; second-line: vitamin D preparations or tar-based treatments.

25 Review Acitretin revisited in the era of biologics. 2011

Booij, Mariëlle Te / Van De Kerkhof, Peter C M. ·Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. ·J Dermatolog Treat · Pubmed #20673152.

ABSTRACT: Acitretin is a time-honored treatment for psoriasis. During the last decade biologics have revolutionized the treatment of psoriasis. This raises the question: What is the position of acitretin as a classical systemic treatment for psoriasis in the era of biologics? Based on the mode of action of acitretin, it is evident that at least one antipsoriatic treatment has to be available in the armamentarium of antipsoriatic treatments that is not immunosuppressive, intended for those patients who are contraindicated for immunosuppressive treatment. It is attractive to speculate that at least an additive or possibly a synergistic effect can be expected in case of combination of acitretin with a biologic. The efficacy of acitretin in chronic plaque psoriasis as a monotherapy is below methotrexate and cyclosporine. However, acitretin in combination with phototherapy has an efficacy at least comparable with the other classical systemic treatments. Based on several clinical studies it can be concluded that acitretin is an important treatment option in case of contraindications for immunosuppression, such as patients with infections or cancer-prone patients. Furthermore, some evidence is available for high efficacy of the combination of acitretin and biologics.

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