Objective. These guidelines for the management of psoriasis have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. Psoriasis has a major impact on the quality of life of sufferers, and it is expected that these guidelines, if implemented, will play a role in achieving improved outcome. Scope. These guidelines were developed to address the diagnosis and treatment of psoriasis, of differing degrees of severity and in patients of all ages, by all health care professionals involved with its management. Recommendations. All health care workers involved in the management of psoriasis should take note of these guidelines and try to implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of psoriasis treatment. Validation. These guidelines were developed through general consensus by a group of 8 South African dermatologists (the ’Working Group’) sanctioned by the Dermatological Society of South Africa (DSSA), by adaptation for the South African situation of the current guidelines used in the USA, the UK, Germany, Canada and Finland. Draft documents were made available for comment to the dermatological community as a whole via the official website of the DSSA, and the guidelines were presented and discussed at the annual congress of the DSSA in 2008. All input from these sources, where appropriate, were then incorporated into these guidelines. Guidelines sponsor. Schering-Plough initiated the project and sponsored the meetings of the working group and all costs generated by these meetings. Plans for guideline revision. The field of biologicals and cytokine modulators is in a rapid phase of development, and revision of the scope and content of these guidelines will be ongoing as longer-term data emerge.

/pdf/guideline-on-the-management-of-psoriasis-in-south-africa-1tz3hzur2h.pdf

Guideline on the management of psoriasis in South Africa.

Objectives
To analyse the treatment sequencing assumptions after failure on a first-line biologic in cost-effectiveness models of treatment of moderate to severe plaque psoriasis, and to compare them with the most recent treatment guidelines.

/pdf/treatment-sequencing-after-failure-of-the-first-biologic-in-3udxm3eq1j.pdf

Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines

Pss1 meta-analysis of biologic therapies for the treatment of moderate to severe psoriasis

PurposeFenfluramine and cannabidiol are licensed as add-on therapies for the treatment of seizures in Dravet syndrome (DS); however, there are no comparative trials of these therapies. We assessed the comparative effectiveness of fenfluramine (with/without concomitant stiripentol) versus cannabidiol (with/irrespective of concomitant clobazam, using robust indirect comparison methods.

MethodsWe systematically searched for randomised controlled trials (RCTs) of licensed regimens published up to 30 November 2021. Outcomes of interest were placebo-adjusted reductions from baseline in monthly convulsive seizure frequency (MCSF), the odds of achieving [≥]25%, [≥]50%, [≥]75% and 100% reductions from baseline in MCSF, and the odds of experiencing serious treatment-emergent adverse events (TEAEs). Comparative efficacy and safety were assessed using Bayesian network meta-analysis (NMA). PROSPERO registration: CRD42021296141.

ResultsWe identified five relevant placebo-controlled RCTs (three for fenfluramine; two for cannabidiol; N=667). All licensed regimens of fenfluramine and cannabidiol significantly reduced MCSF compared with standard of care. When indirectly comparing fenfluramine 0.7mg/kg/day (without concomitant stiripentol) and fenfluramine 0.4mg/kg/day (with concomitant stiripentol) versus cannabidiol 10mg/kg/day, irrespective of clobazam use, the mean differences in placebo-adjusted reduction from baseline in MCSF were 47.3% (95%CrI: 18.9, 64.7) and 35.1% (1.0, 57.5), respectively, and versus cannabidiol 10mg/kg/day plus clobazam were 37.2% (2.0, 59.7) and 23.5% (-20.2, 51.3), respectively. For these outcomes, and for the proportion of patients achieving [≥]25%, [≥]50% and [≥]75% reductions in MCSF, Bayesian treatment ranking indicated [≥]99% probability that fenfluramine is the most effective therapy versus <1% probability for cannabidiol 10 or 20mg/kg/day (maximum recommended dose), with/irrespective of concomitant clobazam. Fenfluramine regimens had lower odds of serious TEAEs.

ConclusionNMA using RCT data indicates fenfluramine provides superior convulsive seizure control compared to cannabidiol across all licensed dose regimens and is comparatively well-tolerated. Fenfluramine may meet the need for a highly effective and tolerable add-on therapy to control seizures in DS.

O_TEXTBOXWhat is already known on this topicO_LIFenfluramine (Fintepla(R)) is a recently licensed add-on therapy to standard of care antiepileptic drugs for the treatment of seizures in Dravet syndrome.
C_LIO_LICannabidiol (Epidiolex(R)/Epidyolex(R)) is also licensed for this use. In Europe cannabidiol is only licensed for use with concomitant clobazam.
C_LIO_LIThere are no direct comparative data to inform on the relative efficacy and safety of these therapies in the management of seizures in Dravet syndrome. No indirect comparisons have been conducted across the full licensed dose regimens of these therapies.
C_LI

What this study addsO_LIBased on NMA using RCT data, fenfluramine provides superior convulsive seizure control in Dravet syndrome compared with cannabidiol across all licensed dose regimens, and is comparatively well tolerated.
C_LIO_LIFenfluramine may meet the need for a highly effective and tolerable add-on therapy to control seizures in Dravet syndrome
C_LI

C_TEXTBOX

Comparative effectiveness of fenfluramine versus cannabidiol in their licensed indications for the treatment of seizures in Dravet Syndrome: a systematic review and network meta-analysis

POSC132 A Mapping Exercise and Temporal Extrapolation of the WOMAC Index for Adults with X-Linked Hypophosphataemia (XLH) Treated with Burosumab

P32 The Use of 'Placebo Adjusted Risk Difference Network Meta-Analysis' to Account for Confounding by Heterogeneity in Placebo Response Across Studies

POSC133 Use of Expert Elicitation to Extrapolate Observed Intermediate Clinical Trial Outcomes to Clinically Meaningful Long-Term Outcomes for Use in Health Technology Assessments: A Case Study in a Rare, Lifelong Disease

NS Hawkins

Papers

Pss1 meta-analysis of biologic therapies for the treatment of moderate to severe psoriasis

Comparative effectiveness of fenfluramine versus cannabidiol in their licensed indications for the treatment of seizures in Dravet Syndrome: a systematic review and network meta-analysis

POSC132 A Mapping Exercise and Temporal Extrapolation of the WOMAC Index for Adults with X-Linked Hypophosphataemia (XLH) Treated with Burosumab

P32 The Use of 'Placebo Adjusted Risk Difference Network Meta-Analysis' to Account for Confounding by Heterogeneity in Placebo Response Across Studies

POSC133 Use of Expert Elicitation to Extrapolate Observed Intermediate Clinical Trial Outcomes to Clinically Meaningful Long-Term Outcomes for Use in Health Technology Assessments: A Case Study in a Rare, Lifelong Disease