American Academy of Dermatology, March 5-9, 2010
American Academy of Dermatology 68th Annual Meeting
The American Academy of Dermatology's 68th Annual Meeting took place March 5 to 9 in Miami Beach, Fla., and attracted a record 19,200 attendees from around the world. The meeting featured 370 sessions, more than 1,300 faculty, and more than 600 electronic posters.
"There was a lot of discussion about the new biologics that have come out, and the newest of these -- ustekinumab -- recently approved in this country, created the biggest buzz," said Jane M. Grant-Kels, M.D., of the University of Connecticut Health Center in Farmington, and chair of the Academy's Scientific Assembly Committee. "It's the most efficacious biologic and requires the least number of injections."
During a standing room-only focus session titled "Biologic Drugs for Psoriasis: Do We Use Them Enough?," Ronald Prussick, M.D., of George Washington University in Washington, D.C., told attendees that biologics also have beneficial effects on common comorbidities such as cardiovascular problems and arthritis.
More than 20 studies presented at the meeting addressed ustekinumab. In a study supported by Johnson & Johnson Pharmaceutical Services, Lynn Guenther, M.D., of the Guenther Dermatology Research Centre in London, Canada, and colleagues assessed disease severity and quality of life in 1,996 patients with moderate to severe psoriasis who were randomly assigned to receive either ustekinumab or placebo. At baseline, 22.6 percent of the patients reported impaired sexual function.
After 12 weeks, the researchers found that ustekinumab was associated with significantly higher quality-of-life scores than placebo. They also found that the rate of impaired sexual function in the ustekinumab group decreased from 22.4 percent at baseline to 2.7 percent, but observed no changes in the placebo group.
In a study supported by Centocor Research and Development, Christopher E.M. Griffiths, M.D., from the University of Manchester in the United Kingdom, and colleagues studied 177 patients with moderate to severe psoriasis who had failed to respond to etanercept and were crossed over to ustekinumab. After 12 weeks, they found that 48.9 percent of the patients achieved a Psoriasis Area Severity Index response of 75 and that 23.4 percent achieved a response of 90. They also observed cleared disease in 40.4 percent of patients and minimal disease in 70.2 percent.
"Ustekinumab was well tolerated in patients previously treated with etanercept with a safety profile consistent with that observed in other ustekinumab phase III studies," the authors concluded.
In a phase III study primarily supported by Peplin Ltd., Neil Swanson, M.D., of the Oregon Health and Science University in Portland, presented results showing that actinic keratoses on areas including the chest and arms may respond to treatment with the new 0.05 percent ingenol mebutate gel (PEP005).
During the study, Swanson randomly assigned 255 patients to either PEP005 or a vehicle gel. After 57 days, they found the complete lesion clearance rate was significantly higher in the PEP005 group than in the vehicle-gel group (27.4 versus 5.1 percent). They also found that PEP005 was associated with complete clearance rates of 88.9 percent for the chest, 25.3 percent for arms, 16.7 percent for legs, and 16 percent for the back of the hand.
Alexa Kimball, M.D., of Harvard Medical School in Boston, presented a study supported by Centocor Research and Development in which she and her colleagues analyzed pooled data on 2,899 patients from three trials of ustekinumab. After comparing baseline medical histories and baseline lab results, the researchers found that 18 percent of patients had undiagnosed diabetes, 25 percent had undiagnosed hypertension, and 19 percent had undiagnosed hyperlipidemia. They also found that most of the patients diagnosed with these conditions had not received optimal treatment.
"Additional efforts are needed to ensure appropriate cardiovascular risk factor screening, referral, and treatment in patients with psoriasis," the authors concluded.
Meeting highlights included an expert review on the newest treatments for acne and rosacea presented by Jenny J. Kim, M.D., of the University of California in Los Angeles.
Kim discussed the complementary treatment of acne with laser and light-based technologies, such as the pulsed-dye laser, red and blue light, and photodynamic therapy, which target the sebaceous glands and can reduce acne flares. "Patients are becoming increasingly concerned about the long-term use of oral medications to fight acne, so lasers and light sources appeal to them," Kim said in a statement. "The problem is that there are limited large, prospective, well-controlled studies that demonstrate the effectiveness of laser and light technology at this point, so that will be an area we need to explore in the future."
Kim also discussed a recent study suggesting that a skin peptide may be associated with rosacea. "There is some evidence to suggest that the peptide cathelicidin within the skin is processed differently in rosacea patients than in individuals not affected by rosacea and induces inflammation that may contribute to rosacea," Kim said in a statement. "These findings are encouraging, as we can identify better treatments for the disease if we have a better understanding of what the cause might be."
In another expert review, Albert C. Yan, M.D., of the Children's Hospital of Philadelphia, discussed the increasing skin and hair problems associated with bedbugs, scabies and head lice.
The bedbug population has exploded, Yan reported, most likely because of increased international travel and the elimination of the effective pesticide DDT. Some studies suggest that resistance to currently available pesticides has accounted for a 500 percent increase in the bedbug population in the past few years.
"In the United States, bed bugs frequently infest hotels and homes and, once established, can spread rapidly and be difficult to eliminate," Yan said in a statement. "For example, New York City reports hundreds of complaints of bedbug infestations every year, and these numbers have been steadily increasing. In addition, in two separate surveys of hotels done by extermination companies, reports have emerged indicating that 14 percent of hotel rooms and up to 25 percent of hotels show evidence of bedbug infestation."
"About one-third of people bitten by bedbugs will develop juicy bite reactions that are often clustered in groups, which dermatologists refer to as a 'breakfast, lunch and dinner' pattern," Yan added. "However, bedbugs have not thus far been associated with any serious health threats nor have there been any documented cases of diseases being transmitted from bedbugs."
Other meeting highlights included a plenary address by Donna E. Shalala, a former secretary of the U.S. Department of Health and Human Services, who spoke on health system reform and education.
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