BackgroundPoor adherence to topical therapy in psoriasis remains an issue; it is associated with poor clinical outcomes, reduced quality of life and increased costs. Treatment‐related factors leading to poor adherence include lack of efficacy, excessive time applying medication and poor cosmetic characteristics (e.g. slow absorption, greasiness).ObjectiveTo assess the topical treatment attributes that influence patient preference for fixed combination calcipotriol 50 μg/g (Cal) and betamethasone 0.5 mg/g as dipropionate (BD) foam vs. gel, as well as in comparison with the latest topical treatment (LTT) a patient received.Methods
PSO‐INSIGHTFUL was a Phase IIIb, prospective, multicentre (Canada/Germany), open‐label, randomized, two‐arm crossover study in patients aged ≥18 years with mild‐to‐severe psoriasis (NCT02310646). Following a washout period of up to 4 weeks, patients were randomized 1 : 1 to once‐daily Cal/BD foam for 1 week, followed by Cal/BD gel for 1 week, or vice versa. Patients completed six questionnaires evaluating patient preferences.ResultsA total of 213 patients were randomized; 118 had received a topical treatment in the previous 3 months. Based on the Subject's Preference Assessment, 50% of patients preferred Cal/BD foam and 50% preferred Cal/BD gel. Based on the Topical Product Usability Questionnaire (TPUQ), overall mean scores were high for both Cal/BD foam and gel, and were often significantly in favour of both products compared with LTT. Greater differences between Cal/BD foam and gel vs. LTT occurred when the previous treatment was an ointment or cream. Cal/BD foam was generally preferred by younger patients (aged 18–39 years), whereas Cal/BD gel tended to be preferred by older patients (aged ≥40 years). Results from other questionnaires were aligned with the TPUQ.ConclusionsPatients with psoriasis have diverse needs and different preferences for topical treatment. This knowledge may help prescribers to choose the right formulation for the right patient, potentially leading to improved adherence and better treatment outcomes.
This article reviews the implications of traditional and novel anti-thrombotic medications in dentistry, focusing on areas relating to the prevalence of significant post procedure bleeding, measures that should be taken to minimize and manage bleeding; and current opinions regarding need for alteration of anti-thrombotic regimens prior to dental procedures in dentistry. Based on the current literature, discontinuation of anti-platelet medications, warfarin therapy, dabigatran and Factor Xa inhibitors is not needed in majority of in office dental procedures. However, it is important that treating clinician must use discretion based on the patient's risk profile (e.g. presence of comorbidities) and extensiveness of planned dental procedures to assess each patient's risk for significant bleeding.
Linked article: This article is commented on by R. Vender et al., pp.e400–e401 in this issue. To view this article visithttps://doi.org/10.1111/jdv.14993
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