Severe Psoriasis Patients Research Articles

TUR-PSO: A cross-sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey.

Psoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76 million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross-sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol-5 dimension (EQ-5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, ≥10). Mean DLQI was 7.03 ± 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ-5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.

Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis.

The objective of this retrospective study is to assess neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as inflammatory markers in patients with psoriasis and psoriatic arthritis (PsA). A hundred and eleven psoriasis patients and 25 PsA patients were compared with 94 healthy controls. Demographic, clinical and laboratory information were collected and analyzed. NLR and PLR were calculated. White blood cell (WBC), neutrophils, eosinophils and NLR were increased in psoriasis patients compared with controls. WBC, neutrophils, NLR, monocytes, platelets and PLR were increased in PsA patients compared with both controls and psoriasis patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein were significantly higher in PsA patients compared with psoriasis patients. Among psoriasis patients, Psoriasis Area and Severity Index (PASI) score correlated positively with platelets, NLR and PLR. These parameters were all significantly higher in moderate to severe psoriasis patients (PASI ≥ 10) compared with mild patients (PASI < 10). Elevated platelets, NLR and PLR were significantly associated with the increased PASI scores in multivariate analysis. NLR, PLR and ESR were statistically significant predictors for the presence of PsA in psoriasis patients. NLR was the strongest predictor (odds ratio = 3.351, P = 0.005). In conclusion, elevated NLR and PLR were significantly associated with psoriasis and PsA. Both NLR and PLR were strong predictors for the presence of PsA among psoriasis patients.

Circulating levels of sphingosine-1-phosphate are elevated in severe, but not mild psoriasis and are unresponsive to anti-TNF-α treatment.

Sphingolipids are bioactive molecules with a putative role in inflammation. Alterations in sphingolipids, in particular ceramides, have been consistently observed in psoriatic skin. Herein, we quantified the circulating sphingolipid profile in individuals with mild or severe psoriasis as well as healthy controls. In addition, the effects of anti-TNF-α treatment were determined. Levels of sphingoid bases, including sphingosine-1-phosphate (S1P), increased in severe (P < 0.001; n = 32), but not in mild (n = 32), psoriasis relative to healthy controls (n = 32). These alterations were not reversed in severe patients (n = 16) after anti-TNF-α treatment despite significant improvement in psoriasis lesions. Circulating levels of sphingomyelins and ceramides shifted in a fatty acid chain length-dependent manner. These alterations were also observed in psoriasis skin lesions and were associated with changes in mRNA levels of ceramide synthases. The lack of S1P response to treatment may have pathobiological implications due to its close relation to the vascular and immune systems. In particular, increased levels of sphingolipids and especially S1P in severe psoriasis patients requiring biological treatment may potentially be associated with cardiovascular comorbidities. The fact that shifts in S1P levels were not ameliorated by anti-TNF-α treatment, despite improvements in the skin lesions, further supports targeting S1P receptors as therapy for severe psoriasis.

Lack of association between leptin, leptin receptor, adiponectin gene polymorphisms and epicardial adipose tissue, abdominal visceral fat volume and atherosclerotic burden in psoriasis patients

Context: Identifying psoriasis patients who present a higher risk of developing cardiovascular co-morbidities is of upmost importance. Two key adipokines, leptin and adiponectin, may play a role connecting psoriasis and its major co-morbidities.Objective: To evaluate the potential contribution of LEPrs2167270(19 G/A), LEPRrs1137100(326 A/G) and ADIPOQrs1501299(276 G/T) gene polymorphisms in psoriasis susceptibility and their influence in epicardial adipose tissue and abdominal visceral fat volume and subclinical atherosclerosis in severe psoriasis patients.Materials and methods: One hundred severe psoriasis patients underwent clinical and laboratory evaluation, DNA genotyping and multi-detector computed tomography scan for epicardial adipose tissue, abdominal visceral fat and coronary artery calcification assessment. DNA control group was obtained from a previously anonymized biobank of 206 adult subjects without psoriasis.Results: No association was observed between the studied gene polymorphisms and psoriasis susceptibility, CAC or increased EAT or AVF volume.Discussion and conclusion: The studied polymorphisms do not seem, at least in this cohort of patients, to be a genetic risk factor for the development of atherosclerosis or increased adiposity in psoriasis.

Long-term Management of Moderate to Severe Plaque Psoriasis Patients With Etanercept: A Case Series.

Currently, etanercept (ETN) safety and efficacy in patients with moderate to severe plaque psoriasis (PsO) has been reported up to 5 years. To present a case series of PsO patients receiving continuous ETN therapy for 7 or more years. Physicians collected data retrospectively from 52 patient charts from 5 centres across Canada. Patients in this case series had PsO an average of 31.5 years. Nearly half of patients also had psoriatic arthritis (24/52). All patients demonstrated sustained improvement in Psoriasis Area and Severity Index (PASI) and percentage of affected body surface area (BSA) following ETN treatment. Of the 52 patients, 33 have been receiving ETN for 10 years or more. The clinical experience described in this case series report suggests maintenance of ETN efficacy in PsO patients who receive therapy for 7 years or more and indicates that patients can be successfully managed with long-term ETN therapy.

Early clinical response as a predictor of efficacy in moderate to severe psoriasis patients treated with tofacitinib in a phase 2 study

Early clinical response as a predictor of efficacy in moderate to severe psoriasis patients treated with tofacitinib in a phase 2 study

Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients.

Previously we assessed the medication adherence for oral and topical remedies by a translated Japanese version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with socioeconomic backgrounds in 3096 Japanese dermatological patients, and found the medication adherence, especially to topical drugs, was poor in these patients. In order to elucidate the disease-specific sociomedical factors, we further sub-analyzed the medication adherence in 237 psoriasis patients and compared it with that in other dermatological diseases such as atopic dermatitis, urticaria or tinea. This study was conducted among patients registered in monitoring system and 3096 eligible patients were enrolled. Our web-based questionnaire included the following items such as age, sex, annual income, main health-care institution, experience of effectiveness by oral or topical medication, overall satisfaction with treatment, and MMAS-8 for oral or topical medication. Mean adherence score by MMAS-8 was 5.2 for oral and 4.3 for topical medication. More patients with psoriasis used a university hospital and fewer used a private clinic compared with those with the other skin disease patients. Experience of drug effectiveness by oral medication and overall satisfaction with treatment was lower in psoriasis patients than in other patients. In oral medication, significantly better adherence was observed in those of higher age and with higher annual income. The adherence to medication, especially to topical drugs, was poor in 237 psoriasis patients. We speculated that some severe psoriasis patients were not sufficiently treated systemically and were resistant to topical therapy, leading to poor adherence.

Plasma-soluble urokinase plasminogen activator receptor (suPAR) levels in psoriasis patients and correlation with disease severity.

Psoriasis is a chronic, relapsing, inflammatory, hyper-proliferative skin disease. Plasma-soluble urokinase plasminogen activator receptor (suPAR) is released from the cell membrane-bound plasminogen activator and is a new biomarker of systemic inflammation. The aim of this study is to investigate plasma levels in psoriasis patients and determine their correlation with the Psoriasis Area and Severity Index (PASI) score. The plasma suPAR levels of 50 healthy individuals and 65 psoriasis patients were measured using the Micro-ELISA method and the relation with PASI was investigated. On comparing plasma suPAR levels of the psoriasis patients with the control group consisting of healthy individuals, no statistically significant difference was determined (5.29 ng/ml ± 2.12 and 6.03 ng/ml ± 2.42, respectively, p = 0.326; Table 1). Likewise, there was no significant correlation between the suPAR levels and PASI score (r = 0.147, p = 0.243 > 0.05). There was no statistically significant difference in the plasma SuPAR levels of psoriasis patients compared to the control group. Nevertheless, we firmly believe that plasma SuPAR, a new biomarker, could indicate disease severity if conducted with larger patient series and with moderate to severe psoriasis patients.

Effectiveness and safety of adalimumab in treating moderate to severe psoriasis patients with psoriatic arthritis in Taiwan

Abstract Background/Objective The incidence of psoriasis vulgaris in Asians is estimated at 0.05–0.30%. Studies in North America and Europe demonstrated that adalimumab, a fully human monoclonal IgG1 antibody, is an efficacious treatment for psoriatic arthritis and chronic plaque psoriasis. The aim of this study was to evaluate the efficacy and safety of adalimumab in treating psoriatic arthritis (PsA) in patients who have moderate to severe psoriasis. Methods This was a retrospective study comprising 12 patients with chronic plaque psoriasis and psoriatic arthritis who were treated with adalimumab between October 2008 and February 2013. All had failed treatment with conventional systemic agents. Patients were started on adalimumab 40 mg every other week. Results At week 12, 3 of 12 patients (25%) achieved a 75% improvement in their Psoriasis Area and Severity Index (PASI 75). With regard to PsA, at week 12, the improved Psoriatic Arthritis Response Criteria (PsARC) response was experienced by 75% (9 of 12) of the patients. Mean improvement in Dermatology Life Quality Index (DLQI) was 42%. Five of 12 patients (42%) experienced adverse events, which were generally mild. Conclusion Patients with refractory psoriatic arthritis appeared to be responsive to adalimumab. The achievement rate of PsARC in our study was comparable to the efficacy reported in previous literature. Detection of antinuclear antibodies was not associated with the responsiveness in this trial, nor did it influence the potential for adverse effects. Adalimumab as a monotherapy is generally effective and safe.

Moderate to severe psoriasis patients' subjective future expectations regarding health‐related quality of life and longevity

Unrealistic expectations regarding treatments and clinical outcomes may lead to disappointment about therapy and sub-optimal compliance; nonetheless, these expectations have not been studied in psoriasis patients yet. To evaluate psoriasis patients' subjective future expectations regarding health-related quality of life (HRQOL) and life expectancy, and to explore clinical features associated with under- or overestimating behaviour. A cross-sectional questionnaire survey of consecutive adult patients with moderate to severe psoriasis was conducted. HRQOL expectations were recorded by applying the EQ-5D descriptive system for 6months ahead and for future ages of 60, 70, 80 and 90 respectively. In total, 167 patients (71% males) were included in the analysis with mean age of 50.4±12.4years and mean EQ-5D score of 0.71±0.30. Overall 65% had chronic plaque psoriasis, 35% nail psoriasis, 35% scalp involvement, 29% psoriatic arthritis, 9% inverse psoriasis and 5% palmoplantar psoriasis respectively (combinations occurred). Participants expected 0.1±0.23 mean improvement in EQ-5D within 6months (P<0.001) that achieves the minimum clinically important difference. Overall 37% expected improvement and 13% decline; however, 49% expected no changes in any of the five dimensions of EQ-5D within 6months. Female gender, inverse or palmoplantar involvement and more severe psoriasis were likely associated with higher expectations. Patients at the initiation of their first biological at the time of the survey expected 0.18±0.24 increase that seems to be realistic compared to the EQ-5D utility gain achieved in randomized controlled trials. Males expected by 2.7±11.1 more, while females expected by 5.2±9.3 less life years compared to the average statistical gender- and age-matched life expectancy (P<0.05). Patients who expected to be alive at ages of 60, 70, 80 and 90 scored their future EQ-5D at ages of 60 to 90: 0.59±0.46, 0.48±0.41, 0.42±0.41 and 0.22±0.47 respectively. Our findings highlight the importance of exploring expectations that might help to increase patients' compliance.

Risk of myocardial infarction in psoriasis patients: a retrospective cohort study

Background: Psoriasis may or may not be associated with a higher risk for myocardial infarction (MI). We sought to assess differences in MI incidence between control, mild psoriasis and severe psoriasis patients.Methods: We performed a retrospective cohort study of Kaiser Permanente Southern California members with psoriasis between 1 January 2004 and 30 June 2012, assessing the risk and incidence rates of MI.Results: There were 50 865 control patients matched to 10 173 patients with mild psoriasis and 19 205 control patients matched to 3841 patients with severe psoriasis. The MI incidence per 1000 person-years for mild psoriasis controls, mild psoriasis, severe psoriasis controls and severe psoriasis were 4.9, 6.7, 3.7 and 5.1, respectively. Upon multivariable analysis, mild psoriasis patients had a significantly higher risk of MI compared to matched control patients {hazard ratio (HR) = 1.31 [95% confidence interval (CI): 1.14, 1.51]} and severe psoriasis patients had a significantly higher risk of MI compared to matched control patients [HR = 1.28 (95% CI: 1.02, 1.60)].Conclusion: Patients with psoriasis are at higher risk for MI compared to control patients.

Development and psychometric validation of the REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire: a common measure of plaque-type psoriasis severity and treatment efficacy for patients and clinicians.

BackgroundTo date, there is no global consensus on the definition of the severity of psoriasis. The REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire has recently been developed to provide a better understanding of plaque-type psoriasis severity and treatment efficacy from both patient and clinician perspectives.ObjectiveThis study aimed to develop and psychometrically validate the new REFLETS questionnaire to evaluate patient and clinician perceptions of plaque-type psoriasis severity and treatment efficacy.MethodsTwo similar versions of the REFLETS questionnaire were developed following a rigorous methodology for clinicians and patients, referring to ‘the psoriasis of your patient' or to ‘your psoriasis’, respectively. An observational, longitudinal, multicentre study was conducted in France with 34 dermatologists and 430 mild to severe plaque-type psoriasis patients to finalize the questionnaire and evaluate its psychometric properties.ResultsTwo dimensions were defined – severity and treatment efficacy – with three subdimensions within severity (impact of psoriasis, symptoms and disease course), and two individual items on joint pain. The questionnaire was well accepted by clinicians and patients. Excellent internal consistency (Cronbach's alpha = 0.66–0.98) and test–retest reliability (intraclass correlation coefficients = 0.83–0.94) were demonstrated. REFLETS scores were moderately to highly correlated to Psoriasis Area and Severity Index (r = 0.35–0.70), Skindex-29 (r = 0.46–0.82) and DLQI scores (r = 0.36–0.82). Patients with decreased psoriasis severity and those with increased treatment efficacy, according to patient global evaluations, had lower severity and higher treatment efficacy REFLETS scores, respectively.ConclusionREFlective evaLuation of psoriasis Efficacy of Treatment and Severity is a promising tool for assessing plaque-type psoriasis severity and treatment efficacy from patient and clinician perspectives. It may help to improve patient and clinician communication in treatment decision making.

Efficacy and safety of adalimumab in psoriatic patients previously treated with etanercept in a real-world setting

Introduction: Knowledge on the efficacy and safety of adalimumab in psoriasis patients switching from etanercept is scarce, especially on the influence that causes of etanercept discontinuation may have on adalimumab response.Objectives: To evaluate the response, adverse effects and factors that may influence the efficacy and safety of adalimumab in psoriasis patients who failed on etanercept therapy in a real-world setting.Methods: Data from all moderate to severe plaque psoriasis patients who switched from etanercept to adalimumab were extracted from a registry of biological therapies of our department. Primary endpoint was the percentage of patients achieving PASI 50 at weeks 12, 24, and 52. Secondary endpoints were the percentages of patients achieving PASI 75 and PASI 90, patients who maintained PASI values <5 and <3, and the safety of adalimumab.Results: Of 35 patients who fulfilled the study criteria, 82.9% achieved PASI 50 at week 12, 74.3% at week 24, and 74.3% at week 52 on adalimumab treatment. Eleven of 16 primary and 11 of 17 secondary nonresponders to etanercept responded to adalimumab. There were no treatment discontinuations due to side effects.Conclusions: Previous etanercept failure seems not influence the success and safety of adalimumab treatment in moderate to severe plaque psoriasis.

Targeting PKC in Human T Cells Using Sotrastaurin (AEB071) Preserves Regulatory T Cells and Prevents IL-17 Production

Regulatory T-cells (Treg) are crucial for immune homeostasis and prevention of immune pathology. Yet, Treg may lose Foxp3 and start secreting IL-17, dependent on environmental cues. Our previous data revealed that Treg from severe psoriasis patients are particularly prone to such conversion. The question of how to maintain Treg stability in the context of inflammation awaits immediate resolution. The pan-protein kinase C (PKC) inhibitor sotrastaurin has shown efficacy in clinical trials of psoriasis. Here, we show that sotrastaurin inhibited effector T-cell responses, whereas the regulatory response was enhanced. Sotrastaurin prevented TCR/CD28-induced T-cell activation and pro-inflammatory cytokine production, but preserved a stable Treg phenotype as evidenced by maintenance of suppressive capacity, high Foxp3 and CD25 expression, and lack of IL-17A and IFNγ production. Moreover, in both circulating and dermal psoriatic Treg, prone to rapid induction of IL-17, sotrastaurin enhanced Foxp3 expression and prevented IL-17A and IFNγ production even when stimulated in the presence of the helper T 17-enhancing cytokines IL-1β or IL-23. Thus, pharmacological inhibition of PKC may serve as a powerful tool to concurrently inhibit effector T cells and to facilitate Treg, thereby showing therapeutic potential for the treatment of psoriasis.

A Combinational Therapy for Patients with Severe Psoriasis Associated with Cardiovascular Disease

Psoriasis a chronic inflammatory disease of skin often involving the joints associated with concomitant factors like cardiovascular involvement, leading to high mortality.Hence, we designed the study to know the effect of combinational therapy and the associated risks of cardiovascular disease (CVD) in psoriasis patients.120 psoriasis patients and 50 healthy individuals of both sexes between 25-65 years of age with severe psoriasis attending Chinese hospital during October 2009-November 2013 were included in the study. Patients were treated with methotrexate, acitretin, cyclosporine and also with combination therapy.Patients experienced a reduced degree of lesions with combination therapy with 40% reduction or had complete normalization of the skin. Severe psoriasis patients are at high risk of mortality due to CVD with hazard ratio (HR) 1 · 57, 95% confidence interval (CI) 1 · 26-1 ·96.Severe psoriasis is often associated with higher risk of cardiovascular death. A large scale prospective study is required for analyzing risk factors of CVD in psoriasis (PsA).

Psoriasis: The visible killer

Psoriasis is a common chronic inflammatory disease associated with serious comorbidities. In recent years, increased mortality due to cardiovascular disease (myocardial infarction and stroke) has been documented in patients with severe psoriasis. Patients with psoriasis have a higher prevalence of traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and obesity, but it has been suggested that the chronic inflammatory nature of psoriasis is also a contributing and potentially an independent risk factor for the development of cardiovascular disease.The authors highlight the need for early identification and treatment of psoriasis‐related comorbidities and cardiovascular disease, as well as effective treatment of psoriasis, in order to reduce the underlying systemic inflammation, and also the importance of a multidisciplinary approach of severe psoriasis patients to optimize the diagnosis, monitoring and treatment of various comorbidities, so as to prevent cardiovascular events.

Psoriasis: The visible killer

Psoriasis is a common chronic inflammatory disease associated with serious comorbidities. In recent years, increased mortality due to cardiovascular disease (myocardial infarction and stroke) has been documented in patients with severe psoriasis. Patients with psoriasis have a higher prevalence of traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and obesity, but it has been suggested that the chronic inflammatory nature of psoriasis is also a contributing and potentially an independent risk factor for the development of cardiovascular disease.The authors highlight the need for early identification and treatment of psoriasis‐related comorbidities and cardiovascular disease, as well as effective treatment of psoriasis, in order to reduce the underlying systemic inflammation, and also the importance of a multidisciplinary approach of severe psoriasis patients to optimize the diagnosis, monitoring and treatment of various comorbidities, so as to prevent cardiovascular events.

Infliximab Does Not Lead to Reduction in the Interferon-gamma and Lymphoproliferative Responses of Patients with Moderate to Severe Psoriasis

Treatment of patients with immune-mediated inflammatory diseases with anti-tumour necrosis factor (anti-TNF) agents increases the risk of tuberculosis reactivation, suggesting that it may affect their cellular immune responses. We evaluated cellular immune responses of 12 severe psoriasis patients before and during infliximab treatment. Peripheral blood mononuclear cells were stimulated with phytohaemagglutinin, the superantigen enterotoxin B (SEB), a cytomegalovirus lysate (CMV), and Mycobacterium tuberculosis (Mtb) antigens. The lymphocyte proliferative and IFN-γ responses were evaluated. Treatment with infliximab did not lead to reduction in the IFN-γ and lymphoproliferative responses: it rather increased the overnight release of IFN-γ in phytohaemagglutinin and SEB stimulated cultures. This effect was most noted at the peak of the anti-TNF clinical effect and less prominent at its nadir. Immunoreactivity to CMV was also either unaffected or slightly increased by the anti-TNF. Of note, the IFN-γ and proliferative responses to Mtb by the two tuberculin skin test-reactors were also increased at the peak of infliximab, declining at its nadir. The deleterious consequences of TNF blockade in severe psoriasis patients undergoing infliximab treatment are apparently attenuated by the abbreviation of the immunosuppressive effect of TNF overexpression.

Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: Implications in cardiovascular risk factors management and primary prevention of cardiovascular disease

Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long-term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long-term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real-world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.

Cost Effectiveness of Moderate to Severe Psoriasis Therapy with Etanercept and Ustekinumab in the United States

Limited information is available on the cost effectiveness of ustekinumab and alternative biologic treatments in a United States (US) setting. Given the recent head-to-head clinical trial study of ustekinumab and etanercept, an economic model comparing the two treatments can be constructed. Etanercept and ustekinumab are indicated for the treatment of chronic moderate to severe plaque psoriasis in adult patients who are candidates for phototherapy or systemic therapy. Clinical trials have evaluated the efficacy of ustekinumab, an anti-cytokine biologic, for the treatment of moderate to severe psoriasis. This study evaluated the cost effectiveness of ustekinumab compared with etanercept from a US societal perspective. A Markov model was constructed to simulate the incremental cost per quality-adjusted life-year (QALY) gained every 12weeks over a base-case 3-year time horizon. A hypothetical patient cohort was based on the characteristics of the phase III Active Comparator Psoriasis Trial (ACCEPT). The main outcome measures were costs and QALYs, which were estimated from the US societal perspective. Costs, utilities, treatment strategy, and resource use estimates were obtained from relevant literature. All costs were adjusted to 2011 US dollars. A 3% annual discount rate was applied to costs and QALYs. Incremental cost-effectiveness ratios were in US dollars per QALY gained. For the base-case 3-year time horizon, the incremental cost-effectiveness ratio comparing ustekinumab 90mg with etanercept 50mg was US$384,401 per QALY gained. Ustekinumab 45mg dominates etanercept 50mg for the same time horizon. These results were robust to sensitivity analyses involving treatment strategy, transition probabilities, valuing outcomes, and resource use and costs. The probabilistic sensitivity analysis suggests ustekinumab 90mg has a minimal (4%) chance of being cost effective compared with etanercept 50mg at a willingness-to-pay threshold of US$150,000 per QALY improvement. For the same threshold, ustekinumab 45mg has a high (88%) chance of being cost effective compared with etanercept 50mg. Under typical US willingness-to-pay cutoffs, ustekinumab 90mg is not cost effective compared with etanercept 50mg therapy in moderate to severe psoriasis patients for the base-case 3-year time horizon. Ustekinumab 45mg dominates etanercept 50mg therapy for an equivalent patient psoriasis severity and time horizon.