Reduction In Psoriasis Area Severity Index Research Articles

Certolizumab pegol effectiveness, survival and safety in patients with psoriasis: A multicenter retrospective analysis in daily clinical practice by the Spanish Psoriasis Group.

Certolizumab is an Fc-free PEGylated tumor necrosis factor-alpha (TNFα) inhibitor recently approved for the treatment of moderate-to-severe plaque psoriasis, although there is limited real-world evidence on the effectiveness and safety in patients with plaque psoriasis treated with certolizumab. The objective of this article is to determine the effectiveness, drug survival, and safety, including pregnancy, childbirth, and lactation, of certolizumab in moderate-to-severe plaque psoriasis under real-world conditions. This is a retrospective, multicenter, observational study performed in 15 hospitals in Spain. It evaluates the effectiveness and safety of certolizumab in plaque psoriasis in the clinical practice setting. A total of 67 patients (73% female) were evaluated with a mean baseline Psoriasis Area Severity Index (PASI) of 8.9. At Week 12, the mean PASI was 2.3 (n = 67), 1.3 (n = 57) at Week 24 and 1.3 at Week 52 (n = 34). Absolute PASI < 3 was achieved in 69, 86, and 92% of patients at Weeks 12, 24, and 52, respectively, as observed. For its part, using the under-response imputation analysis, PASI < 3 at Weeks 12, 24, and 52 were achieved by 69, 73, and 49% of the patients, respectively. A total of 35 patients (52%) had concomitant psoriatic arthritis, and, in 24 of them, Disease Activity in Psoriatic Arthritis Score (DAPSA) was recorded at baseline, with a mean value of 17.9 which decreased to 8.2 at Week 12 (n = 22) and to 3.6 at Week 24 (n = 18). Certolizumab treatment was discontinued in 14 out of 67 patients (21%), due to lack/loss of cutaneous or articular effectiveness (n = 11) or patient decision (n = 2) or adverse event in only one patient who developed active tuberculosis. A lower baseline PASI [hazard ratio (HR): 1.12 (1.02-1.23); P = 0.023] and a more significant reduction in PASI at Week 12 [HR: 1.16 (1.07-1.27); P < 0.001] and Week 52 [HR: 1.47 (1.11-1.96); P = 0.007] was shown to be significantly related with better survival for the entire follow-up period. Fourteen patients were treated during pregnancy and/or lactation without reporting adverse events in either the patient or the newborn. Certolizumab consistently showed high effectiveness and drug survival rates in this real-life cohort. The safety demonstrated in clinical trials during pregnancy and lactation seems to be confirmed in clinical practice.

EFFICACY AND SAFETY OF APREMILAST IN MODERATE TO SEVERE CASES OF CHRONIC PLAQUE PSORIASIS: A RETROSPECTIVE STUDY

The objective of this study was to assess the efficacy and safety of Apremilast in patients with moderate-to-severe plaque psoriasis. A retrospective study was conducted in the Dermatology Department of Bakhtawar Amin Trust Hospital Multan from September 2021 to September 2022. A total of 102 patients were included in the study after evaluation. Apremilast was administered in all the patients, and its clinical response was assessed by the extent of Psoriasis Area Severity Index (PASI) reduction 16 weeks after the start of treatment. Our secondary endpoints included examining the PASI; Dermatology Life Quality Index (DLQI); Physician Global Assessment (PGA); the adverse effects of treatment; survival rate; reasons for discontinuation of treatment, if any, and the rate of patients who managed to reach Psoriasis Area Severity Index reduction up to 50%, 75%, 90% and 100% after 16 weeks. 37 (72.5%) subjects achieved PASI reduction ≥75% or ≥50%, thus achieving the primary endpoint. The majority of the study sample had moderate psoriasis, with a mean baseline DLQI score of 11.2, PASI score of 11.0 and PGA score 2.6. After 16 weeks, 65% subjects had PGA score ≤1. PASI improved rapidly over 4 (4.8) (P&lt;.001) to 16 weeks (4.3) (P&lt;.001). DLQI at baseline was 11.2; after 16 weeks, it was 3.8 (P&lt;.001). Regarding secondary endpoints, after 16 weeks, 35/37 (94.5%) subjects achieved ΔPASI≥50, 18/37 (48.6%) ΔPASI≥75, 8/37 (21.6%) achieved ΔPASI≥90 and 6/37(16.2%) achieved ΔPASI100. Treatment-related adverse effects occurred in 16/51 (31.3%) patients. In total, treatment was stopped in 6 (11.6%)subjects because of adverse effects; gastrointestinal disorders were the most common. Apremilast is an effective and safe drug for the treatment of patients with moderate-to-severe plaque psoriasis.

Efficacy and Safety of Methotrexate in Psoriasis Vulgaris Long-Term Treatment: A Real-World Observation Study.

Methotrexate (MTX) in the therapy of psoriasis vulgaris (PV) is a well and long-established treatment option. To assess the long-term experience of individual patients in the real world with regard to the efficacy and safety of MTX in PV therapy. In a retrospective study, MTX as a weekly used monotherapy in PV was examined. Clinical data including the Psoriasis Area Severity Index (PASI), prevalence of psoriatic-arthritis (PsA), Investigator Global Assessment (IGA), laboratory parameters, occurrence of adverse events (AEs), dosing of MTX and characteristics of patients treated for at least 24 months were collected. A total of 55 patients with 247 patient-years under MTX therapy were included. The mean PASI reduction was 51.2% with a significant (P < 0.001) improvement in the skin condition in the first 6 months of treatment, remaining stable thereafter. The mean MTX dose increased from 11.8 ± 3.7 mg to 12.9 ± 3.8 mg in the first year of therapy, with a constant mean dose in the following years. In 247 patient-years, no serious AE was documented. Gastrointestinal side effects or fatigue were commonly detected. The liver parameter alanine aminotransferase/ glutamate-pyruvate transaminase (ALT/GPT) (baseline 35.8 ± 22.0 U/L) increased after 3 years of therapy (42.0 ± 22.4 U/L; P = 0.013) without clinical significance. In this patient collective, MTX in low doses was effective and safe in long-term therapy. The improved skin condition was steady and reached by an unvarying dose. New data showed a better efficacy of MTX in higher doses; however, additional data must be collected on the long-term efficacy and safety of MTX with a higher dose regime.

The Efficacy of Lactocare® Synbiotic on the Clinical Symptoms in Patients with Psoriasis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Background Attention to the administration of probiotics for the treatment of psoriasis has recently increased. Aim In the present study, improvements in dermatology life quality index (DLQI), psoriasis area severity index (PASI), and visual analogue scale (VAS) scores in the psoriasis patients receiving Lactocare® probiotic were compared to psoriasis patients receiving placebo. Methods A total of 52 psoriasis patients were included in this study and randomly divided into treatment and placebo (control) groups. The control group received topical hydrocortisone associated with placebo; in the treatment group, Lactocare® was administrated orally associated with hydrocortisone. The mean of VAS, DLQI, and PSAI scores was recorded and evaluated pretreatment and post-treatment in both groups for 3 months. The mean of the scores in the control groups was compared to the treatment group. Intragroup analysis was preformed with a comparison of the mean of these scores at baseline 4-, 8-, and 12-weeks post-treatment. Results In the treatment group, a significant decrease was seen in PASI, VAS, and DLQI scores compared to the control group on week 12 post-treatment. Conclusion Oral administration of Lactocare® probiotic (two times daily) associated with administration of topical hydrocortisone resulted in the improvement of PASI, DLQI, and VAS scores in the patients with psoriasis after 12 weeks of treatment. PASI reduction occurred in all patients who received probiotics.

Long-Term Efficacy and Safety of Guselkumab for Moderate to Severe Psoriasis: A 3-Year Real-Life Retrospective Study.

IntroductionGuselkumab safety and efficacy profiles in psoriasis have been showed by VOYAGE (1 and 2) trials. Although trial results have been already previously confirmed by real-life studies, long-term real-life data, and drug survival data about guselkumab are still poor.Patients and MethodsWe performed a 3-year retrospective study, with the aim of assessing guselkumab efficacy and safety profile in the management of plaque psoriasis in a real-life setting.ResultsThirty-one patients completed the study. Both Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) statistically improved since week 16, and up to week 144 [PASI reduction from 16.4 ± 6.2 to 0.6 ± 0.9 (p < 0.0001) at week 144 while BSA from 33.2 ± 14.6 to 1.9 ± 1.4 (p < 0.0001)]. At week 12 PASI90 and PASI100 were achieved by 19 (61.3%) and 11 (35.4%) patients, respectively, as well as 24 (77.4%) and 18 (58.1%) subjects reached PASI 90 and PASI 100 at week 144. As regards the safety, no cases of injection site reaction, candida, serious AEs, malignancy, or major cardiovascular events were reported. Of note, mild AEs were collected with pharyngitis as the main one (7, 22.6%), followed by headache (5, 16.1%) and flu-like illness (5, 16.1%), all without requiring treatment discontinuation.ConclusionOur experience confirmed the efficacy and safety of guselkumab in daily clinical practice up to 3 years, suggesting this drug as an effective treatment option in psoriasis long-term management.

The Impact of Hypertension, Diabetes, Lipid Disorders, Overweight/Obesity and Nicotine Dependence on Health-Related Quality of Life and Psoriasis Severity in Psoriatic Patients Receiving Systemic Conventional and Biological Treatment.

Psoriasis, a chronic disease, is associated with a higher prevalence of comorbidities and has negative impact on health-related quality of life (HRQOL). The objective was to investigate the effect of comorbidities on HRQOL, and psoriasis severity measured appropriately by the dermatology life quality index (DLQI) and the psoriasis area severity index (PASI) before, and after a 3-month treatment and the median DLQI or PASI reduction from baseline in the adult psoriatic patients receiving various types of treatment. The study included 184 adult plaque psoriatic patients. DLQI and PASI scores were assessed in the studied patients before the therapy (a baseline visit) and after a 3-month treatment (a control visit) depending on the presence of comorbidities. Psoriatic patients with comorbidities had worse HRQOL and more severe skin lesions. The presence of comorbidities had a negative effect on the outcome of treatment with the use of conventional therapy. The outcome of therapy with biological agents was independent of each of the analyzed factors. Biological treatment had a high effectiveness on the psoriatic skin lesions improvement despite the presence of comorbidities, whereas methotrexate was effective even if the patients had co-existing hypertension. In psoriatic patients receiving systemic conventional treatment but not biological treatment, comorbidities had a negative impact on HRQOL and psoriasis severity.

Validation of a simple measure of psoriasis severity based on a longitudinal study of Chinese patients.

The product of Physician Global Assessment (PGA) and Body Surface Area (BSA) (PGA × BSA) has been proposed as a simple and sensitive instrument for measuring psoriasis severity. To assess the simple measure, PGA × BSA, with respect to criterion validity, reproducibility, responsiveness, and interpretability among Chinese patients with psoriasis. Assessments of psoriasis severity were performed by two dermatologists independently for the baseline survey and by one dermatologist during follow-up. Criterion validity and reproducibility were assessed using Spearman correlation coefficients (r). Responsiveness was assessed by comparing the percentage changes in PGA × BSA (PGA × ΔBSA [%]) between patients grouped by disease improvement. The receiver operating characteristic (ROC) curve was used to determine the threshold of PGA × ΔBSA for disease improvement, anchored by 50% and 75% reduction in Psoriasis Area Severity Index (PASI). A total of 276 patients participated in the baseline survey, of whom 93 were followed. PGA × BSA highly correlated with PASI (r = 0.94), Simplified PASI (SPASI, r = 0.93), and Psoriasis Log-based Area and Severity Index (PLASI, r = 0.90) measured at baseline, indicating good criterion validity. The between-evaluator consistency of PGA × BSA was r = 0.95, indicating high reproducibility. PGA × ΔBSA highly correlated with both ΔPASI (r = 0.86) and ΔPLASI (r = 0.85), suggesting good responsiveness. The threshold of ΔPGA × BSA for disease improvement was 57% and 73%, as indicated by 50% and 75% reduction in PASI, respectively. PGA × BSA demonstrates good biometric properties and may be used to measure the severity of psoriasis among Chinese patients.

Real-life efficacy and safety of secukinumab in elderly patients with psoriasis over a 2-year period.

The prevalence of psoriasis is increasing among older people. Elderly patients with psoriasis represent a challenge for dermatologists owing to multiple comorbidities, polypharmacy and immune senescence, which lead to an increased possibility of adverse events (AEs), drug interactions and susceptibility to cancers and infections. Therefore, conventional systemic therapies are often contraindicated, with biologics appearing as the mainstay for moderate-to-severe disease. However, the data on efficacy and safety of biologics in older people are scant. To evaluate the efficacy and safety of secukinumab in elderly patients with psoriasis over a 2-year period. A real-life retrospective observational study was performed on patients aged ≥65years with moderate-to-severe plaque psoriasis who were treated with secukinumab at the Psoriasis Care Unit of the University of Naples Federico II, Italy from June 2016 to June 2019. Mean Psoriasis Area Severity Index (PASI) reduced from 11.4±6.3 at baseline to 2.1±1.7 at week 24 and 1.7±1.9 at week 96 (P<0.001 for all follow-up visits), with a final mean PASI reduction of 85.1%. A similar trend was noted for body surface area (BSA), with baseline value of 27.5±15.7 decreasing to 6.8±5.0 at week 24, and to 3.3±2.5 at week 96 (P<0.001 at all follow-up visits), with a final mean BSA score reduction of 88.0%. Registered AEs did not lead to secukinumab discontinuation, except in one patient (3.4%). Secukinumab seems to be a safe and effective treatment for elderly patients with psoriasis, who frequently have multiple comorbidities, polypharmacy and multiple failures with previous systemic treatments including biologics.

Efficacy of apremilast in psoriasis: a cross sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study was done to evaluate the efficacy of apremilast in patients with psoriasis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 20 patients clinically diagnosed with different forms of psoriasis were prescribed apremilast 30 mg twice a day. A psoriasis area severity index (PASI) scoring was done every 4 weeks with a final score taken at the end of 12 weeks.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 20 (eight female and 12 male) patients prescribed apremilast 30 mg, 8 patients achieved 75% and more PASI reduction, 10 patients achieved 50% and more PASI reduction at the end of 12 weeks. One patient did not show any significant PASI reduction, while another patient dropped out from the study after 3 weeks of apremilast due to intolerable vomiting and diarrhoea.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Apremilast, a relatively safe drug, has no effect on the haematological, renal, hepatic systems as well as no major immunological effects like other drugs used in the treatment of psoriasis, making monitoring of laboratory parameters inconsequential. It is also well tolerated with very few side effects in comparison, making it a welcome drug in the long run.&lt;/p&gt;

Clinical efficacy and safety of adalimumab for the treatment of 14 cases of severe psoriasis

Objective To evaluate the clinical efficacy and safety of adalimumab for the treatment of severe psoriasis. Methods Between December 2015 and August 2017, 14 patients with severe psoriasis who showed no response to traditional therapy were enrolled into this study. All the patients received subcutaneous injection of adalimumab at an initial dose of 80 mg, which decreased to a dose of 40 mg once every 2 weeks after 1-week treatment. At week 4, 8 and 12, the psoriasis area severity index (PASI) and physician′s global assessment (PGA) scores were recorded, and clinical efficacy and adverse drug reactions were observed. In patients with psoriatic arthritis, the improvement of arthritis was evaluated according to the American College of Rheumatology 20% response criteria (ACR20) . Results All the 14 patients received the drug treatment for at least 12 weeks. At week 4, 8 patients achieved 50% reduction in PASI (PASI 50) . At week 8, 8 patients achieved PASI 75, and 2 of the 8 patients achieved PASI 90. At week 12, 14 patients achieved PASI 75, 7 of them achieved PASI 90, and 3 of them achieved PASI 100. Before the treatment, the average PGA score of the 14 patients were 4.92 ± 0.02, and decreased to 1.21 ± 0.02 at week 12. The arthritis symptom was markedly improved in the 3 patients with psoriatic arthritis. At week 8, 2 patients achieved ACR20, and 3 achieved ACR20 at week 12. There were no serious adverse drug reactions such as serious infections and malignant tumors in any of the patients. Urticaria occurred in 3 patients, and was relieved after antihistamine treatment. Conclusion Subcutaneous injection of adalimumab every other week is markedly effective and safe for the treatment of severe psoriasis with few adverse drug reactions, and it provides a new treatment choice for patients with severe psoriasis who show no response to traditional therapy. Key words: Psoriasis; Arthritis, psoriatic; Biological agents; Adalimumab

A non-inferiority randomized controlled clinical trial comparing Unani formulation & psoralen plus ultraviolet A sol in chronic plaque psoriasis.

Background & objectives:Though Unani medications have been used for centuries to treat psoriasis, there is paucity of published studies which have systematically evaluated their efficacy and safety. This study was conducted to establish non-inferiority of Unani medications (oral UNIM-401 and topical UNIM-403) vs psoralen plus ultraviolet A (PUVA) sol in treatment of moderate-severe chronic plaque psoriasis (CPP) in achieving psoriasis area severity index (PASI) 75 at 12 wk and to estimate proportion of patients who relapsed in follow up period of 12 weeks, after having achieved PASI 50.Methods:In this randomized, controlled trial patients with CPP were block randomized to receive either Unani treatment (147 patients) or PUVA sol (140 patients) for 12 weeks. Percentage reduction in PASI was determined in each patient at 12 wk to calculate number of patients who achieved PASI 75 as also to estimate median of percentage reduction in PASI in each group. All patients who achieved PASI 50 at 12 weeks were followed up for another 12 wk to determine proportion of patients who relapsed.Results:Of the 287 patients randomized, 84 of 147 in Unani group and 67 of 140 in PUVA sol group completed 12 weeks of treatment. On intention-to-treat (ITT) analysis, the response in patients on Unani medication was not inferior to those receiving PUVA sol, in attaining PASI 75 (16.3% in Unani group vs 15.7% in the PUVA sol group). Median of percentage reduction of PASI at 12 wk from baseline in Unani group (68.2%; −60, 100) and PUVA sol group (63%; −15.7, 100) was comparable. Proportion of patients who relapsed at 24 wk was comparable in both groups. However, frequency of clinical side effects was significantly higher (P =0.001) in PUVA sol group (16.4%) compared to Unani group (2%).Interpretation & conclusions:The findings of the present study indicated that oral UNIM-401 and topical UNIM-403 were effective and well tolerated therapeutic options in patients with moderate-severe CPP.

Narrow-band UVB Phototherapy does not Consistently Improve Quality of Life in Psoriasis Patients: A Prospective Observational Study from Eastern India.

Introduction:Psoriasis is a chronic inflammatory and proliferative condition of the skin which is well-known to impair the patients’ quality of life (QoL). Of the various treatment modalities, narrowband UVB (NBUVB) phototherapy is one of the standard treatments for moderate to severe plaque psoriasis with minimal side-effects compared to other systemic therapies.Objectives:To study whether NBUVB phototherapy administration improves QoL in plaque-type psoriasis and to find the correlation between clinical severity of psoriasis and patients’ QoL by using psoriasis area severity index (PASI), dermatology life quality index (DLQI), and psoriasis disability index (PDI) tools before and after NBUVB phototherapy.Materials and Methods:Thirty-seven patients with plaque psoriasis involving >10% of body surface area (BSA) underwent NBUVB phototherapy thrice weekly for 36 sessions. Clinical severity of psoriasis was assessed by PASI and impact of psoriasis on quality of life by DLQI and PDI. Assessment was done at the baseline, 18th, and 36th session.Results:After 36 sessions of NBUVB phototherapy, mean reduction in PASI was 79.6% which was statistically significant. On the other hand, DLQI and PDI did not show significant improvement and did not correlate with PASI.Conclusion:NBUVB phototherapy reduces clinical severity of psoriasis. However, clinical severity and QoL impairment is independent of one another. DLQI and PDI do not improve proportionate to clinical improvement.

Superiority of a vitamin B12-containing emollient compared to a standard emollient in the maintenance treatment of mild-to-moderate plaque psoriasis.

Psoriasis is a chronic inflammatory skin disease affecting 2%–3% of the population. The wide range of drugs currently available for its treatment could be associated, in the long term, with organ toxicity and adverse events, thus, clinical monitoring throughout treatment is required. This investigator-initiated trial (IIT) evaluated the efficacy and the safety of a vitamin B12-containing ointment in comparison with glycerol-petrolatum-based emollient cream used twice a day to treat mild-to-moderate plaque psoriasis for a period over 12 weeks followed by a wash-out observation period of 4 weeks. This study was conducted as a randomized, controlled, single-blind, intra-patient left- to right-side trial comparing the efficacy and safety of vitamin B12-containing ointment (M-treatment) with a glycerol-petrolatum-based emollient cream (C-treatment). The Psoriasis Area Severity Index (PASI) was determined at baseline (T0), at time points T2 (14 days), T4 (4 weeks), T8 (8 weeks), T12 (12 weeks) and 4 weeks after the end of the wash-out period (F1). In total, 24 patients with plaque psoriasis were randomized to receive left- or right-side treatment with B12 ointment. From time point T2 to time point F1, there was a statistically significant difference in PASI reduction between M-treatment side and C-treatment side. At time point T 12, the difference between the mean reductions from baseline PASI scores by 5.92 ± 2.49 (87, 6%) in the M-treatment side versus 1.08 ± 1.02 (23, 1%) C-treatment side was statistically highly significant (PWex < 0.001). On the contemporary panorama in the treatment of psoriasis, we conclude that vitamin B12 ointment will represent a new concrete therapy option and should be considered in the update of therapeutic algorithm for the treatment of psoriasis

Associations between functional polymorphisms and response to biological treatment in Danish patients with psoriasis

Biological agents including anti-tumor necrosis factor (anti-TNF; adalimumab, infliximab, etanercept) and anti-interleukin-12/13 (IL12/23; ustekinumab) are essential for treatment of patients with severe psoriasis. However, a significant proportion of the patients do not respond to a specific treatment. Pharmacogenetics might be a way to predict treatment response. Using a candidate gene approach, 62 mainly functional single-nucleotide polymorphisms (SNPs) in 44 different genes were evaluated in 478 Danish patients with psoriasis undergoing 376 series of anti-TNF treatment and 230 series of ustekinumab treatment. Associations between genetic variants and treatment outcomes (drug survival and Psoriasis Area Severity Index reduction) were assessed using logistic regression analyses (crude and adjusted for gender, age, psoriatic arthritis and previous treatment). After correction for multiple testing controlling the false discovery rate, six SNPs (IL1B (rs1143623, rs1143627), LY96 (rs11465996), TLR2 (rs11938228, rs4696480) and TLR9 (rs352139)) were associated with response to anti-TNF treatment and 4 SNPs (IL1B (rs1143623, rs1143627), TIRAP (rs8177374) and TLR5 (rs5744174)) were associated with response to ustekinumab treatment (q<0.20). The results suggest that genetic variants related to increased IL-1β levels may be unfavorable when treating psoriasis with either anti-TNF or ustekinumab, whereas genetic variants related to high interferon-γ levels may be favorable when treating psoriasis with ustekinumab.

Increased expression of microRNA-155 in peripheral blood mononuclear cells from psoriasis patients is related to disease activity.

MicroRNAs (miRNAs) gene expression regulators are altered in psoriasis suggesting their role in the pathogenesis. To study expression changes of inflammation and toll-like receptor (TLR)-related miRNAs, miRNA-155, let-7i, miRNA-21, miRNA-146a and miRNA-223 in peripheral mononuclear cells (PBMCs) and miRNA-21, miRNA-146a and miRNA-223 in plasma, from chronic plaque-type psoriasis patients who were treatment-naive or had undergone a washout period (n=11). MiRNAs were evaluated at baseline and after 11 (9-12) months [median (25th-75th percentile range)] of methotrexate (MTX) or topical (betamethasone plus calcipotriene) treatment. MiRNA expression was analysed with quantitative real-time reverse transcription-polymerase chain reaction. Matched controls were studied. Psoriasis patients presented, at baseline, increased expression of miRNA-155, let-7i, miRNA-146a, miRNA-21 and miRNA-223 in PBMCs, plus miRNA-21, miRNA-146a and miRNA-223 in plasma. Receiver-operator characteristic (ROC) curve analysis and area under the curve (AUC) showed that expression of these miRNAs have the potential to distinguish between psoriasis and controls. At baseline, miRNA-155 expression in PBMCs correlated with Psoriasis Area Severity Index (PASI) [12 (8-14)] (Spearman r: 0.7140, P<0.05) suggesting a role in psoriasis. After MTX or topical treatment, reduction in PASI was observed [87.5% (75-100)]; miRNA-155 expression in PBMCs decreased; plasma miRNA-21, miRNA-146a and miRNA-223 were down-regulated. ROC analysis showed that miRNA-155 expression in PBMCs from psoriasis patients have the potential to distinguish between patients' samples at baseline and after treatment (AUC: 0.942, sensitivity: 0.91; specificity: 0.91 values; maximum likelihood ratio =10). After treatment, miRNA-146a expression in PBMCs increased; miRNA-155/miRNA-146a ratio decreased, suggestive of a regulatory feedback; let-7i expression decreased; miRNA-21 and miRNA-223 remained elevated. In this exploratory study, psoriasis patients presented increased expression of miRNA-155 in PBMCs that correlated with PASI and decreased with disease remission. MiRNA-21, miRNA-146a and miRNA-223 in PBMCs and plasma were increased at baseline and differentially modulated, underscoring different roles of TLR-related miRNAs in psoriasis.

The Correlation between the Dermatology Life Quality Index and the Psoriasis Area Severity Index

Background Psoriasis patients experience a significant decrease in quality of life (QoL). Objectives This study was conducted to prospectively measure changes in QoL of patients with moderate-to-severe psoriasis who are treated with ustekinumab. We performed a review of the literature, and discussed the significance of our results in the context of the controversy regarding the correlation between the Dermatology Life Quality Index (DLQI) and Psoriasis Area Severity Index (PASI). Methods Seventeen patients with moderate-to-severe plaque psoriasis received 36 weeks of ustekinumab and were followed every 4 weeks. Results All patients demonstrated significant improvement, both in terms of QoL and physical assessments. The data suggest a strong linear correlation between mean percent reduction in PASI and mean reduction in DLQI (R2=0.94). Conclusion Psoriasis patients treated with ustekinumab achieved significant improvement of QoL, which correlated with physical improvement. This study demonstrates a strong correlation between mean percent reduction in PASI and mean reduction in DLQI.

Acupuncture Therapies for Psoriasis Vulgaris: A Systematic Review of Randomized Controlled Trials

The purpose of this review was to evaluate the efficacy and safety of acupuncture therapies in the treatment of psoriasis vulgaris. Embase, CENTRAL, PubMed, AMED, CINAHL, CNKI, CQVIP, CBM, and Wanfang databases were searched from inceptions to May 2013 for prospective randomized controlled trials evaluating acupuncture therapies for psoriasis vulgaris. No language limitations were applied. Studies were assessed using the Cochrane risk of bias tool. The primary outcome was Psoriasis Area Severity Index (PASI) score. Six studies (involving 522 participants) met the eligibility criteria for this review, and 5 were included in quantitative analysis. Due to the diversity of interventions, comparators and reported outcomes, meta-analysis was not possible. Results from single studies produced conflicting results for the outcomes PASI reduction, lesion reduction (non-PASI), PASI score, and relapse rate. There is some evidence of benefit of acupuncture therapies for the treatment of psoriasis vulgaris. However, the conclusions are limited by the small number of included trials and conflicting results from single studies. More research is needed to clarify the effect of acupuncture therapies for psoriasis vulgaris.

An open label prospective randomized trial to compare the efficacy of coal tar-salicylic Acid ointment versus calcipotriol/betamethasone dipropionate ointment in the treatment of limited chronic plaque psoriasis.

Background:Chronic plaque psoriasis is a common papulosquamous skin disorder, for which a number of topical agents are being used including coal tar, topical steroids and more recently topical calcipotriol/betamethasone dipropionate. There is no study comparing purified coal tar preparation with calcipotriol/betamethasone dipropionate ointment in limited chronic plaque psoriasis.Aims and Objectives:A prospective randomized open label controlled trial to compare the efficacy and safety of topical application of coal tar-salicylic acid ointment with calcipotriol/betamethasone dipropionate ointment applied once at night for 12 weeks for the treatment of limited chronic plaque psoriasis.Materials and Methods:A total of 62 patients of limited chronic plaque psoriasis (body surface area <10%) were randomized into two treatment groups: Group A received topical application of 6% coal tar with 3% salicylic acid ointment and Group B received calcipotriol/betamethasone dipropionate, once at night for 12 weeks. Results were assessed based on psoriasis area severity index (PASI) scores and patient global assessment (PGA) at each visit.Results:Mean PASI was significantly lower at week 2 (P = 0.01) and week 4 follow-up (P = 0.05) and the mean reduction in PASI was significantly higher at week 2 (P = 0.02) with calcipotriol/betamethasone than coal tar-salicylic acid, but this difference was not sustained at subsequent follow-up visits. Similarly, PGA scores at weeks 2 and 4 were significantly lower with calcipotriol/betamethasone dipropionate ointment (P = 0.003 and P = 0.007 respectively). There was no significant difference in any parameter during subsequent follow-up visits or at the end of the treatment phase (12 weeks).Conclusion:Topical nightly application of calcipotriol/betamethasone dipropionate ointment leads to an initial, more rapid reduction in disease severity, but the overall outcome parameters are comparable in the two treatment groups.

Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies

Multiple metrics evaluate the efficacy of psoriasis treatment, but interestingly, the correlation between the mostly widely used clinical trial efficacy end point, the physician-rendered Psoriasis Area Severity Index PASI score and, the most widely used quality of life metric, the Dermatology Life Quality Index DLQI, is not always high. To perform a systematic review to determine PASI to DLQI correlation. RCTs of biological agents for the treatment of moderate-to-severe psoriasis were reviewed in accordance with PRISMA guidelines. The mean percentage PASI improvement and change in mean DLQI values were recorded and compared for treatment groups from baseline to 10-16weeks of therapy. A search of the literature yielded 155 sources, of which 13 RCTs met inclusion and exclusion criteria. Percentage of PASI improvement from baseline correlates with DLQI changes with an r(2) value of 0.80 from baseline through weeks 10-16. When grouped by mean percentage reduction in PASI, agents demonstrating >75% mean reduction in PASI demonstrated a mean DLQI improvement over agents that achieved <75%-50% mean reduction in PASI or <50% mean reduction in PASI [minimal clinically important difference (MCID) 3.2]. In addition, a reduction in mean PASI of at least 75%, predicted a mean movement from DLQI band 3 to DLQI band 1, in all nine treatment arms demonstrating such efficacy. Mean PASI and DLQI correlate predictably in patients with chronic moderate-to-severe plaque psoriasis undergoing treatment with biological agents. A reduction in PASI of at least 75% can translate to significant quality-of-life improvement in patients treated with these therapies.

Oral R115866 in the treatment of moderate to severe plaque‐type psoriasis

R115866 (Rambazole) is a new generation all-trans retinoic acid metabolism blocking agent, highly specific against the retinoic acid 4-hydroxylase. The drug alleviates hyperproliferation and normalizes differentiation of the epidermis in animal models of psoriasis. To explore the efficacy, safety and tolerability of systemic R115866 in patients with moderate to severe plaque-type psoriasis. In this open label, single-arm trial, patients were treated with R115866, 1 mg/day for 8 weeks, followed by a 2-week treatment-free follow-up period. Patients were monitored for efficacy and safety. Nineteen patients (intent-to-treat population) were treated and 14 completed the entire study. Two patients discontinued due to lack of efficacy and three due to adverse events. At the end of the treatment, 26% of the patients showed at least 50% reduction in Psoriasis Area Severity Index (PASI) compared to baseline. Further improvement was observed at the end of the 2-week follow-up period where 47% of the patients showed a 50% or greater reduction in PASI. Kinetic data showed no evidence of accumulation of either R115866 or retinoic acid in plasma. The most common adverse events were pruritus, xerosis, cheilitis and an increase in blood triglycerides. The majority of adverse events were mild to moderate. No deaths or serious adverse events were reported. Eight-week daily treatment with 1 mg R115866 resulted in a significant reduction in PASI from baseline to end of therapy. Additional improvement was seen after the 2-week follow-up period. The drug was well tolerated. R115866 merits further evaluation to optimize its clinical efficacy and safety profile in moderate to severe plaque-type psoriasis.