Biologic Therapy For Psoriasis Research Articles

PBI93 CHANGE IN PERSISTENCE OVER TIME OF BIOLOGIC THERAPIES FOR THE TREATMENT OF PLAQUE PSORIASIS - A NATIONAL OBSERVATIONAL LONGITUDINAL POPULATION STUDY IN SWEDEN

It is largely unknown how persistence of biologic therapies in plaque psoriasis (psoriasis) has changed over time as more biologic options have become available. The objective of the present analysis is to study changes in persistence over time of biologic therapies in psoriasis from 2010-2018 in Sweden. A longitudinal observational population study was conducted in Sweden using individual-level data from the Swedish National Patient Register, Prescribed Drug Register, and Cause-of-Death Register. Included patients were adults diagnosed with psoriasis who were treated with a biologic between 2010-2018. Median treatment persistence time was estimated from 2010-2018 for ±1 year cohorts (2010-2012, 2011-2013, etc.) from Kaplan Meier curves. Biologic therapies with <20 patients and biologics used off label are not reported. The included population had 2,952 treatment periods (adalimumab: n=1,046, etanercept: n=974, ustekinumab: n=488, secukinumab: n=394, and ixekizumab: n=50). For adalimumab, etanercept, and ustekinumab, patients were included in the entire study period. For secukinumab and ixekizumab, patients were included from the 2013 and 2015 onwards, respectively. Median persistence for ustekinumab declined significantly from 62.3 months (45.6-∞) in 2010-2012 to 29.1 months (19.0-36.8) in 2013-2015, with similar results in 2014-2016. In the remaining time periods, ustekinumab did not reach the 50% persistence probability threshold yet. Median persistence for adalimumab and etanercept ranged from 23.5-15.3 months and 18.7-9.6 months, respectively, with no significant differences over time. Secukinumab and ixekizumab did not reach the 50% persistence probability threshold yet in most periods. Median persistence for adalimumab and etanercept was relatively stable over time, whereas a significant decrease in persistence over time was observed for ustekinumab. The timing of the entry of new biologics may need to be considered when analyzing treatment duration in psoriasis: the availability of more, effective treatment options may allow earlier treatment switch when treatment is suboptimal.

AD1 PERSISTENCE OF BIOLOGIC THERAPIES FOR THE TREATMENT OF PLAQUE PSORIASIS - A NATIONAL LONGITUDINAL OBSERVATIONAL POPULATION STUDY IN SWEDEN

Recent observational studies suggest that persistence of biologic therapies in plaque psoriasis (psoriasis) differs from what is observed in clinical trials. The objective of this study is to assess the persistence of biologic therapies for the treatment of psoriasis in clinical practice in Sweden. A longitudinal observational population study was carried out using individual-level data from the Swedish National Patient Register, Prescribed Drug Register, and Cause-of-Death Register. Included patients were adults diagnosed with psoriasis, treated with a biologic between 2010-2018. Median treatment persistence and 1-year predicted persistence probabilities were estimated from Kaplan-Meier curves. Sub-group analysis was conducted with biologic-naïve vs. biologic-experienced patients. Biologic therapies with <20 patients and biologics used off label are not reported. 2,258 patients with 2,975 treatment periods were included (adalimumab: n=1,046, etanercept: n=974, ustekinumab: n=488, secukinumab: n=394, ixekizumab: n=50, and certolizumab pegol: n=23). Mean age at psoriasis diagnosis was 42.1 (SD 14.2); 62% were male; 78.7% had concomitant psoriasis medication; and 61% were biologic naïve (range: 12-93%) Overall median drug persistence was 23.8 months (95% CI: 21.6-26.2). For biologics reaching 50% drug continuation, median persistence ranged from 49.3 months (95% CI: 38.0-59.1, ustekinumab) to 9.3 months (95% CI: 6.4-18.1, certolizumab pegol). Secukinumab and ixekizumab did not reach the 50% drug continuation probability threshold. The proportion of persistent patients after 1 year was highest for ixekizumab (81.3%), followed by ustekinumab (79.9%), secukinumab (75.9%), adalimumab (64.6%), and etanercept (57.8%). Biologic-naïve patients had higher drug persistence than biologic-experienced patients for all treatments except certolizumab pegol and ixekizumab, both limited by low patient numbers. In this observational study in Sweden, median persistence was around 2 years for biologic therapies in psoriasis in clinical practice. The study indicates that modern biologic therapies may have higher persistence than traditional anti-TNFs, though potential confounders need to be explored further.

JAAD Game Changers∗: Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies: A retrospective cohort study and systematic review of the literature

Capsule Summary•Psoriasis patients with hepatitis C infection or low-risk patients without hepatitis who are seropositive for hepatitis B virus core antibody are at minimal risk or no additive risk for viral reactivation with the use of biologic therapies.•However, psoriasis patients who are chronic carriers of hepatitis B virus have an estimated 14% risk for yearly viral reactivation while on biologic therapy and thus may warrant antiviral prophylaxis or re-evaluation of treatment risk/benefit ratios.How did this article change the practice of dermatology?Patients with a history of viral hepatitis carry a reactivation risk, but how this is affected by biologic therapies for psoriasis is uncertain. Patients positive for hepatitis C virus or hepatitis B virus core antibody without evidence of hepatitis had a minimal risk for reactivation, whereas those with chronic hepatitis B virus had a higher risk for reactivation.1 Select patients with a history of viral hepatitis may be safely treated with biologics.

Abstract P185: The Effect of Anti-Interleukin-17A Biologic Therapies on Cardiovascular Outcomes in Patients With Psoriasis

We and others have demonstrated that interleukin-17A (IL-17A) plays a critical role in the pathogenesis of cardiovascular disease and hypertension. Patients with psoriasis, an IL-17A mediated autoimmune disease, are at elevated risk for cardiovascular events. New biologic therapies for psoriasis have been developed that target IL-17A (secukinumab) or its receptor (brodalumab), but their impact on incident hypertension and its associated complications is unknown and remain unexplored outside of short-term safety in clinical trials. Our goal is to perform a retrospective case-control study utilizing the Synthetic Derivative (Vanderbilt’s de-identified version of the electronic health record) to determine whether incident hypertension or other major adverse cardiovascular events is reduced in patients with psoriasis receiving IL-17A targeted therapies versus other therapeutics. Patients are defined as cases by 2 or more mentions of a psoriasis ICD9 or ICD10 code and at least one documented prescription for secukinumab or brodalumab. Controls are defined by the presence of 2 or more psoriasis ICD codes, no documented exposure to the drugs of interest, and a mention of “psoriasis” in their Problem List. Using these definitions, we identified 571 cases and 4484 controls in the Synthetic Derivative. Of the 571 potential cases identified, 65 were confirmed by manual review for an initial validation study. Of the manually confirmed cases, 22 (34%) were male and 43 (66%) were female. Manually reviewed cases had a mean record length of 5.0 years with an average of 29.9 discrete ICD mentions. Twenty-three cases (35%) had an ICD code for hypertension, which predated the first documented psoriasis code in eight patients. Thus, we are able to use the Synthetic Derivative to identify patients with psoriasis receiving biologic therapies and assess temporal relationships relevant to hypertension. We plan to expand this study to the larger cohort identified and analyze rates of hypertension and a composite outcome of hypertension complications, including stroke, myocardial infarction, heart failure, and chronic kidney disease, in cases and controls matched for age, gender, race, and BMI.

Change in body weight and body mass index in psoriasis patients receiving biologics: A systematic review and network meta-analysis

Previous studies have suggested that biologic therapy for psoriasis might relate to body weight gain. To assess the changes in body weight and body mass index (BMI) in psoriasis patients after receiving various biologics. We conducted a systematic review and network meta-analysis to evaluate the changes in body weight and BMI in psoriasis patients receiving biologics. On March 1, 2019, we searched Medline, Embase, and Cochrane Central Register of Controlled Trials for relevant studies. The Newcastle-Ottawa scale was used to assess the risk of bias. We included 6 studies with 862 psoriasis patients. Compared with conventional systemic treatments, treatment with tumor necrosis factor α inhibitors was associated with a significant increase in body weight (mean difference 1.40kg, 95% confidence interval 0.88-1.93kg) and BMI (0.39kg/m2, 95% confidence interval 0.24-0.54kg/m2). In contrast, no significant increase in body weight or BMI was found among patients receiving anti-interleukin (IL)-12/23 or anti-IL-17 biologics. Only 1 study reported body weight and BMI for patients receiving the anti-IL-17 biologic. Tumor necrosis factor α inhibitor treatment appears to be associated with an increase in body weight and BMI, and treatment with anti-IL-12/23 and anti-IL-17 biologics do not. This association should be considered before initiating biologics for overweight and obese patients.

Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index

Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries. To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA). This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline. Biologic therapy for psoriasis. Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status. Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P < .001) concurrent with skin disease improvement (median PASI, 7.7 [IQR, 3.2-12.5] at baseline vs 3.2 [IQR, 1.8-5.7] at 1 year; P < .001), whereas no change in FAI was noted in those not receiving biologic therapy (median FAI, -71.98 [IQR, -77.36 to -65.64] at baseline vs -72.66 [IQR, -78.21 to -67.44] at 1 year; P = .39). The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents, including anti-tumor necrosis factor α (median FAI, -71.25 [IQR, -75.86 to -66.89] at baseline vs -75.49 [IQR, -79.12 to -68.58] at 1 year; P < .001) and anti-IL-12/23 or anti-IL-17 therapy (median FAI, -71.18 [IQR, -75.85 to -68.80] at baseline vs -76.92 [IQR, -81.16 to -71.67] at 1 year; P < .001). In this study, biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular FAI. This finding suggests that perivascular FAI measured by CCTA may be used to track response to interventions for coronary artery disease.

Female patients are less satisfied with biological treatment for psoriasis and experience more side-effects than male patients: results from the prospective BioCAPTURE registry.

Female sex has been reported as a predictor for treatment discontinuation with biological therapies for psoriasis, although reasons remain unclear. It can be hypothesized that lower satisfaction with biological treatment in women might add to the lower drug survival rates. To identify possible differences in satisfaction with biological treatment between female and male patients using the Treatment Satisfaction Questionnaire for Medication (TSQM). Data of psoriasis patients treated with biologics were obtained from the prospective, multicentre, daily-practice BioCAPTURE registry. Longitudinal TSQM data were analysed by linear mixed models. Relevant patient characteristics were incorporated as possible confounding factors. Post hoc analysis of adverse events was performed in order to investigate differences between sexes. We included 315 patients with 396 corresponding treatment episodes (137 adalimumab, 90 etanercept, 137 ustekinumab, 24 secukinumab and 8 infliximab). Almost forty per cent of the patients were female. Women had significantly lower baseline PASI scores (P=0.01). Longitudinal analyses demonstrated lower TSQM scores for 'side-effects' (P=0.05) and 'global satisfaction' (P=0.01) in female patients compared with male patients over 1year of treatment. Women reported more relevant adverse events in the context of biologic treatment compared to men (rate ratio 1.79; P<0.001), with more fungal (rate ratio 2.20; P=0.001) and herpes simplex infections (rate ratio 3.25; P=0.005). This study provides a prospective, longitudinal analysis of treatment satisfaction with biologics in female and male patients with psoriasis. Women were slightly less satisfied with treatment regarding side-effects and global satisfaction. Differences in treatment satisfaction and side-effects might add to the fact that women discontinue biological treatments more often.

Evidence that systemic therapies for psoriasis may reduce psoriatic arthritis occurrence

Contemporary biologic therapies for psoriasis are independently licensed for psoriatic arthritis (PsA). Since skin disease generally predates PsA and PsA has a subclinical phase, we investigated the pattern of PsA evolution in psoriasis treated with biologic agents compared to other medications including oral therapy, topical agents or no treatments. A retrospective chart review was performed in psoriasis patients with musculoskeletal symptoms referred for rheumatological assessment. Patients who had a final diagnosis of PsA were identified. The frequency and clinical features of PsA were compared for biologics versus the other strategies. Between 2015-18, 203 psoriasis patients were referred for musculoskeletal symptoms with 25 on biologics, 31 on non-biologic systemic therapies and 147 on topical/no therapies. A final diagnosis of PsA was similar in all groups (biologics: 36%; non-biologic systemic treatments: 35.4%; none/local treatments: 37.4%). Most patients had musculoskeletal symptoms before systemic therapy initiation but new onset PsA was evident in 12% (3/25) biologics treated patients, 9.6% (3/31) in non-biologic systemic therapy patients and was significantly higher in patients on topical/no therapy (55/147; 37.4%, p<0.001). Among patients with PsA, none of the patients on biologics exhibited dactylitis compared to 28.6% of other systemic treatments and 48.6% of none/local treatments (p=0.046). New symptoms and signs leading to PsA diagnosis appear to decrease with systemic treatments. The characteristic PsA dactylitis lesion was not evident in the biologic therapy group.

Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study

Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched. We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival. In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan-Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival. Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P=.0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P=.014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P=.003, hazard ratio 0.48). As a single-center, retrospective real-life study, the data were not perfectly homogeneous. Switching between biologic classes might increase drug survival but retrospective studiesdesigned ad hoc are needed to confirm this better switching strategy.

Lack of association of biologic therapy for psoriasis with psychiatric illness: An electronic medical records cohort study

Psoriasis and biologic therapies have been associated with psychiatric illnesses. To determine if persons with psoriasis or those exposed to biologics are more likely to develop a psychiatric illness. Retrospective electronic medical records cohort study. Individuals with psoriasis were significantly more likely to have a history of several medical (eg, cardiovascular illnesses) and psychiatric (eg, depression, suicide) illnesses than those without psoriasis. Those with psoriasis who were prescribed a biologic therapy were significantly less likely than those with psoriasis not prescribed a biologic agent to receive a psychiatric illness diagnosis (hazardratio for any psychiatric illness 0.52, 95% confidence interval 0.51-0.53, P<.0001). With respect to any psychiatric illness, this finding was confirmed when comparing biologic therapy versus methotrexate treatment (0.80, 95% confidence interval 0.76-0.84, P<.0001). These findings were likely attributable to treatment selection bias. Individuals with psoriasis have an increased risk of several medical and psychiatric illnesses. Individuals with psoriasis prescribed biologic agents are less likely than those not prescribed biologic agents to develop psychiatric illnesses. Most likely because of treatment selection, individuals with psoriasis prescribed biologic therapy are not currently at increased risk of a psychiatric outcome.

Checklist for the Systemic Treatment of Psoriasis Using Biologics: A Delphi Study.

Despite the complexity of psoriasis treatment using biologic therapy, there does not exist a standardized synoptic reporting form for the initiation of this population. The purpose of this study was to use a modified Delphi approach to develop a standard checklist for the standardized documentation of patients receiving systemic biologic therapy for psoriasis. A modified Delphi survey was conducted over 3 rounds (February 2017 through January 2018). An expert panel generated a 51-item checklist that was proposed to participants. Items were rated on an anchored 1-7 Likert scale. Consensus was defined apriori as ≥ 70% agreement by respondents. A total of 58, 17, and 18 dermatologists participated in 3 consecutive Delphi rounds, respectively. Only half of the dermatologists surveyed reported using a checklist for the management of psoriasis. The final checklist comprised 19, 5, 6, and 9 items pertaining to patient history; physical exam and history of systemic therapy; vaccinations; and lab investigations and bloodwork, respectively. Given the increasing availability and complexity of biologic agents for psoriasis treatment, there is a need to promote standardized documentation for this population. The Checklist for the Systemic Treatment of Psoriasis presents 38 items that should be considered when initiating patients with psoriasis on biologic therapy.

Kasr AL-Ainy’s psoriasis unit protocol for the treatment of psoriasis, part II: biological therapies

Psoriasis is a chronic multisystem inflammatory disease affecting primarily the skin and joints but also involves several comorbidities. The disease affects between 0.2 and 4% of the population worldwide. The Kasr Al-Ainy Psoriasis Unit developed a protocol of therapy for psoriasis. Part I discussed the topical and systemic therapies. This part discusses the biological therapy. Biological therapies for psoriasis are agents that can specifically target an immune mediator and block specific molecular steps important in the pathogenesis of psoriasis. Despite the cost, the use of biological therapies in psoriasis is sometimes necessary. However, the adequate choice of biologic in the proper indication is mandatory for cost–benefit balance for the patient. Physicians using biological therapies should be familiar with complications. The protocol offers regional physicians a practical algorithm for choice of biological therapies in psoriasis and a full workup before therapy and during follow-up. Authors highlight the safety and efficacy data of biologic therapies available in the Egyptian market, with special focus on particular situations (hepatitis, tuberculosis, and demyelinating disorders).

Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature

Biologic drugs, which are molecules designed to act on specific immune system targets, have been shown to be very effective in treating various dermatological, rheumatological, and systemic diseases. As a group, they have an acceptable safety profile, but their use has been associated with the onset of both systemic and organ-specific inflammatory conditions. True paradoxical reactions are immune-mediated disorders that would usually respond to the biologic agent that causes them. There is still debate about whether certain other adverse reactions can be said to be paradoxical. The hypotheses proposed to explain the pathogenesis of such reactions include an imbalance in cytokine production, with an overproduction of IFN-α and altered lymphocyte recruitment and migration (mediated in part by CXCR3), and the production of autoantibodies. Some biologic therapies favor granulomatous reactions. While most of the paradoxical reactions reported have been associated with the use of TNF-α inhibitors, cases associated with more recently introduced biologic therapies —such as ustekinumab, secukinumab, and ixekizumab—are increasingly common. The study of paradoxical adverse events not only favors better management of these reactions in patients receiving biologic therapy, but also improves our knowledge of the pathogenesis of chronic inflammatory diseases and helps to identify potential therapeutic targets.

Biological therapy for psoriasis and risk of cancer

Psoriasis is a common skin disease that affects up to 3% of people worldwide. Psoriasis is driven by faults in the immune system (which protects the body from infection), which leads to excess skin production. People with the most severe form of psoriasis are given therapies to dampen down the immune system. Systemic therapies (methotrexate and ciclosporin) work to reduce the whole immune system, while biologic therapies (adalimumab, etanercept, and ustekinumab) are targeted to specific immune pathways in the skin. However, there is concern that these therapies may increase the risk of cancer. This study of psoriasis patients in Ireland, Israel, Italy, Spain, and the U.K. aimed to find out if the amount of time spent on these therapies increases the risk of cancer. Each person who developed a cancer during the study was compared to four cancer‐free psoriasis patients (controls) of the same sex, age, dermatology centre, and year of entry into the study. The total time spent on systemic and biologic therapies was calculated for each patient. The authors did not find a difference in the time spent on systemic or biologic therapies between patients who developed a cancer and controls. This result remained unchanged after considering the possible effects of previous exposure to other systemic therapies, duration of psoriasis, smoking, previous exposure to phototherapy and other simultaneous diseases. This study showed that cancers were not more likely to develop after up to 8 years of treatment with biologic therapies.

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study.

SummaryBackgroundBiologic therapies have revolutionized the treatment of moderate‐to‐severe psoriasis. However, for reasons largely unknown, many patients do not respond or lose response to these drugs.ObjectivesTo evaluate demographic, social and clinical factors that could be used to predict effectiveness and stratify response to biologic therapies in psoriasis.MethodsUsing a multicentre, observational, prospective pharmacovigilance study (BADBIR), we identified biologic‐naive patients starting biologics with outcome data at 6 (n = 3079) and 12 (n = 3110) months. Associations between 31 putative predictors and outcomes were investigated in univariate and multivariable regression analyses. Potential stratifiers of treatment response were investigated with statistical interactions.ResultsEight factors associated with reduced odds of achieving ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) at 6 months were identified (described as odds ratio and 95% confidence interval): demographic (female sex, 0·78, 0·66–0·93); social (unemployment, 0·67, 0·45–0·99); unemployment due to ill health (0·62, 0·48–0·82); ex‐ and current smoking (0·81, 0·66–0·99 and 0·79, 0·63–0·99, respectively); clinical factors (high weight, 0·99, 0·99–0·99); psoriasis of the palms and/or soles (0·75, 0·61–0·91); and presence of small plaques only compared with small and large plaques (0·78, 0·62–0·96). White ethnicity (1·48, 1·12–1·97) and higher baseline PASI (1·04, 1·03–1·04) were associated with increased odds of achieving PASI 90. The findings were largely consistent at 12 months. There was little evidence for predictors of differential treatment response.ConclusionsPsoriasis phenotype and potentially modifiable factors are associated with poor outcomes with biologics, underscoring the need for lifestyle management. Effect sizes suggest that these factors alone cannot inform treatment selection.

Treating Psoriasis: What Is New About Fumaric Acid Esters?

This publication covers the first session of Almirall’s 11th Skin Academy meeting in Barcelona, Spain. This year, the meeting theme was ‘The Science of Skin’. The meeting included updates in systemic and biologic therapies for psoriasis and new developments in the treatment of skin cancer, as well as hot topics such as onychomycosis and hair loss. In this first session, Prof Thaçi and Prof Augustin reviewed advances in the systemic treatment of psoriasis and explored how successful development of new treatments has led to an improved understanding of underlying disease processes. With a particular focus on the history of treatment with fumaric acid esters (FAE), the speakers explored the impact of the introduction of dimethylfumarate (DMF) monotherapy on knowledge of psoriasis and its treatment. Other topics included the complexities of treatment selection, the importance of meeting patients’ expectations, and the significant role that biomarkers and personalised medicine will have in future treatment decisions.

Biological therapies in psoriasis - revisited.

Psoriasis is a chronic, immune mediated disorder affecting approximately 2% of the population. Even in our days, patients with psoriasis are confronted with stigmatization and social rejection. As a result, their quality of life is significantly impaired. Biological therapies have revolutionized the treatment of moderate to severe psoriasis. The aim of this paper is to look over the most important biological therapies available for the management of plaque-type psoriasis.

Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden?

Patients with psoriasis are at an increased risk for nonalcoholic fatty liver disease (NAFLD) compared with the general population. However, the pathophysiology underlying this comorbidity and elucidation of effective treatment strategies are unclear. This review provides insights into the possible role of chronic, low-grade inflammation in the pathogenesis of NAFLD in patients with psoriasis. Both conditions are associated with increased levels of proinflammatory adipokines (such as tumour necrosis factor-α and interleukin-6) and hepatokines, and decreased levels of adiponectin, an anti-inflammatory adipokine. This imbalance in inflammatory mediators could result in insulin resistance and, thereby, facilitate the occurrence and progression of NAFLD in a multistep manner. All patients with psoriasis should, therefore, be considered candidates for NAFLD screening and managed accordingly. Given the common aetiology of inflammation between these conditions, it is hypothesized that biological therapies for psoriasis may attenuate the systemic inflammatory process and progression of NAFLD in patients with psoriasis.

786 HLA genes associate with response to multiple biologic therapies in psoriasis

786 HLA genes associate with response to multiple biologic therapies in psoriasis

951 Serum leucine-rich-α-2 glycoprotein is a biomarker for the effectiveness of biologic therapies in psoriasis

951 Serum leucine-rich-α-2 glycoprotein is a biomarker for the effectiveness of biologic therapies in psoriasis