the-goeckerman-regimen-for-treatment-moderate-to-severe

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

University of California, San Francisco 

Psoriasis is a chronic skin disorder affecting up to 2.5% of the world's population. Despite the myriad treatment options available, there is no uniformly accepted therapeutic approach for moderate-to-severe psoriasis. The objective of this review is to evaluate the relative efficacy and safety of available therapeutic options and to formulate general recommendations for the treatment of moderate-to-severe psoriasis. MEDLINE and Evidence Based Medicine (Cochrane) were used to perform a comprehensive search of the literature from 1986 to 2006. The most scientifically rigorous clinical trial published in the literature was selected for Psoriasis Area and Severity Index (PASI 75) comparison. Only information from clinical trials, human subjects and English language journals are reported in this study. The percentage of PASI 75 reduction at approximately 12 weeks obtained by the following treatment options were: Goeckerman and RePUVA, 100%; calcipotriene plus PUVA, 87%; ciclosporin, 78.2-80.3%; infliximab, 80%; adalimumab 40 mg every other week, 53% and 40 mg/week, 80%; PUVA, 63%; methotrexate, 60%; NB-UVB, 55%; acitretin 52%; etanercept 50 mg twice weekly, 49% and 25 mg twice weekly, 34%; efalizumab, 31.4%; and alefacept 21%. Psoriatic treatments with safer profiles compared with other agents include bath PUVA, Goeckerman and RePUVA. Based on the literature review of efficacy and safety of biologics and prebiologic treatment options for moderate-to-severe psoriasis, the risk:benefit ratio seems most favorable for Goeckerman and RePUVA, followed by either etanercept or adalimumab.

An attempt to formulate an evidence-based strategy in the management of moderate-to-severe psoriasis: a review of the efficacy and safety of biologics and prebiologic options.

Le psoriasis est une affection cutan&eacute;e chronique affectant jusqu&#39;&agrave; 2,5 % de la population mondiale. Malgr&eacute; les options de traitement multiples disponibles, il n&#39;y a aucune approche th&eacute;rapeutique uniform&eacute;ment accept&eacute;e pour le psoriasis mod&eacute;r&eacute; &agrave; s&eacute;v&egrave;re. L&#39;objectif de cette analyse est d&#39;&eacute;valuer l&#39;efficacit&eacute; relative et la s&eacute;curit&eacute; des options th&eacute;rapeutiques disponibles et formuler des recommandations g&eacute;n&eacute;rales pour le traitement du psoriasis mod&eacute;r&eacute; &agrave; s&eacute;v&egrave;re. MEDLINE et Evidence Based Medicine (Cochrane) ont &eacute;t&eacute; utilis&eacute;s pour effectuer une recherche exhaustive de la litt&eacute;rature de 1986 &agrave; 2006. L&#39;essai clinique plus scientifiquement rigoureuse, publi&eacute;e dans la litt&eacute;rature a &eacute;t&eacute; s&eacute;lectionn&eacute; pour le Psoriasis Area et comparaison de l&#39;indice de gravit&eacute; (PASI 75). Seule l&#39;information des essais cliniques, les sujets humains et les revues de langue anglaise sont rapport&eacute;s dans cette &eacute;tude. Le pourcentage de r&eacute;duction PASI 75 &agrave; environ 12 semaines obtenus par les options de traitement suivantes ont &eacute;t&eacute; : Goeckerman et RePUVA, 100 % ; Calcipotriol et PUVA, 87 % ; Ciclosporin, 78,2-80,3 % ; infliximab, 80 % ; adalimumab 40 mg toutes les deux semaines, 53 % et 40 mg/semaine, 80 % ; PUVA, 63 % ; m&eacute;thotrexate, 60 % ; NB-UVB, 55 % ; Acitretin 52 % ; &eacute;tanercept 50 mg deux fois par semaine, 49 % et 25 mg deux fois par semaine, 34 % ; efalizumab, 31,4 % ; et al&eacute;facept 21 %. Psoriasiques traitements avec des profils plus s&ucirc;rs par rapport aux autres agents comprennent bain PUVA, Goeckerman et RePUVA. D&#39;apr&egrave;s la revue de la litt&eacute;rature de l&#39;efficacit&eacute; et la s&eacute;curit&eacute; des produits biologiques et les options de traitement prebiologic pour le psoriasis mod&eacute;r&eacute; &agrave; s&eacute;v&egrave;re, le ratio b&eacute;n&eacute;fice risque : semble plus favorable pour Goeckerman et RePUVA, suivi de l&#39;&eacute;tanercept ou adalimumab.

Tenter de formuler une strat&eacute;gie fond&eacute;e sur des preuves dans le traitement du psoriasis mod&eacute;r&eacute; &agrave; s&eacute;v&egrave;re : un examen de l&#39;efficacit&eacute; et l&#39;innocuit&eacute; des produits biologiques et des options de prebiologic.

La psoriasi &egrave; una malattia cronica della pelle che colpisce fino al 2,5% della popolazione mondiale. Nonostante le opzioni di trattamento una miriade disponibile, non non c&#39;&egrave; alcun approccio terapeutico uniformemente accettato per la psoriasi da moderata a grave. L&#39;obiettivo di questa revisione &egrave; di valutare la relativa efficacia e sicurezza di opzioni terapeutiche disponibili e di formulare raccomandazioni generali per il trattamento della psoriasi moderata-grave. MEDLINE ed Evidence Based Medicine (Cochrane) sono stati utilizzati per eseguire una ricerca completa della letteratura dal 1986 al 2006. Il trial clinico pi&ugrave; scientificamente rigoroso pubblicato nella letteratura &egrave; stato selezionato per la psoriasi Area and Severity Index (PASI 75) comparison. In questo studio sono riportati sola informazioni da studi clinici, soggetti umani e giornali di lingua inglese. La percentuale di riduzione di PASI 75 a circa 12 settimane, ottenuti mediante le seguenti opzioni di trattamento sono stati: Goeckerman e RePUVA, 100%; Calcipotriene plus PUVA, 87%; Ciclosporin, 78,2-80,3%; infliximab, 80%; Adalimumab 40 mg ogni due settimane, il 53% e 40 mg/settimana, 80%; PUVA, 63%; metotrexato, 60%; NB-UVB, 55%; acitretina 52%; etanercept 50 mg due volte a settimana, 49% e 25 mg due volte a settimana, 34%; efalizumab, 31,4%; e alefacept 21%. Trattamenti psoriasica con profili pi&ugrave; sicuri rispetto ad altri agenti includono bagno PUVA, Goeckerman e RePUVA. Basato sulla revisione della letteratura sull&#39;efficacia e la sicurezza dei prodotti biologici e opzioni di prebiologic trattamento per la psoriasi da moderata a grave, il rapporto rischio: beneficio sembra pi&ugrave; favorevole per Goeckerman e RePUVA, seguito da etanercept o adalimumab.

Un tentativo di formulare una strategia basata sull&#39;evidenza nella gestione della psoriasi moderata-grave: un riesame dell&#39;efficacia e la sicurezza dei prodotti biologici e opzioni prebiologic.

Pyoderma gangrenosum (PG) is a rare ulcerative inflammatory condition of unknown etiology. Therapy for PG involves local wound care along with topical and systemic anti-inflammatory and other immunodulatory agents. Etanercept is one such immunomodulator with activity against the inflammatory cytokine, tumor necrosis factor.

Etanercept for the treatment of refractory pyoderma gangrenosum: a brief series.

Pyodermite phag&eacute;d&eacute;nique (PG) est une affection inflammatoire ulc&eacute;reuse rare d&#39;&eacute;tiologie inconnue. Th&eacute;rapie pour PG implique des plaies locales ainsi que les anti-inflammatoires topiques et syst&eacute;miques et d&#39;autres agents immunomodulateurs. L&#39;&eacute;tanercept est un tel immunomodulateur ayant une activit&eacute; contre les cytokines inflammatoires, le facteur de n&eacute;crose tumorale.

&Eacute;tanercept pour le traitement du r&eacute;fractaire Pyodermite phag&eacute;d&eacute;nique : une s&eacute;rie de br&egrave;ve.

Pioderma gangrenoso (PG) &egrave; una rara malattia ulcerosa infiammatoria ad eziologia sconosciuta. Terapia per PG comporta la cura delle ferite locali insieme a antinfiammatori topici e sistemici e di altri agenti immunodulatory. Etanercept &egrave; un tale immunomodulatore con attivit&agrave; contro le citochine infiammatorie, fattore di necrosi tumorale.

Article	Year
An attempt to formulate an evidence-based strategy in the management of moderate-to-severe psoriasis: a review of the efficacy and safety of biologics and prebiologic options. Expert opinion on pharmacotherapy\| PubMed ID: 17376017	2007
Etanercept for the treatment of refractory pyoderma gangrenosum: a brief series. International journal of dermatology\| PubMed ID: 17910724	2007

Argentina Leon

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