PracticeUpdate Conference Series World Congress of Dermatology 2019

used once-daily achieved a F-VASI75, compared with none on the vehicle group. Finally, 13% of patients using once-daily 1.5% ruxolitinib and 9% using the same dose twice-daily achieved F-PhGVA scores of ‘clear’ or ‘almost clear’, com- pared with none of the patients receiving vehicle control. The investigators found that ruxolitinib cream was generally safe and well- tolerated, using all of the dosing schemes included in the trial. “This is the largest vehicle-controlled, randomized, double-blind, well-designed study ever done in vitiligo,” said Dr. Rosmarin. “The results are very promising. I look forward to the phase III program, which will commence shortly. Hopefully, it will lead to the first medication FDA- approved for re-pigmenting vitiligo. “We still have more information to find out,” he stressed. “For example, what clinical characteristics or baseline demograph- ics make patients responders or not?” He also noted that it is still unknown if “patients continue treatment beyond week Upon multivariate analysis, prevalent users of acitretin were less likely to achieve a PASI <3 relative to incident users (adjusted odds ratio 0.67), as were prevalent users of ciclosporin (adjusted odds ratio 0.64). In the case of ciclosporin, the study authors suggested these find- ings may reflect its intermittent, short-term use in clinical practice. patients who had previously been pre- scribed another systemic therapy were classified as “previous systemic.” The proportions of incident, prevalent, and previous systemic users were similar for methotrexate, ciclosporin, and acitre- tin, but differed for fumaric acid esters. Whereas methotrexate, ciclosporin, and acitretin followed an approximate 2:1:2 ratio of incident to prevalent to previ- ous systemic use, patients prescribed fumaric acid esters were comparatively more likely to have received previous systemic therapy (66%) and less likely to be prescribed these agents as a first-line approach (19%). Overall, 34% of patients receiving ciclo- sporin achieved PASI <3, followed by methotrexate (30%), fumaric acid esters (25%), and acitretin (21%). Notably, the investigators used first PASI reported after initiating therapy for this analysis.

The BADBIR investigators did not iden- tify any significant differences in odds of achieving PASI <3 between prevalent or previous systemic user of methotrexate or fumaric acid esters and incident use. Dr. Mason suggested that the “guidelines on systemic therapies in the management of psoriasis could be revisited to include expected levels of effectiveness and rea- sonable time frames, to ensure patients are not left on suboptimal therapies. By considering these findings, we hope that our data will help in clinical decision-mak- ing and aid in identifying themost effective first-time systemic therapy for patients with moderate-to-severe psoriasis.” She noted that future work will focus on identifying patterns of response among psoriasis patients prescribed various systemic therapies. “We are now working to establish whether there are patterns of treatment response, non-response, and/or partial response across these therapies and whether the time spent on these therapies differs by treatment response groups,” Dr. Mason said. “For example, how long are non-re- sponders on therapy before stopping or switching? What are the most common reasons for stopping/switching systemic therapies?”

0.5% of the surface area of the face and at least 3% body surface area depigmen- tation in non-facial areas. Patients were randomized across five treatment arms consisting of 24 weeks of daily ruxolitinib at 1.5%, 0.5%, and 0.15% strength, twice daily ruxolitinib at 1.5% strength, and vehi- cle control. The primary endpoint was percentage of patients achieving F-VASI50 at week 24, with secondary endpoints including proportion of patients achieving a Facial Physician Global Vitiligo Assessment (F-PhGVA) score of 0 ‘clear’ or 1 ‘almost clear’ at week 24, as well as safety and tolerability. Patients will continue to be followed-up for a full 104 weeks. The best results were obtained using once-daily 1.5% ruxolitinib cream (50% achieving F-VASI50) and twice-daily 1.5% ruxolitinib cream (45% achieving F-VASI50), compared with vehicle control (3% achieving F-VASI50, P < .001). In addi- tion, 30% of patients on the highest dose of topical ruxolitinib cream 1.5% twice a day and 17% of those on the same dose Patients included in the BADBIR study were classified according to their treat- ment history: Those who had received their first systemic therapy were classified as “incident,” whereas patients prescribed registration systemic therapy previously were classified as “prevalent,” and had been prescribed acitretin, and 335 (8%) had been prescribed a fumaric acid ester.

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24, will they continue to re-pigment?” Finally, questions remain as to whether the medication can produce a remission or whether depigmentation will recur when treatment is stopped.

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WCD 2019 • PRACTICEUPDATE CONFERENCE SERIES 13