The Journal of dermatological treatment最新文献

Objectives: Adalimumab was among the first biologics to face widespread biosimilar competition following US market entry of multiple adalimumab biosimilars in 2023. However, Medicare Part D formulary adoption of these products and their associated specialty-tier cost-sharing requirements remain unknown.

Methods: To evaluate adalimumab biosimilar adoption and associated cost-sharing patterns across Medicare Part D formularies, Centers for Medicare & Medicaid Services (CMS) Medicare Part D Formulary and Plan Benefit Package files were analyzed. Plans were categorized as covering originator adalimumab-only, both originator and biosimilar products (dual coverage), or biosimilars-only.

Results: In 2023, all Medicare Part D plans covering adalimumab listed only the originator product. By 2024, 52.5% of plans provided dual coverage, increasing to 79.9% in 2025. Biosimilar-exclusive coverage increased from 8.6% of plans in 2025 to 45.9% in 2026, while originator-only coverage declined to 0.8%. Median specialty-tier coinsurance differed according to coverage strategy. In 2026, median specialty-tier coinsurance was 33% among originator-only plans, 27% among dual-coverage plans, and 25% among biosimilar-only plans.

Conclusions: Medicare Part D formularies rapidly included adalimumab biosimilars following market entry, with substantial growth in biosimilar-exclusive coverage by 2026. Specialty tier coinsurance varied by medication coverage type, suggesting that evolving formulary strategies may influence beneficiary cost-sharing requirements.

Objectives: Bimekizumab, a dual interleukin (IL)-17A/IL-17F inhibitor, has demonstrated clinical efficacy in clinical trials. However, real-world evidence comparing outcomes according to previous biologic exposure remains limited. We evaluated the effectiveness of bimekizumab in biologic-naïve and biologic-experienced patients with plaque psoriasis, including high-impact body areas.

Methods: We retrospectively analyzed 98 patients treated with bimekizumab (23 biologic-naïve, 75 biologic-experienced). Outcomes included Psoriasis Area and Severity Index (PASI), PASI90 and PASI100 response rates, and Physician Global Assessment (PGA) scores for scalp, nail, genital, palmoplantar, and pretibial psoriasis. Biologic-experienced patients were further stratified by the number of prior biologics.

Results: Despite higher baseline PASI values (18.04 vs. 13.29; p = 0.021), biologic-naïve patients achieved significantly faster responses. At week 4, PASI reduction (85.5% vs. 62.5%; p < 0.001), PASI90 (50.0% vs. 13.3%; p = 0.001), and PASI100 (50.0% vs. 11.7%; p = 0.001) were significantly higher in biologic-naïve patients. Similar findings were observed in high-impact areas. Differences persisted through week 16 but disappeared from week 24 onward. Nevertheless, biologic-naïve patients maintained numerically higher response rates throughout follow-up. Previous biologic burden did not compromise long-term outcomes.

Conclusions: Bimekizumab showed sustained effectiveness regardless of prior biologic exposure. Nevertheless, biologic-naïve patients achieved faster and deeper responses, supporting earlier use of bimekizumab to maximize treatment benefit.

Objectives: The potential utility of a novel microwave device for the treatment of a variety of superficial dermatologic indications is reviewed.

Materials and methods: The Swift^® microwave system applies low-dose microwave energy (8 GHz) noninvasively using a precision applicator to directly target lesional tissue, while modulating power setting and application time to maintain patient comfort during heat application. The device has been approved for general dermatology use, with some models labeled more-specifically for HPV-associated lesions and actinic keratosis. New case treatment data and published case reports were reviewed for viral skin infection, fungal nail infection, nodular cystic acne, neoplastic skin lesions, hidradenitis suppurativa (HS), and intractable plantar keratosis (IPK).

Results: Case reports demonstrate preliminary efficacy of microwave hyperthermia in viral skin infection, fungal nail infection, nodular cystic acne, and neoplastic skin lesions, with few reported adverse events. Microwaves additionally provided good pain control for the reviewed cases of HS and IPK.

Conclusions: The data support a possible role for the microwave device in the studied indications. Microwave treatment may be more tolerable for patients than cryotherapy or laser comparators. More systematic investigation of microwave hyperthermia is warranted to better define optimum dosing regimens and efficacy, as well as a wider safety profile.

Background: Pemphigus is a recurrent and potentially life-threatening autoimmune bullous disease. This study aimed to develop a nomogram to predict relapse risk in pemphigus patients after complete remission (CR).

Methods: We retrospectively analyzed 110 pemphigus patients who achieved CR between 2021 and 2023 and were followed for at least 12 months. Independent predictors of relapse were identified using univariate and multivariate Cox regression analyses and incorporated into a nomogram. Model performance was evaluated using calibration curves, receiver operating characteristic (ROC) analysis, and decision curve analysis (DCA).

Results: During follow-up, 41.8% of patients experienced relapse. Multivariate analysis identified anemia, hypercholesterolemia, previous relapse history, elevated desmoglein (Dsg) antibody levels, and discontinuation of therapy after CR as independent risk factors. The nomogram demonstrated good discrimination with a concordance index of 0.726 (95% CI, 0.659-0.793). The AUCs for predicting relapse at 6, 12, and 18 months after achieving CR were 0.771, 0.853, and 0.811, respectively. DCA supported the clinical utility of the model, and survival analysis effectively stratified patients into high- and low-risk groups.

Conclusion: This nomogram may serve as a practical tool for identifying pemphigus patients at high risk of relapse after CR.

Background: Nemolizumab, an anti-IL-31 receptor A antibody, is licensed for atopic dermatitis and prurigo nodularis; its role in other chronic pruritus (CP) syndromes is uncertain.

Objective: To synthesize efficacy, safety and strength of evidence for nemolizumab in CP beyond these indications. Methods: We conducted a PROSPERO-registered systematic review (CRD420251207054) of databases and trial registries to November 2025 for nemolizumab studies in CP outside AD/PN. Eligible reports were extracted and patients grouped as systemic, neurologic/neurogenic, dermatologic (non-AD) or primary CP/CP of unknown origin.

Results: Seventeen reports (one randomized trial, two cohorts, 14 case series/reports) describing 114 patients were included. In chronic kidney disease-associated pruritus, a phase II hemodialysis trial showed modest, statistically uncertain benefit versus placebo, contrasting with rapid, near-complete relief in dialysis and cholestatic case reports. Uncontrolled data in neuropathic itch/pain syndromes, non-AD inflammatory and papular dermatoses (notably amyloidosis and perforating disorders) and long-standing primary CP/CPUO described complete itch clearance. Across indications, nemolizumab was well tolerated, but certainty was low for CKD-aP and very low for other groups.

Conclusions: Nemolizumab shows plausible antipruritic activity across CP phenotypes, yet the evidence base remains fragile; these signals justify cautious experimental use and prioritize etiology-specific IL-31 receptor blockade trials beyond AD/PN.

Objectives: IL-17 inhibitors (IL-17i) and IL-23 inhibitors (IL-23i) are advanced treatments for moderate-to-severe plaque psoriasis. This study aimed to assess the persistence of IL-17i and IL-23i in patients with plaque psoriasis in Taiwan, where a unique healthcare reimbursement policy makes biologic persistence highly reflective of real-world effectiveness.

Methods: We conducted a retrospective cohort study in bio-naïve patients with plaque psoriasis in Taiwan using the Chang Gung Research Database. Persistence was defined as the duration from initiation to discontinuatin of a biologic agent. Patients who were diagnosed with plaque psoriasis and initiated an IL-17i or an IL-23i between January 2015 and December 2022 were included. Persistence rates were estimated by Kaplan-Meier methods, using discontinuation as the event of interest.

Results: A total of 544 and 334 patients were included in the IL-17i and IL-23i cohorts, respectively. Numerically higher persistence was observed for IL-23i compared with IL-17i (p < 0.001). The 48-week and 96-week persistence rates were 71.3% (67.5-75.4%) and 55.2% (50.7-60.1%) for IL-17i, and 82.2% (78.1-86.6%) and 75.1% (70.1-80.5%) for IL-23i.

Conclusions: These findings may inform clinical decision-making by healthcare providers, patients, and policymakers. Further research integrating richer clinical information with extended follow-up will allow deeper investigation of biologic treatment patterns in real‑world settings.

Objectives: To report a case of AA developing during golimumab and leflunomide treatment for seropositive rheumatoid arthritis, with subsequent improvement following initiation of selective Janus kinase 1 (JAK1) inhibition.

Methods: A 55-year-old woman developed progressive, non-scarring alopecia while rheumatoid arthritis disease activity remained well controlled. Clinical and trichoscopic findings were consistent with AA, and laboratory investigations were unremarkable. The patient received serial intralesional triamcinolone at approximately 4-8 week intervals over a 14-month period, with progression in Severity of Alopecia Tool (SALT) score from approximately 20 to 50. Alopecia developed and progressed despite ongoing TNF-α inhibitor therapy and serial intralesional corticosteroids. Upadacitinib was initiated for rheumatoid arthritis management and escalated from 15 mg to 30 mg.

Results: Hair regrowth was observed within six weeks, with SALT improving to approximately 15 by three months.

Conclusions: Although spontaneous remission and delayed corticosteroid effects cannot be excluded, the timing and magnitude of improvement support a temporal association with JAK1 inhibition. This case highlights a pragmatic therapeutic consideration when alopecia arises during TNF-α inhibitor therapy.

Female pattern hair loss (FPHL) significantly affects women's well-being and quality of life (QoL), and low-dose oral minoxidil (LDOM) has increasingly gained attention as a convenient and effective treatment option. Although hypertrichosis is reported more often with LDOM than with topical formulations, patient perceptions and tolerance of this side effect remain poorly understood. We conducted a telephone survey at a single institution among women with FPHL currently taking or previously treated with LDOM for at least one month to evaluate treatment effectiveness, QoL, and side effect burden using the Women's Androgenetic Alopecia Quality of Life Questionnaire (WAA-QOL). Among 102 participants, the median duration of LDOM use was 12 months. Hair loss severity improved from a median score of 7 to 4 on a 10-point scale. Unwanted hair growth occurred in 71.6% of patients, most commonly on the face, arms, and legs; however, 93.2% did not consider it a reason to discontinue treatment, and most cases were mild or moderate. WAA-QOL scores improved significantly from baseline (67 to 39, p<0.001), with no predictors of unwanted hair growth identified. Overall, patients experienced clinical and QoL improvements, supporting a favorable patient-centered profile for LDOM.