Mean Psoriasis Area And Severity Index Score Research Articles

Lactiplantibacillus plantarum IS-10506 Supplementation Improves Clinical Outcome and Immunology Markers in Psoriasis Vulgaris Patients: A Randomized Controlled Trial

BACKGROUND: Probiotics may modify the gut microbiome and have been proven to improve psoriasis vulgaris. Lactiplantibacillus plantarum IS-10506 is a probiotic strain of Indonesian origin. It offers a safe and effective probiotic for psoriasis patients in Indonesia. This study was conducted to evaluate the effect of L. plantarum IS-10506 on clinical and immunology markers in psoriasis vulgaris.METHODS: This randomized, placebo-controlled, and double-blind trial compared L. plantarum IS-10506 (2×1010 CFU/day) and placebo in 49 patients mild-moderate psoriasis vulgaris, which were divided into intervention (n=24) and control groups (n=25). The interventions were given twice daily for 12 weeks. Both groups received topical corticosteroid and emollient as standard treatment. Psoriasis area and severity index (PASI), dermatology life quality index (DLQI), interleukin (IL)-10, IL-17, and forkhead box protein (Foxp3) were then assessed.RESULTS: Mean PASI score for the the subjects in probiotic group was significantly reduced compared to placebo at week-6 (p=0.024), and was sustained until week-12 (p=0.049). At week-12, DLQI scores in the probiotic group were lower than placebo (7.57±5.77 vs. 7.79±5.48). IL-17 level was significantly decreased (p=0.013), while the IL-10 and Foxp3 were significantly increased (p≤0.001 and p=0.048, respectively) in probiotic group. Six months after the completion of study, subjects in probiotic group had a lower probability of flares (52.2%) compared to placebo (79.2%). Two subjects receiving probiotics and one receiving placebo noticed changes in defecation frequency, while another subject in the placebo group complained of mild nausea.CONCLUSION: L. plantarum IS-10506 might effectively improve clinical outcomes and immune biomarkers in psoriasis vulgaris patients, potentially acting as an adjuvant therapy.KEYWORDS: psoriasis, probiotic, clinical severity, immune marker, human and health

Effectiveness and Safety of Etanercept in Paediatric Patients with Plaque-Type Psoriasis: Real-World Evidence.

Background: Psoriasis is a chronic, multisystemic, inflammatory disease affecting approximately 1% of children and significantly reducing their health-related quality of life. Etanercept is a biologic fusion protein-blocking TNF-α and belongs to one of the biologics used among the children population. The purpose of this study was to assess the effectiveness and safety profile of etanercept in paediatric patients with plaque-type psoriasis. Material and methods: The outcome of the treatment was evaluated based on Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Children's Dermatology Life Quality Index (CDLQI). Achievement of at least PASI75 at week 16 was assessed as an adequate response to therapy, which was the primary endpoint. Results: Forty-three paediatric patients were included in the study, 24 females and 19 males. The average age at inclusion into our study was 13 years. At baseline, the mean PASI score, BSA, and CDLQI were 16.3 ± 6.5, 22.3 ± 12.2%, and 17.4 ± 5.3, respectively. At week 16, 90.7% of patients achieved PASI 50, 79.1% achieved PASI 75, and 46.5% attained PASI 90. There was also a decrease in mean BSA and CDLQI values to 3.5 ± 3.8 and 5.4 ± 5.7, respectively. Conclusions: Etanercept proved to be effective, safe, and well-tolerated among the paediatric population with psoriasis.

Short-term efficacy of tildrakizumab on difficult-to-treat areas: a real-world experience.

Novel biologics targeting the IL23/T-17 axis, such as tildrakizumab, have been developed to treat psoriasis. There is limited evidence on the use of tildrakizumab for the treatment of psoriasis in difficult-to-treat areas. Our aim was to evaluate the short-term efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis and with the involvement of difficult-to-treat areas. A multicentric retrospective study was conducted on patients who initiated tildrakizumab between July 2022 and July 2023. Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), Palmoplantar Psoriasis Area and Severity Index (ppPASI), and Nail Psoriasis Severity Index (NAPSI) were measured at baseline and after 16 weeks. The percentages of achieving a PASI75, PASI90, or PASI100 response were assessed. Dermatology Life Quality Index (DLQI) and Itch Visual Analog Scale (VAS) were measured simultaneously. Data about potential safety issues and adverse events were collected. A total of 76 patients were included, and 59 (77.6%) were affected by psoriasis localized to the scalp (n = 32), palmoplantar locations (n = 13), or nails (n = 14). The mean PASI score decreased from 16.5 ± 9.8 at baseline to 1.9 ± 1.6 after 16 weeks. Tildrakizumab treatment resulted in the improvement of PSSI (19.9 ± 10.7 to 2.7 ± 4.2), ppPASI (15.4 ± 6.9 to 1.9 ± 2.3), and NAPSI (20.3 ± 16.9 to 7.6 ± 10.8) from baseline to 16 weeks, respectively. DLQI and Itch VAS also showed marked improvement. Tildrakizumab is a valuable option for treating difficult-to-treat psoriasis and pruritus, with rapid onset of action.

Effectiveness, safety and impact of guselkumab on sexuality and perceived stigmatization in patients with psoriasis in routine clinical practice: Week 28 results from the prospective German multicentre G-EPOSS study.

G-EPOSS is a prospective, non-interventional, German multicentre study of patients with moderate-to-severe plaque psoriasis receiving guselkumab, a therapeutic monoclonal antibody targeting interleukin-23, in a real-world setting. The objective of the study was to evaluate the effectiveness and safety of guselkumab, including its impact on skin, health-related quality of life (HRQoL), sexuality, and perceived stigmatization. Patients (≥18 years old) received guselkumab per routine clinical practice. The primary endpoint was the proportion of patients achieving absolute Psoriasis Area and Severity Index (PASI) ≤ 3 at Week (W)28. Secondary endpoint assessments over 28 weeks included the Nail Psoriasis Severity Index (NAPSI), anogenital Physician's Global Assessment (aPGA), and Dermatology Life Quality Index (DLQI). Sexuality and perceived stigmatization were assessed by patients using the Relationship and Sexuality Scale (RSS) and Perceived Stigmatization Questionnaire (PSQ), respectively. Overall, 293 patients were included in the evaluable set population. Mean age and disease duration were 45.6 and 17.6 years, respectively. At baseline, mean PASI, aPGA and DLQI scores were 15.3, 2.7 and 11.3, respectively. In total, 25.9% of patients had received a prior biologic. Overall, 83.0% of patients achieved PASI ≤ 3, and 56.2%/35.1% achieved PASI ≤ 1/PASI = 0, respectively, at W28. Among those with NAPSI ≥ 1 and aPGA ≥ 1 at baseline, NAPSI = 0 and aPGA = 0 were achieved by 39.2% and 61.1% of patients, respectively, and 61.4% of patients achieved DLQI 0-1 at W28. Improvements were observed over 28 weeks across individual items of the DLQI, RSS and PSQ, indicating improved HRQoL and sex life, and decreased perceived stigmatization. Based on DLQI Question (Q)9, 53.6% of patients experienced sexual difficulties at baseline, which decreased to 12.1% at W28. DLQI Q9 responses were consistent with RSS item responses, highlighting DLQI Q9 as a sentinel for sexual impairment. Guselkumab improved overall skin symptoms and HRQoL in patients with psoriasis and decreased sexual impairment and perceived stigmatization. No new safety signals were observed. CNTO1959PSO4008.

An Oral Interleukin-23–Receptor Antagonist Peptide for Plaque Psoriasis

BackgroundThe use of monoclonal antibodies has changed the treatment of several immune-mediated inflammatory diseases, including psoriasis. However, these large proteins must be administered by injection. JNJ-77242113 is a novel, orally administered interleukin-23–receptor antagonist peptide that selectively blocks interleukin-23 signaling and downstream cytokine production.MethodsIn this phase 2 dose-finding trial, we randomly assigned patients with moderate-to-severe plaque psoriasis to receive JNJ-77242113 at a dose of 25 mg once daily, 25 mg twice daily, 50 mg once daily, 100 mg once daily, or 100 mg twice daily or placebo for 16 weeks. The primary end point was a reduction from baseline of at least 75% in the Psoriasis Area and Severity Index (PASI) score (PASI 75 response; PASI scores range from 0 to 72, with higher scores indicating greater extent or severity of psoriasis) at week 16.ResultsA total of 255 patients underwent randomization. The mean PASI score at baseline was 19.1. The mean duration of psoriasis was 18.2 years, and 78% of the patients across all the trial groups had previously received systemic treatments. At week 16, the percentages of patients with a PASI 75 response were higher among those in the JNJ-77242113 groups (37%, 51%, 58%, 65%, and 79% in the 25-mg once-daily, 25-mg twice-daily, 50-mg once-daily, 100-mg once-daily, and 100-mg twice-daily groups, respectively) than among those in the placebo group (9%), a finding that showed a significant dose–response relationship (P<0.001). The most common adverse events included coronavirus disease 2019 (in 12% of the patients in the placebo group and in 11% of those across the JNJ-77242113 dose groups) and nasopharyngitis (in 5% and 7%, respectively). The percentages of patients who had at least one adverse event were similar in the combined JNJ-77242113 dose group (52%) and the placebo group (51%). There was no evidence of a dose-related increase in adverse events across the JNJ-77242113 dose groups.ConclusionsAfter 16 weeks of once- or twice-daily oral administration, treatment with the interleukin-23–receptor antagonist peptide JNJ-77242113 showed greater efficacy than placebo in patients with moderate-to-severe plaque psoriasis. (Funded by Janssen Research and Development; FRONTIER 1 ClinicalTrials.gov number, NCT05223868.)

Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery

Background. Psoriasis is an independent risk factor for cardiovascular diseases (CVD). One of the markers associated with the CVD course is epicardial fatty tissue (EFT) that is thicker in psoriasis patients. EFT assessment can be used as a useful indicator of CVD in psoriasis patients. The data about the effect of genetically engineered biological therapy (GEBT), used for psoriasis management, on the EFT thickness is limited. Examination of GEBT effects on EFT may improve our understanding of CVD prevention in psoriasis patients.Objective. The aim of the study is to study the changes in EFT thickness on GEBT.Methods. A prospective cohort study included 56 children with severe and moderate psoriasis. Patients underwent transthoracic two-dimensional echocardiography (M-mode) with EFT thickness assessment and PASI (Psoriasis Area and Severity Index) scoring before the GEBT initiation. All the parameters were re-evaluated after 16 weeks. All patients were divided into three groups according to the initiated therapy: adalimumab, secukinumab and ustekinumab. When dividing the therapy received into groups, the age of the patients was taken into account: inclusion in the adalimumab group was carried out from 4 years, in the secukinumab and ustekinumab groups — from 6 years. Otherwise, the process of group assignment was random. The study results were processed using descriptive statistics methods: the changes in EFT thickness in individual groups were compared via the Wilcoxon test, and results were considered statistically significant at p 0.05.Results. Before the start of therapy, in 56 patients the mean of EFT thickness was 2.11 mm, the mean PASI — 18.32. The adalimumab group had the following indicators: the mean EFT thickness before the therapy was 2.1 mm, and it has decreased to 1.77 mm after 16 weeks of therapy. The mean change in EFT thickness was 0.33 mm, and the median — 0.17 mm [CI 0.33 ± 0.25]. The ustekinumab group: the mean EFT thickness before the therapy was 2.13 mm, 16 weeks after — 1.69 mm. The mean change in EFT thickness was 0.44 mm, and the median — 0.38 [CI 0.44 ± 0.13]. The secukinumab group: the mean EFT thickness before the therapy was 2.08 mm, 16 weeks after — 1.82 mm. The mean change in EFT thickness was 0.27 mm, and the median — 0.27 [CI 0.27 ± 0.07]. Evaluation of indicators via Wilcoxon test has shown statistically significant decrease in the EFT after therapy in all groups (p 0.05). 73% of patients achieved PASI 50, and 6% — PASI 75 in the adalimumab group. 21% of patients did not achieve PASI 50. The mean PASI score before therapy was 16.73 points, and after 16 ± 4 weeks — 6.4 points, the mean dynamics was 10.33 points, the median dynamics was 7 points [CI 10.33 ± 4]. All patients achieved PASI 50, 75.3% — PASI 75, 8% — PASI 90, and 16.7% — PASI 100 in the ustekinumab group. The mean PASI score before therapy was 22.17 points, and after 16 weeks — 3.67 points, the mean dynamics was 19.28 points, the median dynamics was 17 points [CI 18.5 ± 3.03]. All patients achieved PASI 50, 47% — PASI 75, and 11% — PASI 90 in the secukinumab group. The median PASI before therapy was 14.29 points, and after 16 ± 4 weeks — 3.71 points, the mean PASI score before therapy was 14.29 points, and after 16 weeks — 3.7 points, the mean dynamics was 10.59 points, the median dynamics was 10 points [CI 10.59 ± 2.27]. Evaluation of indicators via Wilcoxon test has shown statistically significant decrease in the PASI after therapy in all groups (p 0.05). There were no adverse events leading to cessation of therapy during the follow-up period.Conclusion. All groups have shown decrease in the in EFT thickness and in the PASI score. The most significant dynamics was observed in the ustekinumab group. Research limitations were the small patients sample and the absence of a control group (participants without psoriasis).

Effectiveness and tolerability of calcipotriol/betamethasone aerosol foam in patients with psoriasis vulgaris in real‐life setting: A prospective, noninterventional, multicenter observational study in Austria

AbstractBackgroundFor the topical treatment of plaque psoriasis, vitamin D analogues and corticosteroids are used as a fixed combination, which is available in different galenic preparations.ObjectivesThe aim of this study was to investigate the effectiveness and tolerability of calcipotriol/betamethasone (Cal/BD) cutaneous foam in a real‐world setting.MethodsOverall, 107 adult patients with at least mild plaque psoriasis as measured by the Investigator Global Assessment (IGA) were included and treated for 4 weeks. Affected body surface area (BSA), plaque locations, and Psoriasis Area and Severity Index (PASI) were documented at baseline, after 4 weeks and at the end of the study. Pruritus, overall patient satisfaction, tolerability and convenience of use, as well as quality of life (DLQI) were also evaluated.ResultsIn total, 96% of the patients suffered from mild to moderate psoriasis vulgaris. Of all patients included, 76% had previously received topical therapy. Under treatment with Cal/BD aerosol foam, the mean IGA score was reduced from 2.49 to 1.28 points (p &lt; 0.001). The mean PASI score was reduced from 7.01 to 3.58 (p &lt; 0.001). BSA was improved from 9.92% to 4.19% (p &lt; 0.001) and the DLQI from 7.81 to 2.43 points (p &lt; 0.001). Over 88% (84/95 patients) were very satisfied or satisfied with Cal/BD aerosol foam. The treatment was described as soothing (63/89), cooling (70/89), and itch relieving (53/84). Lack of efficacy was documented as an adverse event (AE) in four of 107 patients. No other AEs were observed.ConclusionsThe treatment of psoriasis vulgaris with Cal/BD aerosol foam was demonstrated to be effective, well tolerated and associated with high patient satisfaction.

Long-Term Efficacy, Safety, and Drug Survival of Guselkumab in Patients with Psoriasis: Real-World Data from the Czech Republic BIOREP Registry.

Real-world data on the long-term use of guselkumab for treatment of psoriasis are still limited. We aimed to evaluate long-term efficacy, safety, and drug survival of guselkumab in a real-world setting. This is a retrospective study analyzing Czech Republic registry (BIOREP) data of patients treated with guselkumab. In total, 333 patients were included. Improvement in Psoriasis Area and Severity Index (PASI) score was significant. Mean PASI score decreased from 16 at baseline to 0.7, 0.9, and 0.8 after 12, 24, and 36months, respectively. Absolute PASI scores of ≤ 3 and ≤ 1 were achieved in 93.9% and 77.9%, 94.2% and 71.0%, and 94.8% and 70.7% of patients after 12, 24, and 36months, respectively. Response PASI 90 and PASI 100 were attained in 81.8% and 57.1%, 75.4% and 50.7%, and 75.9% and 55.2% of patients after 12, 24, and 36months, respectively. The percentage of patients achieving PASI 90 and PASI 100 responses was higher throughout the study in bio-naive and in normal-weight patients, while presence of psoriatic arthritis had no influence. Improvement in Dermatology Life Quality Index (DLQI) score was also significant; mean DLQI score decreased from 14.2 at baseline to 0.9, 1.0, and 0.7 after 12, 24, and 36months, respectively. Patients with PASI 100 had lower mean DLQI throughout the study compared with patients with PASI 90. Major reason for discontinuation was loss of effectiveness in 7.1% of patients, while only 0.6% were due to adverse events. Overall cumulative drug survival was high, with only a minimal decline over time, reaching 91.6%, 87.0%, and 85.5% after 12, 24, and 36months, respectively. Drug survival was not affected by previous biological treatment, patient weight, or presence of psoriatic arthritis. This real-world study demonstrated the long-term effectiveness, good safety profile, and high drug survival of guselkumab treatment over a period of 36months.

Is Balneotherapy Protective Against Oxidative Stress? A Pilot Study.

This study aimed to research the effects of Harkány healing water on oxidative stress. The study was performed in a randomized, placebo-controlled, double-blind setup. Twenty patients with psoriasis who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and Malondialdehyde (MDA) - a marker of oxidative stress - were determined, on admission and before discharge. Patients were treated with dithranol. The mean PASI score - determined on admission and before discharge - decreased significantly after the 3-week-long rehabilitation 8.17 vs. 3.51 (p<0.001). The baseline MDA value of patients with psoriasis was significantly higher compared to controls (3.0±3.5 vs. 8.4±7.4) (p=0.018). MDA levels of patients receiving placebo water increased significantly compared to MDA levels of patients receiving healing water (p=0.049). The effectiveness of dithranol resides in the formation of reactive oxygen species. No increased oxidative stress was found in the patients treated with healing water, thus healing water seems to be protective against oxidative stress. However, further research is needed to confirm these preliminary results.

Uticaj biološke terapije na poboljšanje kvaliteta života bolesnika sa psorijazom

Introduction/Aim. Psoriasis is a chronic, relapsing, non-infectious dermatosis, affecting patients' quality of life. There is still insufficient evidence from routine clinical practice on how the biological therapy improves the quality of life of patients with psoriasis. The aim of our study was to examine the effectiveness of biological therapy, regardless of the drug type, on health-related quality of life (HRQoL) in patients with psoriasis. Methods. We performed a prospective observational pilot study at the Clinic of Dermatovenerology, University Clinical Center Niš in the period from from October 1, 2019 to March 1, 2020. The study involved 29 patients with psoriasis vulgaris (11 females, 18 males) on biological therapeutics regardless of the type of the drug. The severity of psoriatic lesions and the patient's response to treatment was assessed using the Psoriasis Area and Severity Index (PASI) before the treatment with secukinumab and ustekinumab and after 10 weeks. Dermatology Life Quality Index (DLQI) was determined at the beginning of biological treatment as well as after 10 weeks. Results. The average age of participants was 49.69 ± 12.75 years and the sample consisted mainly of men (62.1%). The average disease duration among men was 16.44 ± 10.05 years, and among women 17.82 ± 12.79 years. The mean DLQI decreased from 15.62 ± 7.79 to 6.34 ± 7.19 after biological treatment. The initial mean PASI and DLQI scores differed significantly from the average control scores (t-test for paired samples, p &lt; 0.0001). Conclusion. Biological therapies of psoriasis, in addition to improving the clinical picture, demonstrated an improvement in the patients' HRQoL very quickly and they should be considered during evaluating the benefits and risks of this type of therapy.

Effectiveness and Safety of Guselkumab for the Treatment of Psoriasis in Real-World Settings at 52 weeks: A Retrospective, Observational, Multicenter Study from China.

Real-life studies evaluating the long-term efficacy of guselkumab in moderate-to-severe psoriasis in China are limited and not available. In this real-life study, we retrospectively examined a total of 27 patients with moderate-to-severe psoriasis treated with guselkumab [100mg, subcutaneous (s.c.)] with a follow-up period of at least 52weeks in a real-life setting conducted at the Department of Dermatology, Xiangya Hospital, Central South University and Department of Psoriasis, Dalian Dermatosis Hospital. The primary endpoint of the study was long-term effectiveness [reduction of Psoriasis Area and Severity Index (PASI) score, improvement of Dermatology Life Quality Index (DLQI)], safety, and tolerability of guselkumab. Guselkumab treatment decreased the mean PASI score from 12.46 ± 6.34 at baseline to 4.03 ± 3.25 (P < 0.001) and 0.77 ± 1.25 (P < 0.001) at 12 and 52weeks. At 12weeks, PASI 75, 90, and 100 response was achieved in 44.4%, 18.5%, and 11.1% of patients, respectively. At 1year, PASI 75, 90, and 100 response was achieved in 88%, 72%, and 48% of patients, respectively. At 52weeks, 96% of patients achieved a PASI score of ≤ 3 and 80% of patients achieved DLQI (0/1). No patients withdrewed from the study due to primary or secondary ineffectiveness or failure to adhere to the medication. During the follow-up period, only two adverse events were reported (tinea capitis and diarrhea). Our findings confirm that guselkumab is an appropriate therapeutic option in routine clinical practice, particularly when treating sophisticated patients with comorbidities or who failed to previous biologic therapy.

Real-world experience of secukinumab in moderate to severe psoriasis patients in Thailand: Characteristics, effectiveness, and safety.

Secukinumab demonstrated high efficacy and favorable safety profile in patients with moderate-to-severe plaque psoriasis (PsO) in clinical trials. However, understanding of patient characteristics and clinical outcomes in real world in Thailand is still limited. To describe patient characteristics, effectiveness and safety of secukinumab in Thai PsO patients. This retrospective study analyzed data from medical records of adult PsO patients who initiated secukinumab at 7 dermatology centers from September 2017 to April 2021. Study outcomes included patient characteristics and changes in Psoriasis Area and Severity Index (PASI) score from baseline at weeks 4 and 16 after secukinumab initiation. Adverse events were recorded. Subgroup analyses by adherence rate and completeness of loading dose were performed. Of 163 patients, the mean (SD) age was 44.0 (14.0)years. Most patients (84.7%) were previously treated with topical therapy while 62.0% and 21.5% of patients had received systemic and biologic therapy, respectively. The mean baseline PASI score was 15.4 (9.3). Overall, the mean PASI score improved by 58.0% at week 4 and 78.4% at week 16. Statistically significant differences in PASI approvement were revealed among subgroups of patients with different loading dose and adherence rate. Adverse effects were reported in 8.0% of patients. The characteristics of patients in this study were slightly different from clinical trials in terms of demographic and clinical characteristics, as well as PsO treatment. Secukinumab was effective and safe in Thai patients with PsO, especially among those with complete loading dose and a higher adherence rate.

Successful use of anti-IL-23 molecules in overweight-to-obese psoriatic patients: A multicentric retrospective study.

Advances in treatment with biological agents have changed the course of psoriasis. However observational reports and controlled trials draw attention to the heterogeneity of treatment response and point out that Body Mass index (BMI) may be a key factor for therapy efficacy. Therefore, we investigated the impact of BMI on the efficacy of the most recent biological molecules (anti IL-23 inhibitors) to improve patient care management. A bicentric retrospective study was performed to assess efficacy and safety of guselkumab, risankizumab and tildrakizumab in overweight-to-obese patients with moderate to-severe psoriasis up to 52 weeks of treatment. This study involved 113 patients classified according to BMI as overweight or obese. The clinical response to treatment was assessed by Psoriasis Area and Severity Index (PASI) at week 0, 24 and 52. Across all anti-IL-23 treatments, mean PASI score was ≤2 (1.1) after 6months of treatment and decreased under 1 after 12 months in all groups. No severe adverse events, death or malignancy cases were recorded. Our results suggest that overweight or obesity does not influence therapeutic response in psoriatic patients treated with anti-IL-23 antagonists. Therefore, therapeutic strategies with this mechanism of action would be more suitable for high BMI patients.

Real-world clinical outcomes of treatment with brodalumab in patients with moderate-to-severe psoriasis: a retrospective, 24-month experience from four academic dermatology centers in Greece

Objective To assess the real-world clinical treatment outcomes with brodalumab in patients with moderate-to-severe plaque psoriasis in Greece. Materials and methods This was a longitudinal, retrospective, real-world analysis of data from medical records of 106 patients with moderate-to-severe plaque psoriasis, treated with brodalumab for up to 24 months at four University Dermatology Centers in Greece. Efficacy assessments of psoriasis severity [Psoriasis Area and Severity Index (PASI) and Body Surface Area affected (BSA) scores] and its impact on patients’ quality of life (QoL) [Dermatology Life Quality Index (DLQI) score] were evaluated at different timepoints up to 24 months. Results Treatment with brodalumab reduced both mean PASI (14.0–1.5, p < .001) and BSA scores (21.6–2.5, p < .001) across all visits. This effect was accompanied by reduction in mean DLQI score (12.8–2.1, p < .001) across all visits compared with baseline. Moreover, therapeutic efficacy was affected by prior biologic treatment exposure, as biologic naïve patients had greater reductions in all scores from baseline following treatment with brodalumab (numerical for mean PASI, significant for mean BSA and DLQI scores). Conclusion Brodalumab is effective long term, improving disease severity and health-related QoL in patients with moderate-to-severe plaque psoriasis in a real-world setting.

Immunohistochemical Demonstration of Interleukin-17 Positivity in Skin Biopsy Specimens of Patients with Chronic Plaque Psoriasis and its Correlation with Severity of Psoriasis and Associated Metabolic Syndrome and Cardiovascular Changes

Background: Psoriasis is a chronic inflammatory disease which can be associated with metabolic syndrome and cardiovascular abnormalities. Objectives: The aim and objective of the study are to demonstrate interleukin-17 (IL-7) positivity in histopathological sections of psoriatic plaques and to correlate with metabolic syndrome and cardiovascular changes. Materials and Methods: Forty-seven patients with chronic plaque psoriasis with body surface area &gt;10% and psoriasis area and severity index (PASI) score &gt;12, in whom skin biopsy showed munro's microabscesses, were evaluated for IL-17 positivity (intensity and proportion) with associated metabolic syndrome according to the National Cholesterol Education Program adult treatment panel III criteria and cardiovascular comorbidities. A co-relation with PASI score was made. IL-17 intensity and proportion were graded with a score ranging from 0 to 3. IBM SPSS version 16.0 was used for statistical analysis and independent t-test and Chi-square test were used for proportion. Results: The mean age of patients was 43 years. A total of 15 (31.9%) female and 32 (68.1%) male patients were enrolled. The mean PASI score was 21.6. Metabolic syndrome was seen in 31 (65.96%) patients. There was statistically significant association with raised diastolic blood pressure in patients with metabolic syndrome (P = 0.042). The total number of patients with IL-17 positivity with metabolic syndrome was 21 (63.6%). Of these, 9 (42.9%) cases showed IL-17 positivity in the munro's microabscess, 14 (66.7%) cases in the rest of the epidermis, and 18 (85.7%) cases in the dermis. Conclusion: In our study, there was no significant difference in IL-7 positivity between patients with or without metabolic syndrome. Further studies need to be done with large sample size to confirm the significance.

Real-world evidence from the non-interventional, prospective, German multicentre PERSIST study of patients with psoriasis after 1 year of treatment with guselkumab.

PERSIST was a prospective, non-interventional, long-term, German multicentre study of patients with moderate-to-severe psoriasis receiving guselkumab, an approved monoclonal antibody that binds to the p19 subunit of interleukin (IL)-23, in a real-world setting. Evaluation of the efficacy and safety of guselkumab, and its effect on health-related quality of life (HRQoL), in patients with moderate-to-severe psoriasis who have received 52 weeks of treatment. Patients (≥18 years old) were prescribed guselkumab as per routine clinical practice. End points assessed include Psoriasis Area and Severity Index (PASI), Physician's Global Assessment (PGA), target Nail Psoriasis Severity Index (NAPSI), and the Dermatology Life Quality Index (DLQI). Overall, 303 patients were enrolled and treated with guselkumab. Mean disease duration was 21.0 years, and 77.2% and 51.2% of patients had received ≥1 prior conventional systemic or ≥1 prior biologic therapy, respectively. Mean PASI score decreased from 16.4 at baseline to 3.0 by Week (W) 28, and further decreased to 2.4 by W52, while the proportion of patients achieving an absolute PASI score of ≤1 increased from 1.3% at baseline, to 50.8% at W28 and to 58.4% by W52. PASI90 and PASI100 responses also showed marked improvements between W28 and W52, regardless of biologic treatment history. Clearance of psoriatic skin was observed in difficult-to-treat areas, with the percentage of patients achieving a PGA score ≤1 increasing between W28 and W52. Guselkumab improved HRQoL; mean DLQI score decreased from 13.7 at baseline to 2.8 by W28, and further decreased to 2.4 by W52. At W52, 64.6% of patients achieved a DLQI score ≤1. The cumulative probability of drug survival was 92.4% at W52. Guselkumab is efficacious and well tolerated regardless of previous biologic therapies, comorbidities or psoriasis manifestation in difficult-to-treat areas. No new safety signals were observed.

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Certolizumab Pegol Use in the Treatment of Moderate-to-Severe Psoriasis: Real-World Data From Two Canadian Centers.

BackgroundCertolizumab pegol (CZP) is a TNF-ɑ inhibitor used to treat moderate-to-severe plaque psoriasis (PsO) in adult patients, including women of childbearing potential (WOCBP) and patients with psoriatic arthritis (PsA). There are currently limited real-world data on CZP for treatment of PsO.ObjectivesTo examine the use of CZP for treatment of PsO in clinical practice at two dermatology clinics in Canada.MethodsWe conducted a retrospective chart analysis of 59 patients with moderate-to-severe psoriasis receiving CZP. Clinical efficacy was measured using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Physician Global Assessment (PGA). Drug survival was analyzed using Kaplan-Meier plots.ResultsOf the 59 patients, 36 (61%) were female, of whom 23 (63.9%) were WOCBP. Twenty-three (39.0%) patients received CZP as their first biologic treatment. The main reasons for choosing CZP were its efficacy in both PsO and PsA, and for WOCBP due to little or no cross-placental transfer. Improvement of symptoms was observed after 3 months of treatment and was maintained for the 12-month analysis period. After 12 months of treatment, the patients’ mean PASI score decreased from 13.0 (±5.8) at baseline to 2.3 (±4.3), mean BSA score from 13.1% (±6.7%) to 1.7% (±2.6%), and mean PGA score from 3.0 (±0.6) to 0.8 (±0.6). Overall CZP drug survival rate was 76.3% at 12 months, with no difference between biologic-naive and biologic-experienced patients.ConclusionsCZP was effective and well tolerated in this cohort of patients with moderate-to-severe PsO in a real-world setting.

The Impact of Stress-Coping Strategies and the Severity of Psoriasis on Self-Esteem, Illness Acceptance and Life Satisfaction.

IntroductionThe visibility of skin lesions is a significant burden for patients with psoriasis, who experience social hostility as well as many emotional and psychological problems. The recurrent nature of cutaneous manifestations and their location are also a source of emotional distress, which in turn is one of the main factors that intensifies skin lesions in these patients. The aim of the study was to assess the impact of the severity of psoriasis and stress-coping strategies on general psychometric measures in the affected patients.MethodsThe study used a short demographic questionnaire, Psoriasis Area and Severity Index (PASI), and four standardised general psychometric tools: Rosenberg Self-Esteem Scale (SES), Satisfaction With Life Scale (SWLS), Coping Inventory for Stressful Situations (CISS) and Acceptance of Illness Scale (AIS). A total of 111 patients participated in the study.ResultsThe mean PASI score was 14.0 (12.1–15.9). The mean SWLS score was below average, i.e., 18.5 (17.3–19.7), and the SES score—26.8 points (26.1–27.5)—indicated self-esteem slightly above average among patients with psoriasis. The mean stress-coping level measured with CISS was 53.6 (51.9–55.2) for the task-oriented strategy (TOS), 46.2 (43.8–48.6) for the emotion-oriented strategy (EOS) and 50.1 (48.5–51.8) for the avoidance-oriented strategy (AOS). Higher PASI was associated with lower illness acceptance among men (r = 0.48) and lower self-esteem among women (r = 0.44). The level of life satisfaction was lower in respondents with higher PASI scores (mainly in the group of women, r = 0.44).ConclusionsHigher severity of psoriasis (PASI) and greater frequency of emotion-oriented stress-coping mechanisms (CISS) are factors that negatively affect the overall psychophysical condition of respondents.

Goeckerman therapy versus methotrexate for psoriasis: a study on military personnel

Introduction: Although methotrexate is a widely used systemic medication for psoriasis, a restrictive cumulative dosage limits its use in each patient, and a liver biopsy is recommended when the cumulative dose reaches 3.5–4.0 mg. As an alternative, Goeckerman therapy is a safe, efficient, tar-based method of treating psoriasis but one used increasingly less in recent decades due to the inconvenience of tar application and of requiring outpatients to remain covered in tar before receiving phototherapy hours if not a day later. However, for patients such as soldiers who can be treated as inpatients, Goeckerman therapy is preferable due to its efficacy and good safety profile. &#x0D; Material and Method: We retrospectively evaluated 96 patients with psoriasis, all military personnel, who had been treated with either methotrexate (n=49) or Goeckerman therapy (n=47) between 2012 and 2016. Their baseline and exit Psoriasis Area and Severity Index (PASI) scores were comparatively analyzed.&#x0D; Results: No statistical difference in relative recovery emerged between patients who had received methotrexate and ones who had undergone Goeckerman therapy. Both groups had achieved a mean PASI score of 75 at approximately the same time. &#x0D; Conclusion: When the rapid return to work is important, we recommend using Goeckerman therapy to treat psoriasis given its relatively low side effect profile and lack of immunosuppressive action. Both advantages can benefit patients such as soldiers who are able to undergo treatment in inpatient settings, cannot meet physicians frequently due to work requirements, and cannot avoid the risk of infection (i.e., a risk factor for methotrexate use) due to living in crowded spaces.