Chronic Plaque Psoriasis Research Articles

Comparative effectiveness of adalimumab versus ustekinumab in the treatment of severe chronic plaque psoriasis: The results based on data from the program "treatment of moderate and severe forms of plaque psoriasis (B.47)" of the National Health Fund in Poland.

Biological agents: TNF-α inhibitors, IL-12, and IL-23 blockers, IL-17 inhibitors are used in the treatment of plaque psoriasis. Adalimumab (ADA) is an antibody that binds to TNF-α. Ustekinumab (UST) blocks IL-12 and IL-23. The data obtained from medical records is of exceptional value. The aim of the study was to evaluate the efficacy of ADA and UST during a single 40-week period of biological treatment of patients under the drug program "Treatment of moderate and severe form of plaque psoriasis." The group of 620 adult patients with moderate to severe form of plaque psoriasis, who were unresponsive or had contraindications to the standard treatment were qualified to the drug program. In the evaluated group, 50.64% patients were treated with UST, 49.36% with ADA. The efficacy of treatment was assessed during weeks 0, 4, 16, 28, and 40. At week 16th, PASI75 reached 80.72% patients in ADA treated group, PASI ≥90 54.88%, PASI100 19.6% of patients. In the UST group (week 16th) PASI75 reached 70.38%, PASI90 44.26%, PASI100 15.6% of patients. At week 28th PASI90 and PASI100 were more pronounced in the ADA group than in UST. In addition, the total percentage of PASI improvement was significantly higher in the ADA group (p= 0.0006). The percentage of PASI improvement in week 40 was statistically higher in ADA group compared to UST (p= 0.015). Compared to UST, ADA was clinically more effective during a 40-week observation. Patients receiving ADA achieved PASI75, PASI90, and PASI100 more frequently and faster than those treated with UST. Additionally, ADA improved the quality of life of psoriatic patients more substantially compared to UST.

Influence of narrow-band ultraviolet B therapy on sirtuin 1 expression in lesional skin of patients with chronic plaque psoriasis: Relation to clinical improvement and interferon-γ expression.

Reduced sirtuin 1 (Sirt1) expression in psoriasis was previously reported, and its activation was associated with disease improvement. Narrow-band ultraviolet B (NB-UVB) downregulates several pro-inflammatory cytokines such as interferon-γ (IFN-γ) and influences keratinocyte differentiation in psoriasis. The aim of this study was to study the in vivo influence NB-UVB treatment on Sirt1 expression in psoriatic skin in relation to disease improvement and IFN-γ expression. Twenty-six patients with chronic plaque psoriasis were evaluated, and psoriasis area severity index (PASI) was calculated. Skin biopsies were taken from lesional skin of the patients before and after 3 months of treatment with NB-UVB and from 26 controls, where the distribution and immunohistochemistry (IHC) scores of Sirt1 and IFN-γ were determined. After 3 months of treatment, Sirt1 distribution and epidermal IHC score were significantly higher, whereas Sirt1 dermal IHC score and IFN-γ distribution, epidermal and dermal IHC scores were significantly lower than the pre-treatment values. Before and after 3 months of NB-UVB therapy, PASI showed a significant negative correlation with Sirt1 distribution and epidermal IHC score; and a significant positive correlation with interferon-γ distribution and epidermal IHC score. Moreover, Sirt1 distributions were negatively correlated with the corresponding interferon-γ distributions. Conclusions The detected upregulation of epidermal Sirt1 following NB-UVB therapy possibly represents another mechanism by which NB-UVB can act in psoriasis and also highlights the role of Sirt1 upregulation in psoriasis treatment.

Secukinumab dosing every 2 weeks demonstrated superior efficacy compared with dosing every 4 weeks in patients with psoriasis weighing 90 kg or more: results of a randomized controlled trial.

Obesity is a common comorbidity of psoriasis and can attenuate response to biologic treatment. To investigate the efficacy, safety and tolerability of secukinumab 300 mg every 2 weeks (Q2W) vs. secukinumab 300 mg every 4 weeks (Q4W) in patients with a higher bodyweight. In this multicentre, double-blind, parallel-group trial, 331 patients with moderate-to-severe chronic plaque psoriasis weighing ≥ 90 kg were randomized to receive secukinumab 300 mg Q2W or secukinumab 300 mg Q4W. Patients who did not achieve Psoriasis Area and Severity Index (PASI) 90 at week 16 on the Q4W regimen were reallocated to remain on the Q4W regimen or uptitrate to Q2W. At week 16, Q2W dosing (n = 165) led to significantly higher PASI 90 responses vs. Q4W [n = 166; 73.2% vs. 55.5%, one-sided P-value = 0.0003, odds ratio estimate (95% confidence intervals): 2.3 (1.4-3.8)]. At week 52, higher efficacy responses were maintained in the Q2W arm (n = 165) vs. Q4W (n = 83); PASI 75: 88.9% vs. 74.8%; PASI 90: 76.4% vs. 52.4%; PASI 100: 46.7% vs. 27.3%; Investigator's Global Assessment 0/1: 75.9% vs. 55.6% and Dermatology Life Quality Index 0/1: 66.1% vs. 48.8%. PASI 90 nonresponders at week 16 who uptitrated to Q2W (n = 31) showed higher efficacy responses at week 32 (16 weeks post-uptitration, PASI 90: 38.7% vs. 16.5%) vs. those who remained on Q4W (n = 40). Safety results were comparable across treatment arms and consistent with the established secukinumab safety profile. Secukinumab 300 mg Q2W demonstrated superior and sustained efficacy compared with Q4W in patients with moderate-to-severe plaque psoriasis weighing ≥ 90 kg. PASI 90 nonresponders derived additional benefits from uptitration to a Q2W regimen (ClinicalTrials.gov identifier: NCT03504852). What is already known about this topic? Obesity is a common comorbidity of psoriasis and can attenuate response to biologic treatment. Secukinumab is a fully human monoclonal antibody that selectively neutralizes interleukin-17A in the treatment of moderate-to-severe plaque psoriasis. Subgroup analyses of previous study results and pharmacokinetic/pharmacodynamic modelling data suggest that heavier patients may benefit from higher exposure to secukinumab through an increased dosing frequency [300 mg every 2 weeks (Q2W) vs. every 4 weeks (Q4W)]. What does this study add? Over 52 weeks, secukinumab 300 mg Q2W demonstrated superior efficacy compared with secukinumab 300 mg Q4W in patients with moderate-to-severe plaque psoriasis weighing ≥90 kg, with comparable safety results, consistent with the established secukinumab safety profile. In patients who did not achieve PASI 90 at week 16 on the Q4W regimen, uptitration to the Q2W regimen at week 16 resulted in improved efficacy responses through week 52 after switching.

An Open-Label, Randomized, Prospective, Comparative, Three-Arm Clinical Trial to Evaluate the Safety and Effectiveness of Apremilast with Three Different Titration Methods in Patients with Chronic Plaque Psoriasis in India.

PurposeTo minimize adverse effects (AEs), apremilast is recommended to titrate at the initiation of therapy. But still, many patients experience AEs, resulting in discontinuation of therapy. As a result, many dermatologists have adapted to further titrate apremilast in different ways. The present study was planned to evaluate the safety and effectiveness of apremilast in different dose titration methods as initiation therapy in the treatment of plaque psoriasis.Patients and MethodsIn this open-label, randomized, prospective, comparative, three-arm, single center study, 128 plaque psoriasis patients were included. Patients were randomized into three groups. Group I received standard titration for the first 6 days; Group II received all tablets in a starter pack as once a day (OD) total for 13 days; and Group III received two starter packs as 8 tablets each of apremilast 10 mg and 20 mg as OD and 10 tablets of 30 mg as OD, in total for 26 days. All groups received apremilast 30 mg as twice a day after initial titration. The total duration of apremilast therapy in all groups was 16 weeks.ResultsIn safety assessment, AEs were reported in 50%, 41.3% and 25% in Groups I, II and III, respectively (p <0.05) with nausea being the most common AE. In Group I, 10.53% of patients discontinued apremilast whereas 6.52% and 2.27% discontinued in Groups II and III respectively. Maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups. At week 16, on the Psoriasis Area and Severity Index, PASI 75 was achieved in 31.43%, 42.4% and 33.3% of patients in Groups I, II and III, respectively with no statistical difference between any groups.ConclusionIt can be concluded that slower titration is a useful strategy for minimizing AEs while at the same time maintaining effectiveness of apremilast.

Comparison of Efficacy of Combination of Acitretin and Narrow Band Ultraviolet B versus Narrow Band Ultraviolet B Alone in the Treatment of Chronic Plaque Psoriasis

Objective: To compare the efficacy of combination of narrow band ultraviolet B (NBUVB) and Acitretin (ReUVB) versus NBUVB alone in the treatment of moderate to severe plaque psoriasis. Method: This randomized clinical trial was conducted at the Department of Dermatology Services Hospital, Lahore from October 2020 to April 2021. After getting approval from Ethical Review Committee, 100 patients of moderate to severe plaque psoriasis were enrolled. They were divided into two groups of fifty patients each. Group A patients received both acitretin and NBUVB therapy while group B received NBUVB therapy alone for 8 weeks. PASI 50 was set as the efficacy end point. PASI scores and photographs taken before and after treatment were analysed. Results: Mean age of patients was 34.99 ± 9.28 years. In group A, 46 (92%) patients achieved PASI 50 while in group B, 19 (38%) patients achieved PASI 50. Therefore, the efficacy of combination of acitretin and NBUVB was significantly higher compared to NBUVB alone. Statistically significant effect of age, gender, body mass index and duration of disease was found on efficacy. Conclusion: Narrow band Ultraviolet-B therapy is a useful treatment modality in moderate to severe psoriasis. However, combining it with acitretin can significantly enhance its efficacy. How to cite: Qadeer F, Tariq H, Aman S.. Comparison of Efficacy of Combination of Acitretin and Narrow Band Ultraviolet B versus Narrow Band Ultraviolet B Alone in the Treatment of Chronic Plaque Psoriasis. Esculapio - JSIMS 2022;18(01):6-10.

Psoriasis and Myasthenia Gravis: A Common Th-17 Pathway

Psoriasis is a chronic inflammatory skin disease whose treatment arsenal is expanding by the day. However, when comorbidities coexist, therapy can be challenging. We report a case of a 55-year-old female with steroid-dependent myasthenia gravis who presented with a severe form of chronic plaque psoriasis. After the failure of topical corticosteroids and phototherapy, the patient was started on ixekizumab. This anti-IL-17 antibody led not only to the clearance of the psoriatic lesions but also to the remission of the myasthenic symptoms. While on this medication, the patient was able to taper down and discontinue the oral corticosteroids. The remission of the symptoms of myasthenia gravis during this treatment supports the role of IL-17 cytokines in the pathogenesis of this disease and adds it as a management option in steroid-dependent cases.

Adalimumab with Methotrexate vs. Adalimumab Monotherapy in Psoriasis: First-Year Results of a Single-Blind Randomized Controlled Trial

Adalimumab is normally prescribed with methotrexate (MTX) in rheumatoid arthritis given the enhanced treatment effect and reduced antidrug antibody formation compared with adalimumab monotherapy (ADL). In psoriasis, the long-term treatment effects and pharmacokinetic profile have not been investigated extensively. We conducted a randomized controlled trial to assess the efficacy, safety, pharmacokinetics, and immunogenicity of adalimumab combined with MTX 10 mg per week (ADL-MTX group) compared with that of ADL (ADL group) in chronic plaque psoriasis. A total of 31 patients in the ADL-MTX group and 30 in the ADL group were analyzed. After 1 year, a (nonsignificant) better drug survival was found in the ADL-MTX group (74.2 vs. 58.6%, P= 0.15). The PASI 75 response in week 49 was 58.1 versus 36.7% (P= 0.13), and the median (interquartile range) serum-trough concentrations were 6.8 (5.5‒9.2) versus 5.9 (3.5‒8.8) mg/l (P= 0.26) in the ADL-MTX group and ADL group, respectively. Fewer patients showed antidrug antibodies in the ADL-MTX group (22.6 vs. 60.0%, P < 0.01). No serious adverse events occurred. Combination therapy of adalimumab and MTX results in fewer patients showing antidrug antibodies, with a trend toward a better PASI 75 response, drug survival, and higher serum-trough concentrations than ADL. Patient-reported outcomes and adverse events were comparable between the groups.

Adjunctive Use of Calcipotriene 0.005%/Betamethasone Dipropionate 0.064% Foam in Patients With Psoriasis Treated With Ixekizumab.

To examine the effectiveness and safety of adjunctive treatment with calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) foam in adult patients with chronic plaque psoriasis who have localized residual plaques after &ge;24 weeks of treatment with ixekizumab biologic therapy. This study was a prospective, open-label, single-arm study of adult patients with moderate-to-severe chronic plaque psoriasis who had suboptimal response after &ge;24 weeks of treatment with ixekizumab (residual 3&ndash;8% body surface area [BSA] involvement). All patients continued treatment with ixekizumab and received once-daily Cal/BD foam for 4 weeks, followed by every other day for weeks 8 to 12. The primary endpoint was treat-to-target BSA &le;1% at week 4. Additional endpoints included the Physician&rsquo;s Global Assessment (PGA) score, PGA&times;BSA, and the patient-reported Dermatology Life Quality Index (DLQI). Safety evaluations included assessments of adverse events (AEs) and local skin reactions. Among 25 enrolled patients, 36% were female, and the mean age was 50 years. After 4 weeks of daily Cal/BD foam, 56% of patients achieved the treat-to-target goal of &le;1% BSA. Mean % BSA involvement, mean PGA score, and composite PGA&times;BSA score decreased 4 weeks after the addition of Cal/BD foam. Improvements in disease severity outcomes were maintained after reducing Cal/BD dosing frequency. Cal/BD was generally safe and well-tolerated, with no serious AEs reported. In real-world clinical practice, for patients with moderate-to-severe plaque psoriasis who had residual plaques following &ge;24 weeks of ixekizumab monotherapy, adjunctive treatment with Cal/BD foam was associated with notable and sustained improvements in disease control. J Drugs Dermatol. 2022;21(3): 235-240. doi:10.36849/JDD.6396.

A dermoscopic study of nail involvement in chronic plaque psoriasis at a tertiary care center

Background: Psoriasis is a chronic inflammatory disease that affects millions of people throughout the world. Nail involvement is a common feature in psoriasis which is often overlooked despite causing significant functional impairment, disfigurement, and psychological stress to the patient. Dermoscopy is a non-invasive novel tool that enables a rapid and magnified visualization of the nail changes which are often imperceptible to the unaided eye. Aims and Objectives: To study the dermoscopic profile of nail changes in patients with chronic plaque psoriasis. Materials and Methods: The study was conducted from December 2018 to May 2020, in the Department of Dermatology of a tertiary care center in Kerala, including 155 patients of clinically diagnosed chronic plaque psoriasis who had nail involvement. A detailed history was noted along with a clinical and dermoscopic examination of all 20 nails of each patient. Results: The most common finding on dermoscopic examination of the nails was onycholysis seen in 91%, followed by pitting (78.8%) and subungual hyperkeratosis (78.1%). Other findings noted in our study which are not commonly described are wavy lamellar microsplitting (41.9%), cuticular hypertrophy (18.1%), pseudofiber sign (16.1%), dilated nailfold capillaries (12.3%), capillary prominence at onychodermal band (7.7%), dilated hyponychial capillaries (7.7%), and fuzzy lunula (7.1%). Conclusion: Nails are frequently involved in psoriasis but often overlooked. Dermoscope is an effective tool that facilitates the assessment of nail changes in psoriasis.

Italian adaptation of EuroGuiDerm guideline on the systemic treatment of chronic plaque psoriasis.

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by moderate to severe plaque psoriasis. The content of the guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline, suggestions for disease severity grading and treatment goals. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs including acitretin, cyclosporine, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab. Moreover, the guideline provides guidance for specific clinical situations such as patient with concomitant psoriatic arthritis, inflammatory bowel disease, a history of malignancies, a history of depression, diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or those with childbearing potential. Information on vaccination, immunogenicity and systemic treatment during the COVID-19 pandemic is also provided.

Chronic Plaque Psoriasis in Poland: Disease Severity, Prevalence of Comorbidities, and Quality of Life.

The epidemiology of psoriasis has not been widely assessed in Polish population so far. This study aimed to investigate psoriasis epidemiological situation by evaluating disease course and severity, management, comorbidities, environmental factors, and knowledge about this disorder among psoriatic patients in Poland. A cross-sectional cohort population-based study enrolled 1080 psoriatic patients and 1200 controls. The mean age of psoriasis onset was 27.6 years; 78.24% had type I psoriasis. Positive family history of psoriasis was reported in 44.81% of patients, whereas itch was reported in vast majority of patients (83.33%). Based on PASI score moderate psoriasis was the most common in studied group (mean 12.63 ± 9.33, range 0–67.2). The DLQI score (12.01 ± 7.41, range 0–30.0) indicated a very large effect of psoriasis on the quality of life. Hypertension was the most prevalent comorbidity (33.80%), followed by obesity (16.85%) and dyslipidemia (11.85%). Stress was the foremost cause of disease exacerbation (66.20%); however, infections (44.07%) and seasonal changes (45.09%) had also an impact on the course of psoriasis. Psoriatic patients were more often smokers (37.59%) vs. general population (27.50%; p < 0.0001). In conclusion, epidemiological studies help clinicians in better disease and patient understanding, which may translate into better management and patient compliance.

Efficacy and safety of ustekinumab in the treatment of moderate to severe plaque psoriasis in Singapore.

Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis. In this study, we assessed the efficacy and safety of patients receiving ustekinumab for psoriasis. This retrospective study included all adults with chronic plaque psoriasis who were prescribed ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. Efficacy end points included a proportion of patients achieving at least 50% and 75% improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at Weeks 4 and 16. A total of 99 patients were prescribed ustekinumab; 69% of these were Chinese, followed by 15% Indians and 9% Malays. 31 patients had documented PASI scores and 55 patients had documented BSA improvements. In patients with recorded PASI scores, 29 (93.5%) of 31 patients achieved PASI 50, and 21 (67.7%) of 31 achieved PASI 75 at week 16. In patients with recorded BSA, 43 (78.2%) of 55 had at least 50% BSA improvement, and 31 (56.4%) of 55 achieved 75% BSA improvement at 16 weeks. Regarding safety, no patient experienced tuberculosis reactivation. A total of 11 (11%) of 99 patients had latent tuberculosis infection and were treated with prophylactic isoniazid. No patient experienced serious adverse events. No cardiovascular events, cutaneous malignancies or deaths were reported over six years. Ustekinumab is safe and efficacious in the treatment of patients with moderate to severe plaque psoriasis in a multiethnic Asian population.

Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6months, assessed at baseline and thereafter monthly for 6 months. Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

Association Between Short-term Exposure to Environmental Air Pollution and Psoriasis Flare

Psoriasis is a chronic inflammatory disease with a relapsing-remitting course. Selected environmental factors such as infections, stressful life events, or drugs may trigger disease flares. Whether air pollution could trigger psoriasis flares is still unknown. To investigate whether short-term exposure to environmental air pollution is associated with psoriasis flares. This observational study with both case-crossover and cross-sectional design retrospectively analyzed longitudinal data from September 2013 to January 2020 from patients with chronic plaque psoriasis consecutively attending the outpatient dermatologic clinic of the University Hospital of Verona. For the case-crossover analysis, patients were included who had at least 1 disease flare, defined as Psoriasis Area and Severity Index (PASI) increase of 5 or greater between 2 consecutive assessments in a time frame of 3 to 4 months. For the cross-sectional analysis, patients were included who received any systemic treatment for 6 or more months, with grade 2 or higher consecutive PASI assessment. We compared the mean and cumulative (area under the curve) concentrations of several air pollutants (carbon monoxide, nitrogen dioxide, other nitrogen oxides, benzene, coarse particulate matter [PM; 2.5-10.0 μm in diameter, PM10] and fine PM [<2.5 μm in diameter, PM2.5]) in the 60 days preceding the psoriasis flare and the control visits. A total of 957 patients with plaque psoriasis with 4398 follow-up visits were included in the study. Patients had a mean (SD) age of 61 (15) years and 602 (62.9%) were men. More than 15 000 measurements of air pollutant concentration from the official, open-source bulletin of the Italian Institute for Environmental Protection and Research (ISPRA) were retrieved. Among the overall cohort, 369 (38.6%) patients with psoriasis flare were included in the case-crossover study. We found that concentrations of all pollutants were significantly higher in the 60 days before psoriasis flare (median PASI at the flare 12; IQR, 9-18) compared with the control visit (median PASI 1; IQR, 1-3, P < .001). In the cross-sectional analysis, exposure to mean PM10 over 20 μg/m3 and mean PM2.5 over 15 μg/m3 in the 60 days before assessment were associated with a higher risk of PASI 5 or greater point worsening (adjusted odds ratio [aOR], 1.55; 95% CI, 1.21-1.99; and aOR, 1.25; 95% CI, 1.0-1.57, respectively). Sensitivity analyses that stratified for trimester of evaluation, with various lag of exposure and adjusting for type of treatment, yielded similar results. The findings of this case-crossover and cross-sectional study suggest that air pollution may be a trigger factor for psoriasis flare.

Efficacy of Majoon Mundi and Roghan Gul in Chronic Plaque Psoriasis - A Case Report

Psoriasis is a skin condition characterized by erythema, clearly delineated papules that are covered with silvery scales. It is a chronic and debilitating disease affecting the quality of life and involves 3% of world’s population. In Unani Classical literature, it is mentioned as Taqashshur-Jild. 28-year-old male was diagnosed with Psoriasis. Patient was treated with Unani drugs Majoon Mundi and Roghan-Gul. Patient was evaluated before and after treatment using PASI score and DLQI score. Significant improvement was seen in patient after treatment. No adverse effects were observed during and after the study. This case study was done to highlight the efficacy of Unani drugs so as to initiate a step to develop potential herbal-origin drugs for the treatment of Psoriasis. Keywords: Psoriasis, Erythema, Taqashshur-e-Jild, Unani drugs, PASI score, DLQI score.

Effectiveness and Safety of Secukinumab for Psoriasis in a Real-World Clinical Setting in the Asia-Pacific and Middle East Regions: Results from the REALIA Study.

IntroductionSecukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various manifestations of psoriatic disease. We investigated effectiveness and safety of secukinumab, other biologics and conventional systemic therapies in patients with chronic plaque psoriasis in a real-world setting.MethodsREALIA was a non-interventional, multicentre, prospective, parallel group study. Eligible patients were ≥ 18 years old with chronic plaque psoriasis commencing a new treatment with a biologic agent or conventional systemic therapies.ResultsAt baseline, 541 patients were divided into three cohorts based on treatment initiated: conventional systemics (173), secukinumab (184) and other biologics (184). A significantly higher proportion of patients achieved almost clear to clear skin based on physician’s judgement in secukinumab versus conventional systemics at month 3 (64.7% versus 22.8%, P < 0.001) and month 6 (61.8% versus 20.8%, P < 0.001). At month 12, clear to almost clear skin was achieved by 52.1% of the patients in secukinumab versus 35.8% in conventional systemics (P = 0.066). The proportion of patients achieving Psoriasis Area Severity Index (PASI) 90 on conventional systemics, secukinumab and other biologics was 18.8%, 59.7% and 40.0% at month 3 and 35.3%, 60.8% and 50.0% at month 12, respectively. Secukinumab patients showed significantly higher change in PASI total score from baseline versus conventional systemics at month 3 {least squares [LS] mean [standard error (SE)]: −14.49 [0.648] versus −8.48 [1.149], P < 0.001} and numerically higher [LS mean (SE): −13.60 (0.475) versus −10.84 (1.733), P = 0.122] at month 12. The proportion of patients with Dermatology Life Quality Index 0/1 score on conventional systemics, secukinumab and other biologics was 22.6%, 65.0% and 41.6% at month 3 and 32.0%, 63.5% and 41.3% at month 12, respectively. Safety profile was comparable across cohorts.ConclusionsSecukinumab is effective and well tolerated in patients with chronic plaque psoriasis in a real-world setting in an Asia-Pacific and Middle East population, and these results are in agreement with clinical outcomes of secukinumab reported in randomised clinical trials.Trial registration number170803-001645.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00675-w.

Comparison of Th1 and Th17 Inflammatory Cytokine Profiles Between Chronic Plaque and Acute Guttate Psoriasis.

BackgroundThe phenotypic heterogeneity of psoriasis is suspected to reflect differences in its pathogenesis, but not yet completely elucidated. Studies of the Th1 and Th17 cytokines associated with different phenotypes of psoriasis have yielded inconsistent results.ObjectiveTo investigate the tissue expression levels of Th1 and Th17 cytokines among patients with chronic plaque psoriasis, acute guttate psoriasis, and healthy control.MethodsA total of 20 patients with psoriasis (10 with chronic plaque type and 10 with acute guttate type) and 5 healthy controls were enrolled. The tissue mRNA and protein levels of following cytokines were measured: interleukin (IL)-12, IL-2, interferon (IFN)-γ, IL-23, IL-17A, and IL-22.ResultsThe tissue mRNA levels of IL-12, IFN-γ, IL-23, IL-17A, IL-22 and the protein levels of IL-12, IL-2, IFN-γ, IL-17A, IL-22 were significantly increased in the psoriasis patients compared with the healthy controls. In comparisons of the subtypes, the tissue mRNA level of IFN-γ was increased in acute guttate psoriasis, whereas the protein levels of IL-12 and IL-17A were significantly increased in chronic plaque psoriasis. The cytokine ratios of IL-17A/IL-2 and IL-22/IL-2 were significantly higher in chronic plaque psoriasis than in acute guttate psoriasis.ConclusionWe confirmed that the tissue levels of Th1 and Th17 cytokines were increased in psoriasis patients compared with healthy controls. The increased IFN-γ mRNA level in acute guttate psoriasis and increased IL-12 and IL-17A protein levels in chronic plaque psoriasis suggest that an imbalance between Th1 and Th17 cytokines may play a role in the phenotypic transition of psoriasis.

Serum Levels of Tumor Necrosis Factor - alpha in Patients With Psoriasis.

Background:Psoriasis can be described as a T-cell-mediated disease, with a complex role for variety of cytokines and other factors. Among the inflammatory molecules influencing the keratinocites, TNF-α appears critical in sustaining most of the clinical manifestations of psoriasis. It is postulated that changes in cytokine production both locally and systemically could be useful in monitoring disease activity.Objective:The aim of the study was to evaluate serum levels of tumor necrosis factor alpha (TNF-α) in patients with psoriasis and the healthy subjects, and also to assess a possible association between TNF-α, clinical type and severity of disease.Methods:We studied the levels of serum TNF-α in 60 patients with psoriasis and in the serum of helthy 20 controls. According to the clinical type of disease, patients with psoriasis were divided into four groups: chronic plaque psoriasis (CPP), erythrodermic psoriasis (EP), pustular psoriasis (PP) and psoriatic arthritis (PA). Blood samples were collected from all psoriasis patients and from healthy control subjects. Serum level of TNF-α were measured by an enzyme-linked immunosorbent assay (ELISA) technique. The severity of CPP was assessed by Psoriasis Area and Severity Index (PASI).Results:Serum levels of TNF-α in patients with psoriasis were significialy higher than in the control group (3.25+1.74 pg/mL vs 0.20+0.01pg/mL, respectively). Significantly elevated serum TNF-α was in patients with PP type (7.39+6.92 pg/mL). There was statistically significant difference between the mean level of TNF-ɑ compared to the clinical type of psoriasis (p<0.05). The mean PASI score in patients with CPP was 0.56±12.45. It was not found statistically significant correlation between serum level of TNF-ɑ and PASI score in patients with CPP (p>0,05).Conclusion:Our results have demonstrated the imortance of determining serum levels of TNF-ɑ in patients with psoriasis. Further investigations are required to clarify the pathogenic role and clinical significance of TNF-ɑ, and these findings may provide important clues to assist in the development of new therapeutic strategies for patients with psoriasis.

Chronic plaque psoriasis

Psoriasis has a significant emotional and psychosocial impact on patients that extends beyond the physical aspects of the disease, impacting social functioning and interpersonal interactions. Psoriasis is a systemic inflammatory disease that has a number of comorbidities, such as cardiovascular disease and cancer. Most of the diagnosis is clinical. There are various clinical of psoriasis, the most prevalent of which is chronic plaque psoriasis, which affects 80-90% of psoriasis patients. Erythematous plaques that are clearly defined, symmetrical, and covered in silvery scale are the distinguishing features of classic plaque psoriasis. Plaques can appear anywhere on the body, but they are most frequently found on the scalp, trunk, buttocks, and extremities. We here present a case of a patient who came to our institutional outpatient department (OPD) of Datta Meghe Institute of Medical Sciences with complaints of inflammatory red, clearly defined, elevated, dry plaques of various sizes that are typically covered in silvery or white scales on the trunk. The diagnosis of chronic plaque psoriasis was clinically established based on typical presentation. The patient was advised to take conservative as well as topical steroids, and also for frequent follow-up visits to dermatology OPD of the institute.

Clinical Study of Brihatsindooradya Taila and its Malahar on Kustha w.s.r. to Chronic Plaque Psoriasis

Background:In Ayurveda, skin ailments are categorized as "kustha." In skin diseases, external use of drugs is just as important as internal therapy because it may provide greater and faster symptom relief. Acharya Sushrut while prescribing the treatment for kusthaaccording to dhatugatawa, mentioned shodhanand alepanaas first choice of management for twakgata kusthahence lepanakarma has been considered as an ideal therapeutic measure for these diseases. Aim:The aim was to evaluate the role of Ayurveda treatment modalities in Kushtha. To conduct the pharmaceutical –analytical study on BST and its malahar.To study the comparative efficacy of Brihatsindoordya Taila(BST) and its malahar in the management of kusthaw.s.r.to chronic plaque psoriasis. Materials and Methods: The study was prospective, interventional with Randomized, Open labelled, Controlled trial and conducted in 30 clinically diagnosed patients with classical sign and symptoms of kushtha.The study was conducted on 30 clinically diagnosed patients of Kushthadivided into 2 groups having 15 patients in each group. Total 30 patients of kustha w.s.r. to chronic plaque psoriasis had been randomly divided into two groups was given Brihatsindoordya Taila(BST) &amp; Brihatsindoordya Taila Malahar( BSM ) for topical administration, twice a day, for a duration of 30 days respectively.Results:The observations and resultsconcluded that drug i.e BST &amp; BSM showed effective and highly significant results in signs and symptoms of Kushthai.e (p&lt;0.0001).Conclusion:This case study revealed the efficacy of Ayurveda therapy, including external, for 1month in the management ofKushtha. Keywords: Chronic plaque psoriasis, Eka-Kushtha, Shamana, Shodhana.The study reveals that combination of Ayurvedic modalities gives significant result in lakshnas(Symptoms) like Aswedana, Mahavastu, MastyaShakalopama