Craig Leonardi

Guest Editor for the following articles:

Vol. 29. No. 1

Comorbidities in Psoriasis Patients

A.A. Marghoob, MD | Breck Thrash, MD | Noori Kim, BS

Psoriasis is a chronic inflammatory disorder that affects approximately 2% of the general
population. Numerous studies have evaluated the increased prevalence of comorbid diseases
and risk factors in psoriatic patients, including obesity, metabolic syndrome, cardiovascular
disease, psoriatic arthritis, autoimmune disease, psychiatric illness, liver disease,
smoking, malignancy, chronic obstructive pulmonary disease, sleep apnea, and alcohol
abuse. Insight into the overlapping pathogenesis of these comorbidities of psoriasis
highlights the importance of immune-mediated mechanisms in these disease states. Psoriasis,
with its comorbidities, must be approached in a multidisciplinary manner to effectively
and comprehensively understand, manage, and treat those with this complex
Semin Cutan Med Surg 29:10-15 © 2010 Elsevier Inc. All rights reserved.

Vol. 29. No. 1

Assessing Long-Term Drug Safety: Lessons (Re) Learned from Raptiva

Joel M. Gelfand, MS, MSCE | Nicole M. Seminara, BA

Efalizumab was approved for moderate to severe psoriasis in 2003 based on studies in
approximately 2700 patients, of whom only 218 were exposed to the drug for more than 1
year. In 2009, after more than 46,000 patients were exposed to efalizumab, the drug was
withdrawn from the market after 3 confirmed and 1 suspected case of progressive multifocal
leukoencephalopathy (PML) were spontaneously reported. As PML is very rare, it is
extremely unlikely that the 4 reported cases were due to chance and given that PML occurs
primarily in patients who are immunosuppressed, the association is likely causal. The
identification of PML as a serious, but statistically rare risk of efalizumab demonstrates the
strengths and weaknesses of the current drug approval and pharmacovigilance processes
for fully measuring the safety of a drug. Patients and clinicians need to be aware of the
relative completeness and limitations of existing safety data of a drug when selecting a
Semin Cutan Med Surg 29:16-19 © 2010 Elsevier Inc. All rights reserved.