Effective Treatment For Psoriasis Research Articles

Quality by design driven systematic development of nanoemulgel of clobetasol-17-propionate for effective treatment of psoriasis

Nanoemulgels require two step formulation, the first one being formulation of nanoemulsion followed by the incorporation of nanoemulsion within a gel matrix. The current investigation aimed to formulate a Clobetasol-17-propionate (CP-17) nanoemulgel using QbD approach as anti-psoriatic for plaque type psoriasis. CP-17 was selected as a therapeutic agent to incorporate into the nanoemulsion system and then optimized CP-17 loaded nanoemulsion was incorporated into gelling agent (Carbopol 940) for topical use. Central Composite Design (CCD) was used. The independent factors used were amount of Smix (X1) and amount of gelling agent (X2). The dependent factors were in vitro drug release (Y1), droplet size (Y2) and encapsulation efficiency (Y3). The droplet size, rheological evaluation, PDI, in vitro release, ex vivo permeation and, retention and, in vivo studies were carried out. The nanoemulgel formulated was found to have droplet size within the range of 37.16 ± 21.16 nm. The ex vivo permeability was 44.68 ± 1.21 % and the skin retention was 40.86 ± 0.61 % after 7 h, both of which were greater than the marketed formulation. The CP-17 nanoemulgel showed 1.3-fold higher flux (498.66 ± 14.40 μg/cm2 h) than marketed formulation (383.9 ± 8.59 μg/cm2 h). The apparent permeability coefficient (APC) found to be 1.6 × 10−4 μg/min and 1.27 × 10−4 μg/min, respectively. The in vivo evaluation showed a reduction in PASI scores for erythema, thickness and scaling. The nanoemulgel produces sustained effect of CP-17 on the site of application as localized effect is required. The inflamed stratum corneum will demand hydration as well as targeted therapy, which the CP-17 nanoemulgel successfully provides.

Development of an Effective Psoriasis Treatment by Combining Tacrolimus-Encapsulated Liposomes and Iontophoresis.

Psoriasis is a chronic T-cell-mediated autoimmune skin disease. Tacrolimus (FK506) is commonly used treatment for psoriasis. However, since the molecular weight of FK506 is more than 500 Da, its skin penetration is limited, so that there is a need to improve the penetrability of FK506 to allow for more effective treatment. To this end, we employed iontophoresis (ItP), which is a physical, intradermal drug delivery technology that relies on the use of weak electric current. Previous findings suggest that activation of cell signaling by the weak electric current applied during ItP may affect the expression of inflammatory cytokines, leading to aggravation of psoriasis. In this study, we analyzed the effect of ItP on the expression of various inflammatory cytokines in the skin, and subsequently examined the therapeutic effect of ItP using negatively-charged liposomes encapsulating FK506 (FK-Lipo) in a rat psoriasis model induced by imiquimod. We found that ItP (0.34 mA/cm2, 1 h) did not affect mRNA levels of inflammatory cytokines or epidermis thickness, indicating that ItP is a safe technology for psoriasis treatment. ItP of FK-Lipo suppressed the expression of inflammatory cytokines induced by imiquimod treatment to a greater extent than skin treated with FK506 ointment for 1 h. Furthermore, epidermis thickening was significantly suppressed only by ItP of FK-Lipo. Taken together, results of this study demonstrate the successful development of an efficient treatment for psoriasis by combining FK-Lipo and ItP, without disease aggravation associated with the weak electric current.

Formulation and Evaluation of Gel Containing Nigella sativa Seed Extract Loaded Transferosomes for Effective Treatment of Psoriasis

Background: Psoriasis vulgaris is an autoimmune associated skin disease causing plaques or scales formation where the skin cells form quicker than in their typical life cycle. The phenolic phytoconstituents reported in Nigella sativa are effective for the treatment of skin disorders. Transfersomes is an emerging nanoencapsulation drug delivery approach which can squeeze themselves due to its elastic nature as an intact vesicle across narrow pores. It improves the potency of topical formulations with higher permeation efficiencies compared to other vesicular drug delivery systems. Objective: This research work focused to prepare Nigella sativa or black seed extract loaded transfersomes as nanoformulation and further incorporating them in the gel system to give improved therapeutic efficacy due to their self-regulating and self-optimizing capabilities. Methods: The phenolic content of Nigella sativa or black seed was extracted in ethanol and the solvent was removed using a vacuum with suitable storage conditions at 22ºC. Transfersomes of ethanol extract were prepared by thin layer hydration method and further incorporated into gel formulations. The ant-psoriasis activity of prepared gel formulation was performed with histopathology study in the Imiquimod induced albino rat model. Results: A nanoformulation prepared with 0.85 mg lecithin and 0.10 mg tween 80 has the highest entrapment efficiency. The entrapment efficiency, vesicle size, polydispersity index and zeta potential of optimized transferosomes batch were found to be 69.3 ± 2.6%, 178 ± 11 nm, 1.1 ± 0.2, -29.4 mV, respectively. Anti-psoriatic activity of N. sativa seed extract loaded transfersomes showed a more significant reduction in thickness of the epidermis and less elongation of rete ridges with capillary loop dilation as compared to conventional gel formulation. Conclusion: We concluded that the Nigella sativa seed ethanolic extract loaded transfersomes gel formulation showed significant ant-psoriasis activity in an albino rat model.

Excimer Laser System: The Revolutionary Way to Treat Psoriasis.

Psoriasis is a chronic, autoinflammatory skin disease that affects approximately 100 million people worldwide. It is a systemic disease characterized by scaly, red patches on the skin and can also affect the joints. Psoriasis can significantly affect a person's physical and mental health. The prevalence rate of psoriasis may vary depending on the specific population studied and the diagnostic criteria used. Phototherapy is a safe and effective treatment for psoriasis that involves exposing the affected skin to specific wavelengths of light. It can be used alone or with other treatments for severe psoriasis. However, clinicians must choose the right light source for each type of psoriasis and monitor the patient closely during treatment to avoid adverse events. The 308 nm excimer laser is a widely used device in dermatology for treating several skin conditions, including psoriasis. Although the excimer laser can treat various dermatologic diseases, this study will focus only on its effectiveness in treating psoriasis. This study will review the use of an excimer laser, its protocol, and its side effects.

1% Tapinarof cream for the treatment of psoriasis: a network meta-analysis of randomized placebo- and calcipotriol- controlled trials.

Tapinarof is an aromatic hydrocarbon receptor inhibitor for the treatment of adult psoriasis, and with the completion of Phase III clinical trials for this drug, it is important to understand its place among the medications used in the treatment of psoriasis for clinical application. Networks were constructed for 1% tapinarof cream with positive control (calcipotriol) and negative control (placebo). Network meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PISMA) 2015. Relevant randomized clinical trials were searched from PubMed, Cochrane Library, and National Knowledge Infrastructure (CNKI) as of February 2023. Data were analyzed using the gemtc package in R software (RStudio) to evaluate the efficacy and safety of 1% tapinarof cream in the treatment of psoriasis in adults. A totalof 2408 patients wereenrolled in8 clinicalstudiesof1% tapinarof cream, and 6874 patients wereenrolled in 14 clinial studies of calciptriol.1% tapinarof cream was superior to placebo [OR: 8.3 (5.5, 13.0), 8.3 (5.9, 13.0), 7.3 (5.1, 11.0)] and calcipotriol in the treatment of psoriasis at 4, 8, and 12weeks, and the incidence of adverse events was higher than that with placebo [OR: 3.3 (2.6, 4.3)] and calcipotriol, with no serious systemic adverse events. 1% tapinarof cream is a safe and effective treatment for psoriasis.

INNOVATIVE APPROACH TO THE TREATMENT OF PSORIASIS USING NANOTECHNOLOGIES

Psoriasis is a chronic immune-mediated genetic disease with systemic and cutaneous manifestations that can significantly impair patients' quality of life. 2-3% of the world population suffers from psoriasis, and this imposes a significant economic burden on patients. Aetiology is mainly related to genes and environmental factors. The pathophysiology of psoriasis is characterized by T cells and dendritic cells, antimicrobial peptides, genetic predisposition, lipoprotein-2, galactosin-3, fractalkine, vaspin, human neutrophil peptides, etc. in the progression of psoriasis. For patients with psoriasis, conventional treatments include corticosteroids, vitamin D3 analogs, calcineurin inhibitors, methotrexate, cyclosporine, acitretin, phototherapy, and biological agents, etc. Today, there are various standard topical therapeutic approaches that can help control the condition for months to years, however, complete recovery from psoriasis with these treatments has not been reported. Therefore, researchers around the world are mainly considering the possibility of using various nanotechnological therapies for complete recovery. New drug delivery carriers, in particular nanocarriers, can overcome certain disadvantages of conventional treatment methods, such as: dose minimization, frequency of administration, and dose-dependent side effects. Nanodermatology is a new multidisciplinary science that is gaining more and more recognition in the treatment of psoriasis. The use of nanotechnology makes it possible to select drugs to achieve dermal targeting, increase efficiency and minimize unwanted effects. Currently, these nanocarriers are becoming increasingly popular as delivery vehicles for psoriasis drugs due to their non-toxicity, natural degradability, excellent biocompatibility and biodegradability, they do not cause harmful inflammatory reactions and are easily excreted from the body. Reports of nanocarrier delivery for the treatment of psoriasis have shown improved efficacy and reduced toxicity compared to standard pharmacotherapy. To better clarify the application of nanotechnology in the treatment of psoriasis, various drugs based on nanocarriers will be summarized. This review provides a concise overview of the pathophysiology, epidemiology, clinical diagnosis, and classical pharmacotherapy of psoriasis. The review also summarizes various nanotechnological treatments for the effective treatment of psoriasis.

The Psoriasis Disability Index in Romanian Psoriasis Patients during COVID-19 Pandemic: Contribution of Clinical and Psychological Variables.

Psoriasis is one of the most frequent chronic inflammatory skin diseases and has a negative impact on the interpersonal relationship and psychosocial well-being. The aims of this study were to examine the effects of intensity of pruritus on quality of life and depression, to investigate the relationship between anger, self-esteem, and depression, and to compare patients with early and late onset of psoriasis. As our study was carried out during the COVID-19 pandemic, we aimed also to investigate the safety concerns and anxiety related to COVID-19 in psoriasis patients. This cross-sectional study included 137 patients diagnosed with plaque psoriasis. The patients were classified as early-onset (age < 30 years) and late-onset psoriasis (age ≥ 30 years). Duration of disease, pruritus scores, and socio-demographic characteristics were recorded. Measures included the State-Trait Anger Expression Inventory (STAXI), Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI-II), Psoriasis Disability Index (PDI), and Fear and anxiety in relationship with COVID-19 Scale were used for determining anger, anger expression style, self-esteem, depression, anxiety, and quality of life. The psoriasis patients had a lower score for self-esteem than the normative data from the Romanian general population. The average scores for state anger and trait anger are similar to the normative data from the Romanian general population, but the scores for anger-in and anger-out are higher. Patients with early onset had higher depression scores and lower quality of life. Self-esteem correlates negatively with depression, anger, severity of disability due to psoriasis, number of affected areas, and duration of disease. Lower level of self-esteem led to increased anger. Reduced self-esteem, increased anger levels, and depression are present in psoriasis patients. The effective treatment of psoriasis must, therefore, consist of a multidisciplinary approach, in which the personalized treatment of the skin condition is as important as the adjuvant therapies that reduce the patients' stress level.

Effect of Narrow-Band Ultraviolet B Therapy of Psoriasis Vulgaris on Skin Directional Reflectance, Skin Density and Epidermal Thickness

Psoriasis is an inflammatory dermatosis manifested by the appearance of brown-red papules on the body, covered with silver scales. One of the most common and effective treatments for psoriasis is narrow-band UVB phototherapy. Narrow-band UVB has a wavelength of 311 nm, which results in shallow skin penetration, is absorbed only by the epidermis and the superficial layers of the dermis. The aim of the study was to assess the effect of narrow-band UVB 311 nm phototherapy on skin covered with psoriatic scales and without psoriatic lesions in patients with psoriasis vulgaris on the total directional hemispherical reflectance (DHR) of the skin, skin density and epidermis thickness. For this purpose, a 410 Solar DHR reflectometer and high-frequency ultrasonography DUB SkinScanner were used. A total of 48 volunteers were enrolled. There was a difference in the reflectance of skin without psoriatic scales and psoriatic skin. Depending on the wavelength range, the skin was characterized by different reflectance values. During the course of phototherapy, the reflectance values decreased, both in the psoriatic skin and skin without psoriatic scales. After the phototherapy, the epidermis thickness and SLEB layer decreased and skin density increased in the area with psoriatic plaque. The density of the skin without psoriasis after a series of 20 irradiations increased, while the thickness of the epidermis did not change.

A Novel Methacryloyl Chitosan Hydrogel Microneedles Patch with Sustainable Drug Release Property for Effective Treatment of Psoriasis.

Psoriasis is a chronic and recurrent skin disease that often requires long-term treatment, and topical transdermal drug delivery can reduce systemic side effects. However, it is still a challenge in efficient transdermal drug delivery for psoriasis treatment due to low penetration efficiency of most drugs and the abnormal skin conditions of psoriasis patients. Here, a safe and effective methacryloyl chitosan hydrogel microneedles (CSMA hMNs) patch is developed and served as a sustained drug release platform for the treatment of psoriasis. By systematically optimizing the CSMA preparation, CSMA hMNs with excellent morphological characteristics and strong mechanical properties (0.7 Nneedle-1 ) are prepared with a concentration of only 3% (w/v) CSMA. As a proof-of-concept, methotrexate (MTX) and nicotinamide (NIC) are loaded into CSMA hMNs patch, which can produce a sustained drug release of 80% within 24h in vitro. In vivo experiments demonstrated that the CSMA hMNs patch can effectively inhibit the skin thickening and spleen enlargement of psoriatic mice and has a good biosafety profile at sufficient therapeutic doses. This study provides a new idea for the preparation of hMN systems using modified CS or other biocompatible materials and offers an effective therapeutic option for psoriasis treatment. This article is protected by copyright. All rights reserved.

The psoriasis area and severity index is an independent risk factor for cardiovascular events: A prospective register study.

Patients treated with systemics for moderate-to-severe psoriasis have increased risk of cardiovascular disease (CVD). However, to the best of our knowledge, there are no data on the association between clinical disease activity and future cardiovascular events in this population. Such data could help identify patients at increased CVD risk and inform the potential for CVD prevention with effective psoriasis treatment. To estimate the association between the Psoriasis Area and Severity Index (PASI) and cardiovascular events defined as hospitalization for CVD and cardiovascular death. We linked prospectively collected data on PASI and CVD risk factors to population-based administrative data on hospitalizations and causes of death. We estimated the association between PASI and cardiovascular events using Cox proportional hazard models with PASI and Framingham 10-year cardiovascular risk as time-varying covariates. A total of 767 patients with 6264 PASI scores were included. After adjusting for 10-year cardiovascular risk and prior CVD, a one-point increase in PASI was associated with a hazard ratio of 1.04 (95% CI: 1.01-1.07) for cardiovascular events. The findings were robust in sensitivity analyses. PASI is an independent marker for future cardiovascular events in patients with moderate-to-severe psoriasis.

Elucidating the NB-UVB mechanism by comparing transcriptome alteration on the edge and center of psoriatic plaques

Narrow band-ultraviolet B (NB-UVB) is an effective treatment for psoriasis. We aim to generate a potential mechanism of NB-UVB through comparing the transcriptomic profile before and after NB-UVB treatment between the peripheral edge of lesional skin (PE skin) and the center of lesional skin (CE skin) on the basis of molecular mechanisms of these two areas display different downstream functions. More than one-fourth of the NB-UVB-altered genes were found to be plaque-specific. Some of them were psoriasis signature genes that were downregulated by NB-UVB in, both, PE and CE skin (core alteration), such as IL36G, DEFB4A/B, S100A15, KRT16, and KRT6A. After NB-UVB treatment, the activity score of upstream cytokines, such as interferons, interleukin (IL)-6, IL-17, and IL-22 in pathogenesis decreased. In addition, NB-UVB could restore normal keratinization by upregulating LORICRIN and KRT2, particularly in the CE skin. Finally, we illustrated that NB-UVB is capable of suppressing molecules from the initiation to maintenance phase of plaque formation, thereby normalizing psoriatic plaques. This finding supports the usefulness of NB-UVB treatment in clinical practice and may help in the development of new treatment approaches in which NB-UVB treatment is included for patients with psoriasis or other inflammatory skin diseases.

Novel Synergistic Approach: Tazarotene-Calcipotriol-Loaded-PVA/PVP-Nanofibers Incorporated in Hydrogel Film for Management and Treatment of Psoriasis.

Psoriasis is an autoimmune skin disease that generally affects 1%-3% of the total population globally. Effective treatment of psoriasis is limited because of numerous factors, such as ineffective drug delivery and efficacy following conventional pharmaceutical treatments. Nanofibers are widely being used as nanocarriers for effective treatment because of their multifunctional and distinctive properties, including a greater surface area, higher volume ratio, increased elasticity and improved stiffness and resistance to traction, favorable biodegradability, high permeability, and sufficient oxygen supply, which help maintain the moisture content of the skin and improve the bioavailability of the drugs. Similar to the extracellular matrix, nanofibers have a regeneration capacity, promoting cell growth, adhesion, and proliferation, and also have a more controlled release pattern compared with that of other conventional therapies at the psoriatic site. To ensure improved drug targeting and better antipsoriatic efficacy, this study formulated and evaluated a tazarotene (TZT)-calcipotriol (CPT)-loaded nanofiber and carbopol-based hydrogel film. The nanofiber was prepared using electrospinning with a polyvinyl alcohol/polyvinylpyrrolidone (PVA/PVP) K-90 polymeric blend that was later incorporated into a carbopol base to form hydrogel films. The prepared nanofibers were biochemically evaluated and in vitro and in vivo characterized. The mean diameters of the optimized formulation, i.e., TZT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-PVA/PVP-NF) and TZT-CPT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-CPT-PVA/PVP-NF) were 244.67 ± 58.11 and 252.31 ± 35.50 nm, respectively, as determined by scanning electron microscopy, and their tensile strength ranged from 14.02 ± 0.54 to 22.50 ± 0.03 MPa. X-ray diffraction revealed an increase in the amorphous nature of the nanofibers. The biodegradability studies of prepared nanofiber formulations, irrespective of their composition, showed that these completely biodegraded within 2 weeks of their application. The TZT-CPT-PVA/PVP-NF nanofibers exhibited 95.68% ± 0.03% drug release at the end of 72 h, indicating a controlled release pattern and following Higuchi release kinetics as a best-fit model. MTT assay, antioxidant and lipid profile tests, splenomegaly assessment, and weight fluctuation were all performed in the in vitro as well as in vivo studies. We found that the TZT-CPT-PVA/PVP-NF-based hydrogel film has high potential for antipsoriatic activity in imiquimod-induced Wistar rats in comparison with that of TT-PVA/PVP-NF nanofibers.

Real-Life Effectiveness of Tildrakizumab in Chronic Palmo Plantar Psoriasis: A Case Series of 7 Patients with 28 weeks of Follow Up

Palmo-plantar psoriasis (PPP) is highly debilitating and difficult to treat impairing quality of life of patients. Tildrakizumab is an anti-IL23p19 subunit monoclonal antibody approved for the treatment of moderate-severe chronic plaque psoriasis in adult candidates for systemic therapy. Objective of this study is to investigate the safety and efficacy of tildrakizumab in the management of palmo-plantar psoriasis. A total of 7 adults patients with moderate to severe PPP were retrospective analysed. Tildrakizumab 100 mg was administered at weeks 0, 4 and then every 12 weeks, by subcutaneous injection. Patients were visited at baseline, at week 16 and at week 28. Safety and efficacy were assessed at weeks 0, 16 and 28. Physician's Global Assessment (PGA) and Palmoplantar Pustular Psoriasis Area and Severity Index (PPPASI) clinical score were used to measure the efficacy. The mean PGA score was reduced from 3.6 at baseline to 1.7 after 16 weeks and 1.3 after 28 weeks. The mean PPPASI score was reduced from 19.2 at baseline to 9.2 after 16 weeks and 5.2 after 28 weeks. In conclusion tildrakizumab represents a safe and effective treatment for psoriasis even in difficult areas such as the palms and soles.

Designing of novel nanoemulsions of retinol using box Behnken design for psoriasis

Psoriasis is a chronic inflammatory disease, which is triggered by genetic and environmental factors, has been found to be associated with comorbidities like psoriatic arthritis, Crohn's disease etc. Retinol acetate is an effective, first line anti-psoriatic drug for Psoriasis but researchers have indicated toxicity in case of its overdose. Present study is an attempt to design Retinol Acetate Nanoemulsion RANE with optimum dosage, improved hydration and penetration, hence better absorption. Box Behnken model of Design Expert version 12 was used for the optimization process to prepare O/W Nanoemulsion. RANE was evaluated by pH, viscosity, conductivity, particle size analysis and responses like % drug content and % in-vitro drug release at different time intervals were experimentally recorded. Predicted value and experimental value of % drug content was found to be 83.84 ± 0.12 and 80.24 ± 1.14 respectively with relative error of 3.6 ± 1.02. While these values for in-vitro drug release at 90 min interval was 47.21 ± 0.21 % and 48.23 ± 2.90 respectively with relative error of 1.02 ± 2.69. It’s p-value was found to be 0.02, which is significant and f value was 0.27 which is non-significant, VIF value was 1.0–1.03 and Ri 2 range was found to be 0–0.03 which proves the model is fit for optimization. These findings for optimized formulation might suggest promising results in effective treatment of psoriasis on further investigation.

Advances in pathogenesis and nanoparticles (NPs)-mediated treatment of psoriasis.

Psoriasis is a chronic papulosquamous skin disease with an autoimmune pathogenic traits and strong genetic predisposition. In the past few decades, with the rapid development of molecular biology and cell biology, the inherent pathogenesis of psoriasis has been gradually elucidated, in which cytokine inflammatory loops, cell signaling pathways, and epigenetic factors such as miRNAs have been demonstrated to play important roles in regulating the development and progression of psoriasis. More importantly, understanding the pathogenesis of psoriasis has promoted the development of effective treatment for psoriasis. In this review, we systemically summarized the molecular mechanisms regulating the development and progression psoriasis, introduced various therapeutics used for clinical psoriasis therapy, and highlighted the recent advances in nanoparticles (NPs)-mediated drug delivery for psoriasis treatment.

Topical treatment of psoriasis

Psoriasis is an autoimmune systemic disease that affects approximately 2-3% of the population. Its symptoms, although focused mainly on the skin, can also have a negative impact on other spheres of the patient's life, including their mental state, because this illness still works with some misunderstanding on the part of society. This chronic, severe inflammatory disease affects mainly skin, but other manifestations, such as joint manifestations, may occur in about 30% of patients. One of the aims of this work is to present the topic of psoriasis, and in particular its topical treatment. It discusses the most commonly used topical preparations for the treatment of psoriasis. Currently thanks to the dynamic development in the fields of medicine, pharmacology and chemistry, schemes and specimens for the effective treatment of psoriasis have been developed. They allow to treat the main, persistent and most affecting the patient’s health symptoms, at the same time improving their quality of life. These specimens are divided into local and systemic ones. They can be used in monotherapy or in combination, depending on the severity of the disease. Topical agents have a symptomatic effect, limited to the maximum remission of skin lesions. These agents not only support the healing process, but also improve the condition of the patient’s skin, which undoubtly has a positive impact on the patient’s daily life.

Effect of Roflumilast Cream (ARQ-151) on Itch and Itch-Related Sleep Loss in Adults with Chronic Plaque Psoriasis: Patient-Reported Itch Outcomes of a Phase 2b Trial.

Itch is the most bothersome symptom reported by patients with psoriasis. Safe and effective treatments for psoriasis that also address itch are needed. To report effects of roflumilast cream on itch-related outcomes from a Phase 2b trial. Adults with chronic plaque psoriasis were randomized to roflumilast 0.3%, roflumilast 0.15%, or vehicle once-daily for 12 weeks. Psoriasis severity was assessed via the Investigator Global Assessment (IGA; a 5-point scale assessing plaque thickening, scaling, and erythema ranging from 0 [clear] to 4 [severe]) and ≥ 2 on a modified Psoriasis Area and Severity Index (PASI-HD, which combines severity of lesions and area affected, ranging from 0 [no disease] to 72 [maximal disease], with the actual percentage of the anatomical area involved in those patients with < 10% of anatomical area involved [e.g., 0.1 for 1% to 0.9 for 9%]). Itch was evaluated via Worst Itch Numeric Rating Scale (WI-NRS), Psoriasis Symptom Diary (PSD) Items 1 (severity of itch) and 2 (bother of itch), and itch-related sleep loss NRS scores. Post hoc correlation analyses between WI-NRS and PASI, WI-NRS and itch-related sleep loss, and WI-NRS and DLQI were also performed. Roflumilast-treated patients had significantly greater improvements than vehicle-treated patients in WI-NRS and PSD Items 1 and 2 beginning at Week 2 and in itch-related sleep loss Weeks 6 through 12. Among patients with baseline WI-NRS ≥ 6, significantly more patients achieved ≥ 4-point improvement with roflumilast than with vehicle as early as Week 2. Itch severity had low correlation with PASI while WI-NRS and IGA were not always aligned. The first assessment was at 2weeks, limiting the ability to assess early onset of itch response. Roflumilast cream improved itch and itch-related sleep loss associated with chronic plaque psoriasis. NCT03638258.

Benvitimod for the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials.

Benvitimod is a topical drug that has recently been approved for mild to moderate psoriasis and atopic dermatitis. The drug has just completed phase 3 trials for psoriasis, which calls for a systematic update of current evidence on the efficacy and safety of this drug. We searched MEDLINE (PubMed), EMBASE, Science Direct, International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials, and Google Scholar for all available randomized controlled trials concerning the topic. We included six randomized controlled trials evaluating the efficacy of benvitimod 1.0% with a total of 1925 patients. Our meta-analysis demonstrated that more patients in the benvitimod group achieved physician global assessment score of 0 or 1 (RR 6.53, 95% CI 4.39-9.71), psoriasis area and severity index (PASI) 75 (RR 4.34, 95% CI 2.96-6.36), PASI 90 (RR 8.83, 95% CI 5.22-14.95) and body surface area reduction (MD -3.85, 95% CI -4.83, -2.88) than placebo at week 12. Patient-reported outcomes were also analyzed, yielding a significant benefit in the benvitimod group for peak pruritus numerical rating scale (PP-NRS) score (MD -1.20, 95% CI -1.98, -0.42), ≥4-point decrease in PP-NRS score (RR 1.58, 95% CI, 1.24-2.03) and dermatology life quality index score (MD -2.54, 95% CI -4.00, -1.07). There was a significantly higher incidence of adverse events in the benvitimod group compared to placebo (RR 1.98, 95% CI 1.73-2.27), while the risk was found to be non-significant for serious adverse events. Benvitimod is an effective treatment of psoriasis as compared to a placebo. However, more large-scale, high-quality trials are needed to comment on the safety of this drug.

Erianin-Loaded Photo-Responsive Dendrimer Mesoporous Silica Nanoparticles: Exploration of a Psoriasis Treatment Method.

Psoriasis is a chronic inflammatory skin disorder accompanied by excessive keratinocyte proliferation. Erianin (Eri) is an ideal drug candidate for inhibiting proliferation and inducing apoptosis in the treatment of psoriasis. However, Eri’s poor water solubility and low penetration activity across the skin hinder its application in local medicine. In this study, we developed a novel photo-responsive dendritic mesoporous silica nanoparticle-based carrier to deliver erianin, improved its bioavailability, and achieved sustained-release effects. Spiropyran (SP), 3-aminopropyltriethoxysilane (APTES), and perfluorodecyltriethoxysilane (PFDTES) were conjugated to the outer surface, which allowed Eri to be released in response to UV radiation. The physicochemical properties of photo-responsive dendritic mesoporous silica nanoparticles (Eri-DMSN@FSP) were characterized via multiple techniques, such as using a Fourier-transform infrared spectrometer, a high-resolution transmission electron microscope, and nuclear magnetic resonance (NMR) spectroscopy. The anti-proliferative properties and light-triggered release of erianin-loaded photo-responsive dendritic mesoporous silica nanoparticles were assessed via the MTT assay and a drug release study in vitro. Erianin-loaded photo-responsive dendritic mesoporous silica nanoparticles (UV) exhibit a significantly enhanced HaCat cell-inhibiting efficacy compared to other formulations, as demonstrated by their extremely low cell viability of 10.0% (concentration: 500 mg/mL), indicating their capability to release a drug that responds to UV radiation. The cellular uptake of photo-responsive dendritic mesoporous silica nanoparticles (DMSN@FSP) was observed via confocal laser scanning microscopy (CLSM). These experimental results show that Eri-DMSN@FSP could be effectively endocytosed into cells and respond to ultraviolet light to release Eri, achieving a more effective psoriasis treatment. Therefore, this drug delivery system may be a promising strategy for addressing the question of Eri’s delivery and psoriasis therapy.

Treatment Patterns for Targeted Therapies, Non-Targeted Therapies, and Drug Holidays in Patients with Psoriasis.

IntroductionWe aimed to evaluate US treatment patterns and, more specifically, switch patterns among patients with psoriasis (PsO) who initiated treatment with targeted therapy (TT) and subsequently switched to another therapy.MethodsThis retrospective study used IBM® MarketScan® Commercial and Medicare Databases (1/1/2006–3/31/2020) to evaluate treatment patterns in biologic- and apremilast-naive patients with PsO. TT included apremilast, adalimumab, etanercept, infliximab, ustekinumab, or other biologics (certolizumab pegol, secukinumab, brodalumab, ixekizumab, guselkumab, or tildrakizumab). Adults with ≥ 1 prescription for a TT, ≥ 2 PsO claims separated by ≥ 1 day on or before the index date (date of first TT prescription), and continuous medical and pharmacy enrollment for 1 year before and 2 years after the index date were eligible. Non-targeted therapy (NTT) was defined as non-targeted oral systemic treatment, topical treatment, phototherapy, or no treatment. Kaplan–Meier (KM) analysis was used to estimate time to reinitiation of TT (24-month continuous enrollment post-index was not required).ResultsA total of 11,526 patients with PsO were included; mean [standard deviation (SD)] age and Charlson Comorbidity Index score were 48.3 (12.8) years and 0.9 (1.43), respectively. During the follow-up, 69.2% of the patients were treated with NTT. Median time to first NTT, for those who received NTT, was 205 days (longest: adalimumab, 252 days). Among patients who switched to NTT after initiating treatment with TT, 52.6% reinitiated treatment with TT (least common: apremilast, 45.6%), with a median time to reinitiation of 106 days (longest: other biologics, 136 days). For all patients on NTT, the probability of reinitiating any TT was 60.7% at 24 months.ConclusionsPsO treatment is often cyclical in nature. Patients frequently experience drug holidays or transition back to TT after using NTT. The consideration of real-world treatment patterns in future economic models may provide new insights into the clinical effectiveness and value of PsO treatments.