196 Clinical and cost effectiveness of antioxidants and lifestyle modification as treatment for psoriasis in Veteran patients

Abstract

196 Clinical and cost effectiveness of antioxidants and lifestyle modification as treatment for psoriasis in Veteran patients C Young, T Abbas, G Messenger and L Savoy 1 Dermatology, John D. Dingell VA Medical Center, Detroit, MI and 2 Wayne State University School of Medicine, Detroit, MI Psoriasis is a chronic immune-mediated skin disease often characterized by red, raised, scaly patches. Current treatment options including systemic, biologic, and steroid-based drugs are often associated with severe side effects and high costs to health institutions. The current research study conducted at the John D. Dingell VA Medical Center sought to find a safer and more cost-effective treatment for patients with psoriasis. The clinical study was based on research that points to inflammation as the driving factor of psoriasis, which may be why psoriasis is present in patients who also have metabolic syndrome. The goal of the study was to reduce inflammation through a regimen of daily topical and oral antioxidants and diet and exercise modification. 115 veterans with psoriasis participated in the study. They were instructed to use oral and topical antioxidants as well as practice a healthy lifestyle through diet and exercise modifications. A cost-effective analysis was conducted to calculate the hospital’s savings on treating psoriasis before and after patients joined the study. Results of the analysis showed that the Detroit VA Medical Center saved an estimated $240,000 in treatment costs for every 100 patients enrolled in the study. Furthermore, patients’ psoriasis and overall health was improved without experiencing the side effects associated with many mainstream treatment options. These findings show promising directions for future treatment of immune-mediated diseases that will improve patient health while cutting costs for health institutions. 197 Sociodemographic characteristics predict persistent atopic dermatitis disease activity into early adulthood: A longitudinal cohort study K Abuabara, O Hoffstad, AB Troxel, JM Gelfand and D Margolis 1 Department of Dermatology, UCSF, San Francisco, CA, 2 Center for Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA and 3 Department of Dermatology, University of Pennsylvania, Philadelphia, PA To address the research gap around persistence of atopic dermatitis (AD) into adulthood, we performed a longitudinal cohort study to 1) define patterns of AD disease control over time and 2) examine basic patient characteristics associated with each pattern. We used data on self-reported disease control and medication use from 5,798 children and young adults ages 2-26 years with physician-diagnosed AD. They were followed at 6-month intervals for up to 10 years in the Pediatric Elective Eczema Registry (PEER). We performed a latent class analysis using generalized linear latent and mixed models and found 2 distinct classes of individuals: 91% fell into a ‘persistently active’ class, and 9% fell into a ‘resolving’ class that was more likely to report better disease control with age. Patients in the persistently active class were more likely to be female (54% vs 44%) and non-white (59% vs 47%), less likely report family income >$50,000/year (18% vs 42%), and had an earlier age at onset (mean 2.2 vs 2.6 years). These factors were significantly associated with persistently active disease in a multivariate model (p<0.05). Many prior studies that suggest that AD onset may be associated with markers of higher socioeconomic status, but fail to account for the chronic nature of the disease. In contrast, our results suggest that AD persistence may be associated with lower income and non-white race and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.