I can’t tell you how refreshing it is to read an editorial that portrays PA autonomy in a positive light (2017;27[2]:12-14). I live in Michigan, and the physician I worked with for years is relieved to finally see laws changing for PAs. Physicians want less accountability, as they are carrying so much already. The phrase “supervising physician” can feel burdensome, particularly because of its implications in a court of law. When I took time off to spend with my kids, the physician I worked with hired two NPs; he said that their increased drive for autonomy made him feel less legally responsible. The new bill passed here has altered his thinking about hiring PAs versus NPs.

I believe eventually, with increased practice authority, a title change is inevitable for the PA profession. According to my 14–year-old niece, “PAs obviously can’t do anything by themselves, or their title wouldn’t be ‘assistant.’” This is truly a misnomer that doesn’t reflect the PA scope of practice.

Diana Burmeister, PA-C
Southfield, MI

I can’t tell you how refreshing it is to read an editorial that portrays PA autonomy in a positive light (2017;27[2]:12-14). I live in Michigan, and the physician I worked with for years is relieved to finally see laws changing for PAs. Physicians want less accountability, as they are carrying so much already. The phrase “supervising physician” can feel burdensome, particularly because of its implications in a court of law. When I took time off to spend with my kids, the physician I worked with hired two NPs; he said that their increased drive for autonomy made him feel less legally responsible. The new bill passed here has altered his thinking about hiring PAs versus NPs.

I believe eventually, with increased practice authority, a title change is inevitable for the PA profession. According to my 14–year-old niece, “PAs obviously can’t do anything by themselves, or their title wouldn’t be ‘assistant.’” This is truly a misnomer that doesn’t reflect the PA scope of practice.

Diana Burmeister, PA-C
Southfield, MI

I can’t tell you how refreshing it is to read an editorial that portrays PA autonomy in a positive light (2017;27[2]:12-14). I live in Michigan, and the physician I worked with for years is relieved to finally see laws changing for PAs. Physicians want less accountability, as they are carrying so much already. The phrase “supervising physician” can feel burdensome, particularly because of its implications in a court of law. When I took time off to spend with my kids, the physician I worked with hired two NPs; he said that their increased drive for autonomy made him feel less legally responsible. The new bill passed here has altered his thinking about hiring PAs versus NPs.

I believe eventually, with increased practice authority, a title change is inevitable for the PA profession. According to my 14–year-old niece, “PAs obviously can’t do anything by themselves, or their title wouldn’t be ‘assistant.’” This is truly a misnomer that doesn’t reflect the PA scope of practice.

Diana Burmeister, PA-C
Southfield, MI

I have witnessed firsthand the evolution of patient satisfaction (2017;27[1]:13-14). When I became an NP in 1986, I worked in rural areas as the primary provider. My patients trusted that I cared for them and in the best way possible. A lot changed with the internet—Google became the primary care provider, and I became the consultant. Expressions of gratitude and respect from patients have been replaced by entitlement to services mandated by them. I have had patients bring in requests for diagnostic studies and further work-up for which there is no clinical evidence of need. They have their minds made up; if I am noncompliant, there is something wrong with me.

I have been reported to administration for being rude, insensitive, and incompetent. Now, I am not perfect, but most of these complaints were a result of me saying “no.” I was initially shocked by these demands and complaints, but they have become the new normal. Precious care time has been replaced by explanations and discussions about why I can’t do what patients want me to do.

Many providers give in to patients’ desires just to keep them happy and coming back. Unnecessary antibiotics, misuse of controlled pain medication, and pointless diagnostic studies have drained insurance and kept providers from just doing what is right. Big corporations run many medical practices, and unfortunately their main goal is to keep the doors open—even if that means compromising evidence-based medicine.

We have a generation of entitled people who become offended when you disagree with them. Many administrators transfer patient complaints to providers so that they will toe the line but fail to include pertinent information, such as what the complaint was and who filed it. This is a control technique; the provider is now automatically guilty, without a trial or defense.

I am blessed to work for a company that agrees that if concern is expressed, I have the right, as the provider, to know the details. If I am perceived as rude or abrupt, then knowing who feels that way can help me improve. Upon that patient’s next visit, I will adopt a gentler attitude and make an extra effort to pick up on cues that I may have missed.

Sometimes, patients express dissatisfaction because I will not dispense a controlled substance for pain upon request. My administration allows me to respond to situations like this in writing, and they can then verify that the complaint is unwarranted, and it will not be held against me or used as a control tactic. This approach has been so helpful. The company I work for also informs providers when patients express gratitude and thankfulness, which creates a great balance.

Surveys can be useful, but only if they are used as a tool to help the provider excel at his/her job—not create compliance for maintaining the patient head count. Providers should not have to worry about pleasing administration; they need to give quality care without fear.

Sue Beebe, APRN
Wichita, KA

I have witnessed firsthand the evolution of patient satisfaction (2017;27[1]:13-14). When I became an NP in 1986, I worked in rural areas as the primary provider. My patients trusted that I cared for them and in the best way possible. A lot changed with the internet—Google became the primary care provider, and I became the consultant. Expressions of gratitude and respect from patients have been replaced by entitlement to services mandated by them. I have had patients bring in requests for diagnostic studies and further work-up for which there is no clinical evidence of need. They have their minds made up; if I am noncompliant, there is something wrong with me.

I have been reported to administration for being rude, insensitive, and incompetent. Now, I am not perfect, but most of these complaints were a result of me saying “no.” I was initially shocked by these demands and complaints, but they have become the new normal. Precious care time has been replaced by explanations and discussions about why I can’t do what patients want me to do.

Many providers give in to patients’ desires just to keep them happy and coming back. Unnecessary antibiotics, misuse of controlled pain medication, and pointless diagnostic studies have drained insurance and kept providers from just doing what is right. Big corporations run many medical practices, and unfortunately their main goal is to keep the doors open—even if that means compromising evidence-based medicine.

We have a generation of entitled people who become offended when you disagree with them. Many administrators transfer patient complaints to providers so that they will toe the line but fail to include pertinent information, such as what the complaint was and who filed it. This is a control technique; the provider is now automatically guilty, without a trial or defense.

I am blessed to work for a company that agrees that if concern is expressed, I have the right, as the provider, to know the details. If I am perceived as rude or abrupt, then knowing who feels that way can help me improve. Upon that patient’s next visit, I will adopt a gentler attitude and make an extra effort to pick up on cues that I may have missed.

Sometimes, patients express dissatisfaction because I will not dispense a controlled substance for pain upon request. My administration allows me to respond to situations like this in writing, and they can then verify that the complaint is unwarranted, and it will not be held against me or used as a control tactic. This approach has been so helpful. The company I work for also informs providers when patients express gratitude and thankfulness, which creates a great balance.

Surveys can be useful, but only if they are used as a tool to help the provider excel at his/her job—not create compliance for maintaining the patient head count. Providers should not have to worry about pleasing administration; they need to give quality care without fear.

Sue Beebe, APRN
Wichita, KA

I have witnessed firsthand the evolution of patient satisfaction (2017;27[1]:13-14). When I became an NP in 1986, I worked in rural areas as the primary provider. My patients trusted that I cared for them and in the best way possible. A lot changed with the internet—Google became the primary care provider, and I became the consultant. Expressions of gratitude and respect from patients have been replaced by entitlement to services mandated by them. I have had patients bring in requests for diagnostic studies and further work-up for which there is no clinical evidence of need. They have their minds made up; if I am noncompliant, there is something wrong with me.

I have been reported to administration for being rude, insensitive, and incompetent. Now, I am not perfect, but most of these complaints were a result of me saying “no.” I was initially shocked by these demands and complaints, but they have become the new normal. Precious care time has been replaced by explanations and discussions about why I can’t do what patients want me to do.

Many providers give in to patients’ desires just to keep them happy and coming back. Unnecessary antibiotics, misuse of controlled pain medication, and pointless diagnostic studies have drained insurance and kept providers from just doing what is right. Big corporations run many medical practices, and unfortunately their main goal is to keep the doors open—even if that means compromising evidence-based medicine.

We have a generation of entitled people who become offended when you disagree with them. Many administrators transfer patient complaints to providers so that they will toe the line but fail to include pertinent information, such as what the complaint was and who filed it. This is a control technique; the provider is now automatically guilty, without a trial or defense.

I am blessed to work for a company that agrees that if concern is expressed, I have the right, as the provider, to know the details. If I am perceived as rude or abrupt, then knowing who feels that way can help me improve. Upon that patient’s next visit, I will adopt a gentler attitude and make an extra effort to pick up on cues that I may have missed.

Sometimes, patients express dissatisfaction because I will not dispense a controlled substance for pain upon request. My administration allows me to respond to situations like this in writing, and they can then verify that the complaint is unwarranted, and it will not be held against me or used as a control tactic. This approach has been so helpful. The company I work for also informs providers when patients express gratitude and thankfulness, which creates a great balance.

Surveys can be useful, but only if they are used as a tool to help the provider excel at his/her job—not create compliance for maintaining the patient head count. Providers should not have to worry about pleasing administration; they need to give quality care without fear.

Sue Beebe, APRN
Wichita, KA

ORLANDO – Confused about what MACRA, MIPS, and APMs mean for you and your practice this year?

Clifford Lober, MD, offered some very simple advice at the annual meeting of the American Academy of Dermatology: “If you take nothing else from this annual meeting – not this session, but the whole meeting – submit one quality measure or one improvement activity or the required advancing care information base measures – one time, on one patient” to the MIPS program, Dr. Lober said. “If you do that, you will save 4% of your Medicare payments in 2019.”*

• Choose to not participate. These physicians will see an automatic 4% reduction in their Medicare payments in 2019.
• Test QPP. Report on one quality measure or improvement activity for one patient. Of note: This information does not have to be submitted electronically; paper submission is okay. These physicians will avoid the 4% Medicare pay cut.
• Participate for part of the year. These physicians will report for 90 consecutive days of their choice on more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category. Reporting must start before Oct. 2, 2017. These physicians may earn a pay increase.*
• Participate for the full year. Submit a full year of data to Medicare. These physicians may get a pay increase.

Dr. Lober said pointedly, “The first choice – doing nothing – is the dumbest move you could make.”

He also noted that the CMS regulations say verbatim that “positive adjustments are based on data on the performance information submitted, not the amount of information or the length of time submitted.”

A few physicians and other clinicians are exempted from the QPP for 2017. Those who are in their first year of participating in Medicare Part B are exempt, as are those who bill less than $30,000 or have fewer than 100 Medicare patients.*

“The low-value exemption alone, CMS actuaries think, will exempt 32.5% of clinicians in the United States – a huge exemption,” Dr. Lober said, adding that when it comes to dermatologists, it’s estimated that about 18.3% will be exempt from MIPS.

Despite the new political landscape in Washington, Dr. Lober said that he does not think MACRA will go away.

“One of the things I want to say out front is, what is the likelihood of MACRA being repealed?” he said. “Somewhere between slim and none or even none and none. It was supported by both Democrats and Republicans and I think it’s here to stay. It might be modified, but it’s here to stay.”

He urged physicians to reach out to CMS if they have comments about the MIPS, APMs, and the Quality Payment Program, noting that despite the formal comment period being closed, agency officials have been receptive to comments and suggestions.

*This article was updated on March 13, 2017 at 3:30 p.m.

[email protected]

On Twitter @denisefulton

ORLANDO – Confused about what MACRA, MIPS, and APMs mean for you and your practice this year?

Clifford Lober, MD, offered some very simple advice at the annual meeting of the American Academy of Dermatology: “If you take nothing else from this annual meeting – not this session, but the whole meeting – submit one quality measure or one improvement activity or the required advancing care information base measures – one time, on one patient” to the MIPS program, Dr. Lober said. “If you do that, you will save 4% of your Medicare payments in 2019.”*

• Choose to not participate. These physicians will see an automatic 4% reduction in their Medicare payments in 2019.
• Test QPP. Report on one quality measure or improvement activity for one patient. Of note: This information does not have to be submitted electronically; paper submission is okay. These physicians will avoid the 4% Medicare pay cut.
• Participate for part of the year. These physicians will report for 90 consecutive days of their choice on more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category. Reporting must start before Oct. 2, 2017. These physicians may earn a pay increase.*
• Participate for the full year. Submit a full year of data to Medicare. These physicians may get a pay increase.

Dr. Lober said pointedly, “The first choice – doing nothing – is the dumbest move you could make.”

He also noted that the CMS regulations say verbatim that “positive adjustments are based on data on the performance information submitted, not the amount of information or the length of time submitted.”

A few physicians and other clinicians are exempted from the QPP for 2017. Those who are in their first year of participating in Medicare Part B are exempt, as are those who bill less than $30,000 or have fewer than 100 Medicare patients.*

“The low-value exemption alone, CMS actuaries think, will exempt 32.5% of clinicians in the United States – a huge exemption,” Dr. Lober said, adding that when it comes to dermatologists, it’s estimated that about 18.3% will be exempt from MIPS.

Despite the new political landscape in Washington, Dr. Lober said that he does not think MACRA will go away.

“One of the things I want to say out front is, what is the likelihood of MACRA being repealed?” he said. “Somewhere between slim and none or even none and none. It was supported by both Democrats and Republicans and I think it’s here to stay. It might be modified, but it’s here to stay.”

He urged physicians to reach out to CMS if they have comments about the MIPS, APMs, and the Quality Payment Program, noting that despite the formal comment period being closed, agency officials have been receptive to comments and suggestions.

*This article was updated on March 13, 2017 at 3:30 p.m.

[email protected]

On Twitter @denisefulton

ORLANDO – Confused about what MACRA, MIPS, and APMs mean for you and your practice this year?

Clifford Lober, MD, offered some very simple advice at the annual meeting of the American Academy of Dermatology: “If you take nothing else from this annual meeting – not this session, but the whole meeting – submit one quality measure or one improvement activity or the required advancing care information base measures – one time, on one patient” to the MIPS program, Dr. Lober said. “If you do that, you will save 4% of your Medicare payments in 2019.”*

• Choose to not participate. These physicians will see an automatic 4% reduction in their Medicare payments in 2019.
• Test QPP. Report on one quality measure or improvement activity for one patient. Of note: This information does not have to be submitted electronically; paper submission is okay. These physicians will avoid the 4% Medicare pay cut.
• Participate for part of the year. These physicians will report for 90 consecutive days of their choice on more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category. Reporting must start before Oct. 2, 2017. These physicians may earn a pay increase.*
• Participate for the full year. Submit a full year of data to Medicare. These physicians may get a pay increase.

Dr. Lober said pointedly, “The first choice – doing nothing – is the dumbest move you could make.”

He also noted that the CMS regulations say verbatim that “positive adjustments are based on data on the performance information submitted, not the amount of information or the length of time submitted.”

A few physicians and other clinicians are exempted from the QPP for 2017. Those who are in their first year of participating in Medicare Part B are exempt, as are those who bill less than $30,000 or have fewer than 100 Medicare patients.*

“The low-value exemption alone, CMS actuaries think, will exempt 32.5% of clinicians in the United States – a huge exemption,” Dr. Lober said, adding that when it comes to dermatologists, it’s estimated that about 18.3% will be exempt from MIPS.

Despite the new political landscape in Washington, Dr. Lober said that he does not think MACRA will go away.

“One of the things I want to say out front is, what is the likelihood of MACRA being repealed?” he said. “Somewhere between slim and none or even none and none. It was supported by both Democrats and Republicans and I think it’s here to stay. It might be modified, but it’s here to stay.”

He urged physicians to reach out to CMS if they have comments about the MIPS, APMs, and the Quality Payment Program, noting that despite the formal comment period being closed, agency officials have been receptive to comments and suggestions.

*This article was updated on March 13, 2017 at 3:30 p.m.

[email protected]

On Twitter @denisefulton

ORLANDO – Not quite a fifth of teens experience excessive, uncontrollable sweating, according to the results of an online survey presented during this year’s annual American Academy of Dermatology.

Because nearly 70% of teens who reported the condition said it interferes with their activities of daily living, late-breaking research presenter, Adelaide A. Hebert, MD, chief of pediatric dermatology at the University of Texas, Houston, said it was time medical schools paid more attention to it.

Miyuki-3/Thinkstock

ORLANDO – Not quite a fifth of teens experience excessive, uncontrollable sweating, according to the results of an online survey presented during this year’s annual American Academy of Dermatology.

Because nearly 70% of teens who reported the condition said it interferes with their activities of daily living, late-breaking research presenter, Adelaide A. Hebert, MD, chief of pediatric dermatology at the University of Texas, Houston, said it was time medical schools paid more attention to it.

Miyuki-3/Thinkstock

ORLANDO – Not quite a fifth of teens experience excessive, uncontrollable sweating, according to the results of an online survey presented during this year’s annual American Academy of Dermatology.

Because nearly 70% of teens who reported the condition said it interferes with their activities of daily living, late-breaking research presenter, Adelaide A. Hebert, MD, chief of pediatric dermatology at the University of Texas, Houston, said it was time medical schools paid more attention to it.

Miyuki-3/Thinkstock

ORLANDO – A teletriage app significantly reduced the time between triage and evaluation by a dermatologist, helping a volunteer-staffed clinic for the uninsured see more patients and improve rates of accurate diagnosis and treatment.

Peter Chansky, a medical student at the University of Pennsylvania, Philadelphia, presented the data on a study of the app during a late-breaking research session at this year’s annual meeting of the American Academy of Dermatology.

Whitney McKnight/Frontline Medical News

ORLANDO – A teletriage app significantly reduced the time between triage and evaluation by a dermatologist, helping a volunteer-staffed clinic for the uninsured see more patients and improve rates of accurate diagnosis and treatment.

Peter Chansky, a medical student at the University of Pennsylvania, Philadelphia, presented the data on a study of the app during a late-breaking research session at this year’s annual meeting of the American Academy of Dermatology.

Whitney McKnight/Frontline Medical News

ORLANDO – A teletriage app significantly reduced the time between triage and evaluation by a dermatologist, helping a volunteer-staffed clinic for the uninsured see more patients and improve rates of accurate diagnosis and treatment.

Peter Chansky, a medical student at the University of Pennsylvania, Philadelphia, presented the data on a study of the app during a late-breaking research session at this year’s annual meeting of the American Academy of Dermatology.

Whitney McKnight/Frontline Medical News

ORLANDO – There are ways to assess the psychosocial needs of your patients with vitiligo, even if you don’t believe you have the necessary skills to do a complete mental health work-up, according to Seemal R. Desai, MD.

In an interview recorded at this year’s annual meeting of the American Academy of Dermatology, Dr. Desai, an assistant clinical professor of dermatology at the University of Texas, Dallas, shares his ideas for how to have casual conversations with patients that can help reveal important clues to psychosocial stress patients with this serious medical skin condition might be facing.

“There are subtle clues to look for to know that these patients are uncomfortable with others seeing their skin,” says Dr. Desai.

In the video interview, he also covers taking a multidisciplinary approach to caring for these patients, what treatments are available to those who are suffering psychosocial stress after having failed several interventions, and how patients from many Asian and African counties are especially at risk for ostracization.

“It’s important to let your patients know that you understand this is really affecting them psychosocially, and that you care,” says Dr. Desai.

ORLANDO – There are ways to assess the psychosocial needs of your patients with vitiligo, even if you don’t believe you have the necessary skills to do a complete mental health work-up, according to Seemal R. Desai, MD.

In an interview recorded at this year’s annual meeting of the American Academy of Dermatology, Dr. Desai, an assistant clinical professor of dermatology at the University of Texas, Dallas, shares his ideas for how to have casual conversations with patients that can help reveal important clues to psychosocial stress patients with this serious medical skin condition might be facing.

“There are subtle clues to look for to know that these patients are uncomfortable with others seeing their skin,” says Dr. Desai.

In the video interview, he also covers taking a multidisciplinary approach to caring for these patients, what treatments are available to those who are suffering psychosocial stress after having failed several interventions, and how patients from many Asian and African counties are especially at risk for ostracization.

“It’s important to let your patients know that you understand this is really affecting them psychosocially, and that you care,” says Dr. Desai.

ORLANDO – There are ways to assess the psychosocial needs of your patients with vitiligo, even if you don’t believe you have the necessary skills to do a complete mental health work-up, according to Seemal R. Desai, MD.

In an interview recorded at this year’s annual meeting of the American Academy of Dermatology, Dr. Desai, an assistant clinical professor of dermatology at the University of Texas, Dallas, shares his ideas for how to have casual conversations with patients that can help reveal important clues to psychosocial stress patients with this serious medical skin condition might be facing.

“There are subtle clues to look for to know that these patients are uncomfortable with others seeing their skin,” says Dr. Desai.

In the video interview, he also covers taking a multidisciplinary approach to caring for these patients, what treatments are available to those who are suffering psychosocial stress after having failed several interventions, and how patients from many Asian and African counties are especially at risk for ostracization.

“It’s important to let your patients know that you understand this is really affecting them psychosocially, and that you care,” says Dr. Desai.

ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.

“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Doug Brunk/Frontline Medical News

ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.

“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Doug Brunk/Frontline Medical News

ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.

“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Doug Brunk/Frontline Medical News

ORLANDO – Results from two phase III trials indicated the tumor necrosis factor alpha inhibitor certolizumab pegol led to significant improvements in moderate to severe chronic plaque psoriasis, compared with placebo, according to an oral presentation at this year’s annual Academy of Dermatology Meeting.

Across the CIMPASI-1 and CIMPASI-2 trials, at 16 weeks, both certolizumab pegol (Cimzia) 400 mg and 200 mg, administered subcutaneously every 2 weeks in groups of patients with moderate to severe chronic plaque psoriasis, demonstrated statistically significant, clinically meaningful improvements in Psoriasis Area and Severity Index (PASI) scores, and on the Physician Global Assessment (PGA) scores, when compared with placebo. The data were presented by Alice B. Gottlieb, MD, PhD, professor of dermatology at New York Medical College, Valhalla. Certolizumab pegol currently is approved in the United States for use in psoriatic arthritis, but not for psoriasis.

In CIMPASI-1, 234 mostly white male patients in their mid-40s who had moderate to severe chronic plaque psoriasis were randomly assigned to one of three groups. There were 88 participants in the arm given 400 mg every 2 weeks at weeks 0, 2, and 4; 95 given 200 mg at weeks 0, 2, and 4; and 51 given placebo. At week 16, the percentage of patients who achieved a PASI 75 was 75.8% in the first group, 66.5% in the second, and 6.5% for placebo. A PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 57.9% for group 1, 47.0% for the second group, and 4.2% for placebo.

Also at week 16, the percentage of patients who achieved a PASI 90 was 43.6% in the 400 mg dose group, 35.8% in the 200 mg dose group, and 0.4% in the placebo group.

In CIMPASI-2, 227 mostly white patients with moderate to severe chronic plaque psoriasis, most of whom were in their mid-40s, evenly distributed across the sexes, were randomly assigned to one of three groups. There were 87 participants in the 400 mg every 2 weeks at weeks 0, 2, and 4 group; 91 in the 200 mg every 2 weeks at weeks 0, 2, and 4 arm, and 49 in the placebo group. At week 16, 82.6% of patients in the first group and 81.4% in the second group had a PASI 75, compared with 11.6% of the placebo group. Also at 16 weeks, a PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 71.6% for group 1, 66.8% for the second group, and 2.0% for placebo. At week 16, 55.4% of patients receiving the 400 mg dose had a PASI 90, as did 52.6% of patients receiving the 200 mg dose every 2 weeks, compared with only 4.5% of the placebo group.

Additionally, Dr. Gottlieb said that at week 16, patients in the 400-mg and 200-mg groups showed significant improvements over baseline Dermatology Life Quality Index (DLQI) average scores, compared with placebo: a 10.2 decrease in the 400-mg group and a 9.3 decrease in the 200-mg group, compared with a 3.3 decrease in the placebo arm (P less than .001) in the CIMPASI-1 study. In the CIMPASI-2 study at week 16, there was a drop of 10.0 DLQI in average scores in the 400-mg group, 10.4 in the 200-mg group, and an average drop of only 3.8 in controls (P less than .001).

Dr. Gottlieb, who disclosed that her mother suffers from severe plaque psoriasis, told the audience that the patient improvements were on par with those seen with infliximab, which she said was “the best anti–TNF alpha in the pack to date, and that’s an intravenous drug. These are impressive drops in the DLQI.”

Adverse events were, said Dr. Gottlieb, “a whole lot of nothing. There’s nothing that stands out.” She said there were no cases of tuberculosis, one case of vulvovaginal candidiasis, and equal distribution of herpes zoster across the study.

[email protected]

On Twitter @whitneymcknight

ORLANDO – Results from two phase III trials indicated the tumor necrosis factor alpha inhibitor certolizumab pegol led to significant improvements in moderate to severe chronic plaque psoriasis, compared with placebo, according to an oral presentation at this year’s annual Academy of Dermatology Meeting.

Across the CIMPASI-1 and CIMPASI-2 trials, at 16 weeks, both certolizumab pegol (Cimzia) 400 mg and 200 mg, administered subcutaneously every 2 weeks in groups of patients with moderate to severe chronic plaque psoriasis, demonstrated statistically significant, clinically meaningful improvements in Psoriasis Area and Severity Index (PASI) scores, and on the Physician Global Assessment (PGA) scores, when compared with placebo. The data were presented by Alice B. Gottlieb, MD, PhD, professor of dermatology at New York Medical College, Valhalla. Certolizumab pegol currently is approved in the United States for use in psoriatic arthritis, but not for psoriasis.

In CIMPASI-1, 234 mostly white male patients in their mid-40s who had moderate to severe chronic plaque psoriasis were randomly assigned to one of three groups. There were 88 participants in the arm given 400 mg every 2 weeks at weeks 0, 2, and 4; 95 given 200 mg at weeks 0, 2, and 4; and 51 given placebo. At week 16, the percentage of patients who achieved a PASI 75 was 75.8% in the first group, 66.5% in the second, and 6.5% for placebo. A PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 57.9% for group 1, 47.0% for the second group, and 4.2% for placebo.

Also at week 16, the percentage of patients who achieved a PASI 90 was 43.6% in the 400 mg dose group, 35.8% in the 200 mg dose group, and 0.4% in the placebo group.

In CIMPASI-2, 227 mostly white patients with moderate to severe chronic plaque psoriasis, most of whom were in their mid-40s, evenly distributed across the sexes, were randomly assigned to one of three groups. There were 87 participants in the 400 mg every 2 weeks at weeks 0, 2, and 4 group; 91 in the 200 mg every 2 weeks at weeks 0, 2, and 4 arm, and 49 in the placebo group. At week 16, 82.6% of patients in the first group and 81.4% in the second group had a PASI 75, compared with 11.6% of the placebo group. Also at 16 weeks, a PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 71.6% for group 1, 66.8% for the second group, and 2.0% for placebo. At week 16, 55.4% of patients receiving the 400 mg dose had a PASI 90, as did 52.6% of patients receiving the 200 mg dose every 2 weeks, compared with only 4.5% of the placebo group.

Additionally, Dr. Gottlieb said that at week 16, patients in the 400-mg and 200-mg groups showed significant improvements over baseline Dermatology Life Quality Index (DLQI) average scores, compared with placebo: a 10.2 decrease in the 400-mg group and a 9.3 decrease in the 200-mg group, compared with a 3.3 decrease in the placebo arm (P less than .001) in the CIMPASI-1 study. In the CIMPASI-2 study at week 16, there was a drop of 10.0 DLQI in average scores in the 400-mg group, 10.4 in the 200-mg group, and an average drop of only 3.8 in controls (P less than .001).

Dr. Gottlieb, who disclosed that her mother suffers from severe plaque psoriasis, told the audience that the patient improvements were on par with those seen with infliximab, which she said was “the best anti–TNF alpha in the pack to date, and that’s an intravenous drug. These are impressive drops in the DLQI.”

Adverse events were, said Dr. Gottlieb, “a whole lot of nothing. There’s nothing that stands out.” She said there were no cases of tuberculosis, one case of vulvovaginal candidiasis, and equal distribution of herpes zoster across the study.

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On Twitter @whitneymcknight

ORLANDO – Results from two phase III trials indicated the tumor necrosis factor alpha inhibitor certolizumab pegol led to significant improvements in moderate to severe chronic plaque psoriasis, compared with placebo, according to an oral presentation at this year’s annual Academy of Dermatology Meeting.

Across the CIMPASI-1 and CIMPASI-2 trials, at 16 weeks, both certolizumab pegol (Cimzia) 400 mg and 200 mg, administered subcutaneously every 2 weeks in groups of patients with moderate to severe chronic plaque psoriasis, demonstrated statistically significant, clinically meaningful improvements in Psoriasis Area and Severity Index (PASI) scores, and on the Physician Global Assessment (PGA) scores, when compared with placebo. The data were presented by Alice B. Gottlieb, MD, PhD, professor of dermatology at New York Medical College, Valhalla. Certolizumab pegol currently is approved in the United States for use in psoriatic arthritis, but not for psoriasis.

In CIMPASI-1, 234 mostly white male patients in their mid-40s who had moderate to severe chronic plaque psoriasis were randomly assigned to one of three groups. There were 88 participants in the arm given 400 mg every 2 weeks at weeks 0, 2, and 4; 95 given 200 mg at weeks 0, 2, and 4; and 51 given placebo. At week 16, the percentage of patients who achieved a PASI 75 was 75.8% in the first group, 66.5% in the second, and 6.5% for placebo. A PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 57.9% for group 1, 47.0% for the second group, and 4.2% for placebo.

Also at week 16, the percentage of patients who achieved a PASI 90 was 43.6% in the 400 mg dose group, 35.8% in the 200 mg dose group, and 0.4% in the placebo group.

In CIMPASI-2, 227 mostly white patients with moderate to severe chronic plaque psoriasis, most of whom were in their mid-40s, evenly distributed across the sexes, were randomly assigned to one of three groups. There were 87 participants in the 400 mg every 2 weeks at weeks 0, 2, and 4 group; 91 in the 200 mg every 2 weeks at weeks 0, 2, and 4 arm, and 49 in the placebo group. At week 16, 82.6% of patients in the first group and 81.4% in the second group had a PASI 75, compared with 11.6% of the placebo group. Also at 16 weeks, a PGA scale improvement of at least two points over baseline toward a final score of clear or almost clear skin at week 16 was 71.6% for group 1, 66.8% for the second group, and 2.0% for placebo. At week 16, 55.4% of patients receiving the 400 mg dose had a PASI 90, as did 52.6% of patients receiving the 200 mg dose every 2 weeks, compared with only 4.5% of the placebo group.

Additionally, Dr. Gottlieb said that at week 16, patients in the 400-mg and 200-mg groups showed significant improvements over baseline Dermatology Life Quality Index (DLQI) average scores, compared with placebo: a 10.2 decrease in the 400-mg group and a 9.3 decrease in the 200-mg group, compared with a 3.3 decrease in the placebo arm (P less than .001) in the CIMPASI-1 study. In the CIMPASI-2 study at week 16, there was a drop of 10.0 DLQI in average scores in the 400-mg group, 10.4 in the 200-mg group, and an average drop of only 3.8 in controls (P less than .001).

Dr. Gottlieb, who disclosed that her mother suffers from severe plaque psoriasis, told the audience that the patient improvements were on par with those seen with infliximab, which she said was “the best anti–TNF alpha in the pack to date, and that’s an intravenous drug. These are impressive drops in the DLQI.”

Adverse events were, said Dr. Gottlieb, “a whole lot of nothing. There’s nothing that stands out.” She said there were no cases of tuberculosis, one case of vulvovaginal candidiasis, and equal distribution of herpes zoster across the study.

[email protected]

On Twitter @whitneymcknight

ATLANTA – Systemic reactions against subcutaneous allergen immunotherapy have trended down overall in recent years, but there has been an uptick in reports of severe grade 4 reactions for reasons that are not yet clear, according to a review of 46.6 million injection office visits from 2008-2015.

The data come from annual surveys of members of the American Academy of Allergy, Asthma, and Immunology and of the American College of Allergy, Asthma, and Immunology, of whom 27%-51% responded each year.

ATLANTA – Systemic reactions against subcutaneous allergen immunotherapy have trended down overall in recent years, but there has been an uptick in reports of severe grade 4 reactions for reasons that are not yet clear, according to a review of 46.6 million injection office visits from 2008-2015.

The data come from annual surveys of members of the American Academy of Allergy, Asthma, and Immunology and of the American College of Allergy, Asthma, and Immunology, of whom 27%-51% responded each year.

ATLANTA – Systemic reactions against subcutaneous allergen immunotherapy have trended down overall in recent years, but there has been an uptick in reports of severe grade 4 reactions for reasons that are not yet clear, according to a review of 46.6 million injection office visits from 2008-2015.

The data come from annual surveys of members of the American Academy of Allergy, Asthma, and Immunology and of the American College of Allergy, Asthma, and Immunology, of whom 27%-51% responded each year.

ORLANDO – Pregnancy prevention remains a challenge when prescribing isotretinoin to women of childbearing years with acne, Megha M. Tollefson, MD, said at the annual meeting of the American Academy of Dermatology.

Like so many promises having to do with love, a promise of sexual abstinence, however earnest, may at some point fall by the wayside, said Dr. Tollefson of the Mayo Clinic, Rochester, Minn., in a video interview.

ORLANDO – Pregnancy prevention remains a challenge when prescribing isotretinoin to women of childbearing years with acne, Megha M. Tollefson, MD, said at the annual meeting of the American Academy of Dermatology.

Like so many promises having to do with love, a promise of sexual abstinence, however earnest, may at some point fall by the wayside, said Dr. Tollefson of the Mayo Clinic, Rochester, Minn., in a video interview.

ORLANDO – Pregnancy prevention remains a challenge when prescribing isotretinoin to women of childbearing years with acne, Megha M. Tollefson, MD, said at the annual meeting of the American Academy of Dermatology.

Like so many promises having to do with love, a promise of sexual abstinence, however earnest, may at some point fall by the wayside, said Dr. Tollefson of the Mayo Clinic, Rochester, Minn., in a video interview.