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      The evolving role of topical treatments in adjunctive therapy for moderate to severe plaque psoriasis.


      Administration, Oral, Treatment Outcome, pathology, Skin, Severity of Illness Index, Quality of Life, drug therapy, Psoriasis, Patient Satisfaction, Middle Aged, Male, Humans, adverse effects, administration & dosage, Glucocorticoids, Female, Drug Therapy, Combination, Dermatologic Agents, Clobetasol, analogs & derivatives, Calcitriol, Biological Products, Aged, Adult, Administration, Topical

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          The Clobex Spray Community-Based Research Assessment (COBRA) trial was a 4-week, open-label, observational, community-based trial that evaluated the use of twice-daily clobetasol propionate spray 0.05% either as monotherapy (n = 1254, effectiveness-evaluable [EE] population) or therapy added on to an existing regimen (n = 731, EE population) in subjects with moderate to severe plaque psoriasis. The key outcome measures were the change in target plaque severity (TPS) rating between weeks 0 (baseline) and 4 and the investigators' global assessment of improvement (GAI) rating at 4 weeks. This article focuses on clobetasol spray 0.05% when it is added to the 5 most commonly used treatment regimens in the COBRA trial add-on therapy group. Among the group of subjects receiving clobetasol propionate spray 0.05% as add-on therapy, the most common ongoing treatment was a biologic agent. The other more common ongoing treatments were topical calcipotriene, oral antipsoriatic agents, other topical corticosteroids (non-class 1), and topical calcipotriene plus other topical corticosteroids. Similar rates of treatment success (clear or almost clear) were seen in the subgroup analysis for each of the add-on regimens when assessed by both the TPS and GAI scales. On the TPS scale, success rates at week 4 were 76.0% to 84.0% for clobetasol propionate spray 0.05% added to biologic agents, topical calcipotriene, oral antipsoriatic agents, other topical corticosteroids, or topical calcipotriene plus other topical corticosteroids. It is notable that in subjects who were being treated with a variety of agents, the addition of clobetasol propionate spray 0.05% during the course of the study resulted in improvements in disease severity.

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