Therapy In Psoriasis Patients Research Articles

The risk of malignancy in patients with psoriasis treated with long-term tumor necrosis factor-α inhibitor: a systematic review and meta-analysis.

The relationship between tumor necrosis factor-α inhibitors (TNFi) and cancer risk is complex, given their pivotal role in managing chronic inflammatory conditions. Persistent concerns about TNFi therapy potentially increasing cancer risk necessitate a thorough understanding of its long-term effects on cancer development in patients with psoriasis to guide therapeutic decision-making. This systematic review and meta-analysis aimed to evaluate the association between long-term TNFi therapy and cancer risk in patients with psoriasis. Data were collected from PubMed, Embase, and the Cochrane Library, from their inception to January 1, 2024. The studies included adults with psoriasis or psoriatic arthritis receiving TNFi, presenting standardized incidence ratio (SIR) data for cancer. Data extraction followed PRISMA guidelines, with independent extraction by two authors, and pooled data synthesis was conducted using a random-effects model. The primary outcomes were SIRs for all cancers excluding non-melanoma skin carcinoma (NMSC) and for NMSC itself. The secondary outcome was the SIR of specific cancer types. The meta-analysis included eight studies with a total of 32,765 psoriasis patients. The pooled results showed no increased risk of cancers, including all cancers excluding NMSC, melanoma, lymphoma, prostate cancer, and breast cancer, among individuals receiving long-term TNFi therapy for psoriasis compared to the general population. However, subgroup analysis found an elevated risk of NMSC in patients with psoriatic arthritis and a significant increase in the risk of squamous cell carcinoma (SCC) among psoriasis patients treated with TNFi compared to the general population (SIR, 1.84; 95% CI, 1.16 - 2.92 and SIR, 2.84; 95% CI, 1.64 - 4.91, respectively). Our systematic review and meta-analysis indicate that most cancers examined did not demonstrate an increased risk following long-term TNFi therapy in psoriasis patients. However, for patients with psoriatic arthritis or those at high risk of SCC, these findings underscore the importance of personalized treatment strategies that weigh individual risks and benefits.

NLRP3 (rs10754558) gene polymorphism and tumor necrosis factor alpha as predictors for disease activity and response to methotrexate and adalimumab in psoriasis

BackgroundPsoriasis has a global prevalence of 1–3%, with variations observed across different ethnic groups and geographical areas. Disease susceptibility and response to anti-tumor necrosis factor-α (TNFα) drugs suggest different genetic regulatory mechanisms which may include NLR family pyrin domain containing 3 (NLRP3) polymorphism. Evaluation of the NLRP3 gene polymorphism, the serum level of CRP and TNFα in psoriasis patients and assessment of the NLRP3 (rs10754558) gene polymorphism, CRP and TNFα with disease severity and their role as biomarkers for response to Methotrexate and Adalimumab in psoriasis. The study had a total of 75 patients diagnosed with psoriasis vulgaris, who were compared to a control group of 75 healthy individuals.ResultsThere was a highly significant difference in NLRP3 genotypes and alleles distribution between psoriasis patients and controls (P = 0.002,0.004). The heterozygote genotype GC (OR = 3.67,95%CI:1.75–7.68, P = 0.0006), was linked with increased risk of psoriasis. Additionally, The GC genotype was significantly associated with nonresponse to psoriasis therapy (OR = 11.7,95%CI:3.24–42.28, P = 0.0002). Regarding serum CRP and TNFα levels, there was a highly statistically significant difference between psoriasis patients and controls (P < 0.0001), and there was also a highly statistically significant difference between responders and non-responders in psoriasis patients regarding PASI 50 (P < 0.0001).ConclusionsThe NLRP3 (rs10754558) genotypes GC was associated with the severe form of psoriasis and with nonresponse to psoriasis medication. Therefore, NLRP3 (rs10754558) gene polymorphism is an important prognostic biomarker in psoriasis patients. The serum TNFα can be used as a predictor for response to therapy in psoriasis patients. More research for evaluation of role of the NLRP3 gene polymorphism in the genetic risks and treatment outcomes associated with psoriasis is still required.

Efficacy and safety of weekend cyclosporine treatment as maintenance therapy for preventing frequent disease exacerbations in moderate to severe chronic plaque psoriasis patients - A retrospective cohort study.

Background Psoriasis is a chronic, inflammatory, systemic disease with predominant manifestations in the skin and joints impairing patient's quality of life. A proportion of patients have frequent severe disease exacerbations requiring repeated systemic treatments. There is a scarcity of literature evaluating the role of systemic maintenance therapy in psoriasis patients in preventing such frequent disease flares. Objective To evaluate the efficacy and safety of weekend cyclosporine treatment (WCT) as maintenance therapy in moderate to severe chronic plaque psoriasis patients for the prevention of frequent disease exacerbations. Methods In this retrospective cohort study, 22 psoriasis patients with a history of frequent disease exacerbations (≥ 3 in the last 1 year) who were administered WCT (group A) were compared with the same number of matched patients (age and gender) not on WCT or any systemic maintenance therapy (group B). Results Four patients (18.2%) in group A had disease exacerbations which was significantly lower (p = 0.00, Fisher's exact test) as compared to 21 patients (95.5%) in group B during the study period. Also, patients in group A had significantly lower number of overall exacerbations [mean ± SD: 0.23 ± 0.53 vs 2.95 ± 1.43) p = 0.00, Mann-Whitney U test] as compared to group B. Four (9.1%) patients in group A encountered adverse effects (acneiform eruptions - two, mild gingival hyperplasia - one, myalgia - one) as compared to three (acneiform eruptions - two, headache - one) in group B (p = 1.00). Conclusion WCT significantly reduced the number of disease exacerbations and is a safe and effective mode of maintenance therapy in such subset of psoriasis patients.

Psoriasis'te Biyolojik Tedavi Öncesi Latent Tüberküloz Enfeksiyonunun Değerlendirilmesi: Web Tabanlı Yorumlayıcı ile Yeni Bir Tanı Yaklaşımı

Purpose: The use of biological agents, particularly anti-TNF-alpha treatments, is associated with an elevated risk of tuberculosis (TB). Hence, a comprehensive assessment of latent tuberculosis infection (LTBI) before biologic therapies is imperative. The objective of this study was to evaluate the utility of an online tuberculin skin test (TST)/ interferon-γ release assay (IGRA) interpreter (OI-TST/IGRA) in assessing the risk of LTBI prior to initiating biological therapies in psoriasis patients.&#x0D; Materials and methods: 116 psoriasis patients who were previously evaluated for TB by a pulmonologist before being treated with a biologic agent were re-evaluated retrospectively with OI-TST/IGRA (tstin3d.com). Mean positive predictive value (PPV), mean annual risk of development of active tuberculosis (ARDATB), and mean cumulative risk of active tuberculosis (CRATB) values were calculated with OI-TST/IGRA and compared with previous results. Chi-square, Fisher-Freeman-Halton exact tests, Cohen's Kappa, and Mann-Whitney U-test were used in comparisons of groups. &#x0D; Results: The PPV of the LTBI-positive group was significantly higher than the LTBI-negative group. The PPV, ARDATB and CRATB values of the TST size of &gt;15 mm group were significantly higher than the TST size of 5-9 mm and TST size of 10-15 mm groups. The PPV, ARDATB, and CRATB values of the QuantiFERON-TB Gold In-tube test (QFT-GIT)-positive group were significantly higher than the QFT-GIT-negative group. And the same values of the chest X-ray (CXR)-positive group were significantly higher than the CXR-negative group. The PPV, ARDATB, and CRATB values were positively correlated with QFT-GIT and CXR results. In addition, the PPV was positively correlated with previous LTBI decisions and TSTs.&#x0D; Conclusion: OI-TST/IGRA in which many factors are questioned and PPV, ARDATB, and CRATB values are evaluated together, may be a valuable tool for assessing the risk of active TB in psoriasis patients and preventing overdiagnosis and unnecessary prophylaxis.

Association between cardio-cerebrovascular disease and systemic antipsoriatic therapy in psoriasis patients using population-based data: A nested case-control study.

The effect of antipsoriatic therapy on cardio-cerebrovascular disease (CCVD) is not well described. Thus, we performed a population-based nested case-control study to investigate the effect of systemic antipsoriatic therapy on CCVD in psoriasis patients. Using nationwide cohort data from the Korean National Health Insurance Claims database, newly diagnosed psoriasis patients were identified. Among the enrolled participants, postenrollment development of CCVD events (ischemic heart disease, myocardial infarction, cerebral infarction, and cerebral hemorrhage) was investigated. To evaluate the effect of systemic antipsoriatic therapy on CCVD risk, we calculated the proportion of the treatment period with systemic antipsoriatic therapy during the study period (PTP [%]: the sum of all systemic antipsoriatic therapy durations divided by total observation period). Among 251 813 participants, 6262 experienced CCVD events during the study period (CCVD group). Controls included 245 551 patients without CCVD history during the study period (non-CCVD group). The non-CCVD group had greater PTP than the CCVD group (CCVD 2.12 ± 7.92, non-CCVD 2.64 ± 9.64; P < 0.001). In multiple logistic regression analysis, PTP was inversely associated with the CCVD risk after adjusting for age, sex, diabetes, hypertension, and dyslipidemia. A 10% increase in PTP reduced CCVD risk by 0.96 (95% confidence interval 0.93 to 0.99). Reduced CCVD risk was robust for both conventional antipsoriatic therapy and biologics. Our study found that systemic antipsoriatic therapy use was inversely associated with CCVD risk in psoriasis patients. These findings suggested that systemic antipsoriatic therapy could reduce CCVD development in patients with psoriasis.

Cognitive Behavioral Therapy as an Adjunctive Treatment for Anxiety and Depression in Psoriasis Patients

Psoriasis is a skin disease associated with the body's immune system. Mental health is one of the accompanying diseases of psoriasis. The clinical manifestations of psoriasis allow sufferers to experience anxiety and depression. There is a significant correlation between anxiety and depression to psoriasis, therefore, an adjunctive therapy is needed in addition to pharmacological therapy. One of these is Cognitive Behavioral Therapy (CBT), which aims to overcome anxiety and depression. This literature review summarizes recent findings regarding the application of CBT in psoriasis patients. The aim of this review is to summarize the latest findings about CBT as an alternative therapy in psoriasis patients. The literature review method was carried out by conducting literature reviews from various online databases, namely NCBI, Science Direct, Elsevier, and Mendeley using predetermined criteria. The results of the literature review showed that psoriasis causes severe psychological suffering, sadness, stigmatization, and decreased health-related quality of life. Result of this review is psychotherapy can lead to positive results in the development of a patient's condition. When performed regularly, CBT can effectively treat a variety of mental health conditions in individuals experiencing mild to moderate anxiety. CBT includes psychological training, self-monitoring, cognitive reconstruction, the prevention of exposure to negative stimuli, and rigorous training. The implications of writing this review are, CBT can be included in the treatment of psoriasis to obtain faster healing results through therapy methods for anxiety and depression in psoriasis patients.

Pharmacogenetic Study of the Impact of ABCB1 Single Nucleotide Polymorphisms on the Response to Cyclosporine in Psoriasis Patients.

Psoriasis is a chronic, T cell-mediated skin disease affecting 2-3% of the Caucasian population. Cyclosporine A is a calcineurin inhibitor that acts selectively on T cells. The cyclosporine A treatment response has been suggested to be modulated by single-nucleotide polymorphisms (SNPs) in the ABCB1 gene. The aim of this research was to evaluate the effect of ABCB1 genetic variants that could affect the response to a cyclosporine treatment in Russian psoriasis patients with the ABCB1 genotype status. The ABCB1 T-129C, G1199A, C1236T, G2677T/A and C3435T SNPs in the 168 patients with psoriasis were genotyped by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) and TaqMan SNP genotyping assays. The ABCB1 C1236T, G2677T/A and C3435T SNPs were significantly associated with a negative response to cyclosporine therapy. A very strong association was evident for the C3435T SNP in the ABCB1 gene in the allele, dominant and recessive models (OR = 2.58, OR = 4.01, OR = 2.50, respectively). ABCB1 C1236T and G2677T/A polymorphisms were significantly associated with a negative response to the cyclosporine therapy in the codominant, dominant and recessive models (p ˂ 0.05). Additionally, the haplotype analysis identified that the TGC haplotype is significantly associated with a negative response to cyclosporine therapy in psoriasis patients (p ˂ 0.05). The current study to the best of our knowledge is the first of its kind to be performed in the Russian population. In conclusion, the present results suggest an association between the ABCB1 genetic variants and unresponsiveness to cyclosporine in the Russian population. Further, larger studies are necessary to confirm our findings and replicate them in various ethnic populations before its implementation in the clinical practice.

The Role of Psychological Stress in Psoriasis: A Narrative Literature Review

Psoriasis is a chronic, persistent skin disease characterized by characteristic lesions in the form of well-defined erythematous patches covered by thick white, shiny scales resembling wax droplets. Psoriasis has a psychological, social, and emotional impact. Psychological stress has also been shown to influence the disease and course of psoriasis. Therapy in psoriasis patients with psychological stress can be given pharmacologically and psychologically. Patients with moderate to severe psoriasis using the Goeckerman regimen for psoriasis showed significant improvements in anxiety and depression scores. Psychological therapies such as relaxation therapy and meditation are able to control the emotions that trigger stress and reduce the appearance and severity of psoriasis. This literature review aims to describe the impact of psychological stress on psoriasis patients so as to increase awareness to detect psychological stress and provide appropriate treatment.

Profile of mean platelet volume, neutrophil - lymphocyte ratio and platelet - lymphocyte ratio in patient with psoriasis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis is a chronic, inflammatory, systemic disease. In response to therapy in psoriasis patients, the psoriasis area severity index (PASI) is used to evaluate the disease activity. However more objective laboratory tools should be developed besides PASI. In various inflammatory diseases, mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) are inflammatory biomarkers that are known to be evaluated. The aim of the study was to assess the frequency of platelet activation and leukocyte infiltration by measuring MPV, NLR, and PLR.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a case-control observational study conducted at department of dermatology and venereology at Bangabandhu Sheikh Mujib Medical University from July 2016 to December 2017. A total of 55 psoriasis cases and 55 healthy controls were included according to inclusion and exclusion criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We have investigated a total of 55 psoriasis patients and another 55 age-sex matched control. There were 31 males (56.36%) and 24 females (43.44%) psoriasis patients in the study. The mean age of the patient was 34.27±13.44 years. Mean±standard deviation (SD) value of MPV, NLR, and PLR in our study cases were 9.92±1.21, 4.32±8.53, and 292.96±88.80 whereas in the case of control values were 9.46±0.636, 4.54±8.51, and 162.26±103.38 respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In conclusion, we suggest MPV is a strong indicator of psoriasis severity. MPV and PLR should be followed up routinely to take preventive measures against psoriasis-related micro and macro vascular thrombotic complications.&lt;/p&gt;

PSY13 Relationship between Affected Body Surface Area and Initiation of Systemic Therapy in Psoriasis Patients

The objective of this study is to evaluate the relationship between psoriasis severity, as measured by the affected body surface area (BSA), and the initiation of systemic therapy. Adult psoriasis patients from the OMNY Health Dermatology Database were indexed at their first BSA measurement with no history of traditional systemic, biologic, or ultraviolet therapy. Patients were followed from index BSA until initiation of systemic therapy or censoring. Patients were characterized at index BSA, and Cox regression with time-varying effects was employed to quantify the effect of BSA on time to initiation of systemic therapy while controlling for patient characteristics. A total of 4489 patients were included. Age and gender were normally distributed, and 64% of patients had a history of topical therapy. The distribution of BSA at index was skewed (mean: 8.8, median: 4) and ranged from 0 to 96. Follow-up BSA distributions were similar regardless of proximity to systemic therapy initiation. However, univariable Cox regression demonstrated a notable association between BSA categories with values of at least 5 and time to initiation of systemic therapy, which remained after controlling for age, gender, race, region, history of topical therapy, and continuous BSA value at index. Relative to BSA of 0-1, hazard ratio estimates (95% confidence intervals) from the multivariable Cox model were 1.06 (0.95-1.18) for BSA of 2-4, 1.31 (1.16-1.48) for BSA of 5-9, 1.46 (1.28-1.66) for BSA of 10-19, and 1.32 (1.11-1.58) for BSA of 20 or greater. All covariates were also independently associated with time to systemic therapy initiation. These results suggest a modest association between affected BSA and the initiation of systemic therapy in psoriasis patients. Further research is needed to understand the potential influence of other variables on this association in the real-world setting.

Colonoscopy in patients with psoriasis before the initiation of treatment with biological agents.

Psoriasis may lead to subsequent colorectal cancer, since chronic systemic inflammation is the common etiologic factor in both psoriasis and colorectal cancer. It is a matter of dispute whether biological agents used in the treatment of psoriasis cause predisposition to colorectal cancer as a result of their immunosuppressive effect. Medical records of psoriasis patients who underwent colonoscopy before biological agents were reviewed. Colonoscopy was performed in all patients who were aged 50 years and older and in patients younger than 50, if they had positive fecal occult blood test results. The study included 95 patients between the age of 34 to 84. Colonoscopy results revealed tubular adenoma in 16 (16.8%) patients, hyperplastic polyps in 7 (7.4%) patients, villous adenoma in 1 (1.1%) patient, and tubulovillous adenoma in 1 (1.1%) patient. Two patients were diagnosed with colon cancer detected by a former colonoscopy, which was recommended by their dermatologist before the biological agent treatment plan. These results revealed that adenomatous polyps which can evolve to colon adenocarcinoma were the most frequent polyp type in patients with psoriasis. We suggest that routine colonoscopy should be performed before the initiation of biological therapy in psoriasis patients who are aged 50 years old and over.

Predictors of drug survival of biologic therapies in psoriasis patients

Introduction We aimed to investigate the clinical, immunological, and genetic factors affecting the response to anti-TNFα (tumor necrosis factor-α) and interleukin-12/23 therapies and drug survivals. Methods A total of 180 patients were divided into two groups: 89 patients who used at least two biologic agents, with the initial biologic agent used less than 12 months (group A), and 91 biologic-naive patients who have been receiving a single biologic agent for more than 12 months (group B). ELISA (enzyme-linked immunosorbent assay) was used to analyze anti-drug antibodies (ADAs) in blood samples. Clinical data of the patients were retrospectively analyzed. HLA-SSO (sequence-specific oligonucleotide) Typing Kits were used for HLA-C typing. IBM SPSS v.21 was used for statistical analysis. Results: Infliximab had the longest drug survival as the first biologic agent in group A (p = .015). Etanercept had the lowest ADA count compared to the other anti-TNF agents (p = .001). HLA-Cw6 negativity, late-onset psoriasis, smoking and alcohol use were determined to be risk factors for treatment failure in group A. HLA-Cw6 was found to be associated with type I psoriasis (p = .000). Conclusions Although our study is retrospective of a relatively low number of patients, this is a preliminary study focusing on two different patient populations based on therapy response.

Hepatitis B Virus Reactivation in Patients with Psoriasis on Biologic Therapies: A Retrospective Study

Background: There are limited data on the safety of biological therapies in psoriasis patients with hepatitis B virus (HBV) infection in the literature, and are still ongoing controversies about HBV reactivation in patients treated with biologics for psoriasis. Aims: This was aimed to investigate the demographic, clinical, and laboratory characteristics of the patients with HBV seropositive receiving biological treatment for psoriasis. Study Design: This was a retrospective observational study. Materials and Methods: Ninety-seven patients with psoriasis treated with biologics in the outpatient clinic were evaluated retrospectively. Of these, 16 patients with HBV seropositive were included in the study. Patients with positive HBV serology were divided into three groups as chronic HBV infection, past HBV infection, and isolated core antibody positivity (HBV core-specific antibody [HBcAb]). The demographic, clinical, and laboratory characteristics of the patients were obtained from the records. Results: Of the patients, 5 patients were female (31.2%), and 11 were male (68.8%). The mean age of the patients was 55.81 ± 11.05. Thirteen of the patients had past HBV infection, three had isolated HBcAb positive. Infliximab (n = 13) was the most common biologic agent used, followed by adalimumab (n = 6), secukinumab (n = 4), ustekinumab (n = 2), and etanercept (n = 2). The mean duration of treatment was 3.59 ± 2.76 years. The HBV reactivation occurred in only one patient with past HBV infection receiving infliximab (6.2%). Conclusion: It remains unclear how exactly the biologic drugs for psoriasis impact viral reactivation. For the safe use of biological agents in psoriasis patients with HBV seropositive, screening tests must be performed with a triple serology, including HBV surface antigen, HBV surface-specific antibody, and HBcAb. The patients who have positive HBV serology must be monitored closely with reactivation markers and receive antiviral prophylaxis if they are at moderate-to-high risk of HBV reactivation.

Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study

Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched. We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival. In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan-Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival. Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P=.0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P=.014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P=.003, hazard ratio 0.48). As a single-center, retrospective real-life study, the data were not perfectly homogeneous. Switching between biologic classes might increase drug survival but retrospective studiesdesigned ad hoc are needed to confirm this better switching strategy.

Effectiveness of resuming ustekinumab therapy in psoriasis patients with metabolic disorders. Clinical experience

Psoriasis is a chronic immune-mediated inflammatory skin disease with possible damage to the musculoskeletal system, affecting 2-3 % of the adult population of the planet. To date, special attention in the treatment of psoriasis is paid to the comorbid background, since it is known that it can aggravate the course of psoriasis and affect the effectiveness of therapy. The purpose of psoriasis therapy is to achieve clean or almost clean skin, sustainable improvement of psoriatic arthritis, improving the quality of life, all this became possible with the advent of genetically engineered biological drugs. However, in the treatment of genetically engineered biological drugs there are “pain points”: primary inefficiency, “the effect of slipping”, the scheme of transition from one drug to another, the safety of the combined use of GIBP and system-based drugs, interruption of therapy.Objective. To study the therapeutic efficacy of ustekinumab in psoriasis patients with forced interruption of treatment, taking into account metabolic disorders.Materials and methods. 52 patients with a diagnosis of plaque psoriasis receiving ustekinumab for 3 years were under observation, which were divided into 2 groups, depending on body weight and metabolic disorders.Results. More than 80 % of patients taking the drug at a dosage of 45 mg, and at a dosage of 90 mg, to week 12 therapy reached PASI 75. By week 24, the proportion of patients in group I who reached PASI 75 was 96.3 %, in group II — 88.0 %.By week 48 PASI 75 reached 90.4 % patients: in group I — 100 % patients, in group II — 80.0 % patients.At 76 weeks, patients were interrupted ustekinumab treatment in connection with the purchase of the drug. The duration of treatment interruption ranged 36 weeks. By week 112, 86.5 % patients in both groups had a relapse of psoriasis, which was assessed by the loss of the therapeutic response of PASI 75.By week 124 (12 weeks after the resumption of therapy) 82.7 % patients reached PASI 75: in group I — 92.6 % patients, in group II — 72.0 % patients.After 16 weeks (week 128), all patients 100 % achieved PASI 75 IN group I. In group II to week 128 PASI 75 was observed in 80 % patients.Conclusion. With the resumption of treatment of patients with psoriasis with ustekinumab after a long interruption, there is a rapid and complete restoration of therapeutic effectiveness, however, in patients with psoriasis with metabolic disorders, there is a decrease in efficiency after the resumption of therapy in comparison with patients without abdominal obesity, which can determine the further strategy and tactics of management of such patients.

238 The risk of keratinocyte carcinoma (KC) in psoriasis patients receiving biologic therapy compared to conventional systemic therapy: Results from The British Association of Dermatologists Biologic Interventions Register (BADBIR)

Whether psoriasis patients exposed to biologic therapies have an elevated risk of KC (basal cell carcinoma [BCC] or cutaneous squamous cell carcinoma [cSCC]) remains uncertain. The aim of the present study was to determine whether such patients were at higher risk of developing a KC compared to those on conventional therapy. BADBIR, a pharmacovigilance register of psoriasis patients, explores the long-term safety of systemic therapies. Patients with chronic plaque psoriasis registering to BADBIR on their first biologic or a conventional therapy, who had at least one follow-up completed were included in analyses if they were of white ethnicity, Fitzpatrick skin types 1-4 and reported no previous cancers. Confounding factors included: age; sex; smoking; and previous exposure to acitretin, psoralen ultraviolet-A (PUVA), ciclosporin, and/or PUVA and ciclosporin. Propensity score-weighted Cox-proportional hazard models estimated the hazard ratio (HR) for developing a first KC or separately, first BCC or cSCC. In total, 5672 patients initiating biologic therapy and 3188 patients on conventional therapy who met the entry criteria were identified with 20558 and 7829 person-years of follow-up, respectively. During follow-up, 74 (1.3%) patients initiating a biologic therapy were diagnosed with their first KC (43 BCC; 34 cSCC first) and 22 (0.7%) patients receiving conventional therapy with their first KC (15 BCC; 10 cSCC first). No significant difference in risk was observed for developing a KC (adjusted HR 1.05; 95% CI 0.64, 1.73), BCC (0.84; 95% CI 0.45, 1.54) or cSCC (1.20; 95% CI 0.57, 2.50) on biologic compared to conventional therapy. In conclusion, biologic therapy does not appear to confer a higher risk of developing a first KC as compared to conventional therapy in psoriasis patients. These data will help inform clinical decision making in psoriasis patients at risk of KC in whom biologic or conventional therapy is being considered.

Genetic prediction of the effectiveness of anti-TNF-α therapy for psoriasis patients

Genetic prediction of the effectiveness of anti-TNF-α therapy for psoriasis patients

Psoriasis and Fat-soluble Vitamins: A Review

Fat-soluble vitamins exhibit numerous routes of immune modulation and specifically alter a variety of pathways in psoriasis pathology. Psoriasis, a chronic immune-mediated disease, often requires a combination of topical, oral, and occasionally, subcutaneous or intravenous therapies making disease management complex. With the complexity of treatment, patient adherence is reduced. Vitamin supplementation as an adjunctive treatment would minimize potential adverse effects from systemic medication, increase patient adherence and decrease overall cost. While vitamin A and D are effective topically, oral supplementation is not currently a mainstay of therapy although data exists to support such supplementation. Data on vitamin E and K implicate the significant role each has in the alteration of the inflammatory cascade responsible for psoriasis. Research showing fat-soluble vitamin deficiency in psoriasis exists and presents greater evidence for oral vitamin treatment in addition to first-line therapies. This review presents the mechanism of action in psoriasis of each fat-soluble vitamin and the data on the efficacy of oral fat-soluble vitamin supplementation in psoriasis and systemic inflammation. We also present fat-soluble vitamin deficiency data shown in psoriasis patients. With the evidence of their targeted mechanism of action, efficacy data with oral supplementation, and evidence of deficiency in patients, oral fat-soluble vitamins should be considered as an adjunct to therapy in psoriasis patients.

Persistence of biologic therapy in psoriasis patients with comorbidity

Persistence of biologic therapy in psoriasis patients with comorbidity

Biologics therapy in psoriasis patients with viral hepatitis, HIV, and cardiovascular diseases

Biologics therapy in psoriasis patients with viral hepatitis, HIV, and cardiovascular diseases