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19 March, 2018 00:00 00 AM / LAST MODIFIED: 19 March, 2018 12:56:26 AM

New drug relieves hand eczema psoriasis

WebMD Health News
New drug relieves hand eczema psoriasis

Charlene Laino

A new drug called alitretinoin can help relieve cracked, itchy, irritated hands in people with severe hand eczema, researchers report.

Hands "completely or almost completely" cleared up in nearly half of people with hand eczema that didn't respond to standard treatment, says Charles Lynde, MD, assistant professor of dermatology at the University of Toronto.

Up to 10% of people have hand dermatitis, in which the skin becomes inflamed, typically from an allergic reaction to an irritant, Lynde says. The hand becomes dry and chapped and eventually red, scaly, and inflamed.

Of those, about 5% have dermatitis as severe as the people in the new research, he says.

"These were hard-core patients who weren't getting better when treated with ointments containing corticosteroids," the standard drugs used to reduce inflammation in people with severe dermatitis. They had suffered for nine or 10 years, on average, Lynde tells WebMD.

"At present, we don't have very much to offer when corticosteroid [ointments] fail," he says. Enter alitretinoin, a relative of vitamin A that is approved for severe hand eczema in some European countries and Canada but not the U.S. It's given in capsule form, once a day. At the annual meeting of the American Academy of Dermatology (AAD), Lynde summarized findings from three studies showing that alitretinoin is effective in a substantial proportion of these patients.

"The first and second studies show that itching, redness, fissures, and dryness go away. The third shows it will help if you relapse," he says.

Alitretinoin clears up severe hand dermatitis

The largest of the studies involved 1,032 people with severe hand dermatitis in Europe and Canada. The patients took a 10-milligram or 30-milligram dose of alitretinoin, or placebo, once a day for 12 or 24 weeks.

Participants were told to avoid irritants such as detergent that could trigger or exacerbate their dermatitis.

The skin condition completely or almost completely resolved in 48% of patients treated with the higher dose of alitretinoin. "That means they were 90%, 95%, 100% improved," Lynde says.

In contrast, 28% of patients treated with the lower dose and 17% of placebo-treated patients completely or almost completely responded.

The second study involved 249 patients in Europe and Canada. All had suffered from hand eczema for years. Steroid ointments no longer worked for them, Lynde says. All received the higher dose of alitretinoin for up to 24 weeks. The hand rash cleared up in 47% of patients.

The third study was designed to determine if the drug could help patients who relapse after treatment with alitretinoin. "About a third relapsed, so we tried alitretinoin again," Lynde says. It worked, with the rash resolving in about four-fifths of patients given the 30-milligram dose. In contrast, fewer than 10% of patients given a placebo responded.

Alitretinoin doesn't work overnight -- it typically takes four to six weeks to see any change, Lynde says. And not everyone responds.

"But this does offer new hope for dermatitis we thought was incurable. Patients improve and quite a few go into remission," he says.

The most frequent side effects are headache and dryness and flushing of the skin, Lynde says. Also, it can cause serious, even fatal birth defects, so women who are pregnant or thinking about getting pregnant should never take it, he says.

Additionally, the medication can make you more sensitive to the sun, so you may burn more easily, says past AAD president Darrell S. Rigel, MD, clinical professor of dermatology at New York University Medical Center.

"On the flip side, chronic hand eczema is very hard to treat. If it's so severe you don't want to go out in public or you're in business and don't want to shake hands, this appears to offer a good option," he tells WebMD.

Treating psoriasis if Enbrel fails

If the drug Enbrel stops working, people with psoriasis have two effective options, new research suggests.

One new study shows that the recently approved drug Stelara can help treat moderate to severe psoriasis if Enbrel fails.

A second study suggests Remicade is effective for people with psoriasis who are no longer helped by Enbrel.

The findings were presented at the annual meeting of the American Academy of Dermatology. Both studies were sponsored by Centocor, which makes Stelara and Remicade. About 7.5 million Americans suffer from psoriasis, a lifelong disorder characterized by inflammation of skin and, often, the joints.

Stelara, Remicade, and Enbrel are all biologics -- drugs made of genetically engineered proteins -- that are generally used to treat patients who aren't responding to traditional therapies such as light therapy and methotrexate.

Remicade and Enbrel both block tumor necrosis factor-alpha (TNF-alpha), a chemical produced by immune cells that fuels inflammation, much like gas on a fire. Stelara targets two proteins, interleukin 12 and interleukin 23, that also drive the inflammatory process.

The new findings show that if Enbrel stops working, "there are other effective options," says Alan Menter, MD, chair of the psoriasis research unit at Baylor Research Institute in Dallas.

Up to 10% of people have hand dermatitis, in which the skin becomes inflamed,
typically from an allergic reaction to an irritant, Lynde says

Menter was an investigator in the Stelara study, a follow-up analysis of a larger trial of more than 900 patients that showed Stelara was more effective than Enbrel in the treatment of moderate-to-severe plaque psoriasis.

Comparing psoriasis treatment

The new analysis focused on 50 patients who continued to have moderate-to-severe psoriasis after 12 weeks of Enbrel therapy. Compared with people who were helped by Enbrel, they tended to be heavier, male, and have more severe psoriasis.

All were given Stelara injections four weeks and eight weeks later.

Three months later, 40% had, at most, minimal signs of their psoriasis; 70% had mild disease at most.

The second study involved 217 psoriasis patients who had significant disease despite ongoing treatment with Enbrel. All were switched to Remicade therapy.

"While both drugs block TNF-alpha, they do so in slightly different ways. There are subtle difference that made us think that Remicade may work more effectively," says Robert Kalb, MD, a clinical professor of dermatology at the State University of New York, Buffalo, who was involved in the trial.

By 10 weeks later, two-thirds had, at most, minimal disease.

So if you fail Enbrel, how do you decide whether to try Remicade or Stelara?

There has been no head-to head comparison, but generally Stelara is reserved for people with more severe disease, Menter notes.

"Once on it, the vast majority of patients maintain improvement over the course of the next few years," he adds.

If the patient's joints are inflamed, "I may be more likely to use a TNF-alpha blocker," which have been used to treat arthritis for over a decade, Menter says. (A study looking at the effects of Stelara on joint inflammation is just starting.)

In general, the safety of all three drugs has been similar in various studies, he says.

But Stelara has not been around long enough for researchers to know if it will increase the risk for infections or cancer, known risks of biologic agents that affect the body's immune system, says past American Academy of Dermatology president Darrell S. Rigel, MD, clinical professor of dermatology at New York University Medical Center.

The bottom line, he tells WebMD, is that many psoriasis patients have been helped by Enbrel for psoriasis. "If it doesn't work well or stops working, [Stelara and Remicade] are very good drugs to consider. But if a drug is

working, I would stay on it," he says.

 

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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