Treatment Of Psoriasis Patients Research Articles

Treatment of psoriasis with biologic and non-biologic targeted therapies in patients with latent tuberculosis infection or at risk for tuberculosis disease progression: Recommendations from a SPIN-FRT expert consensus.

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a significant global health problem. In immunocompetent individuals, the microorganism can remain in a latent, non-contagious form, however, it may become active under conditions of immunosuppression. Tumour necrosis factor (TNF) inhibitors, which are frequently used for the management of immune-mediated disorders like psoriasis, have been associated with a significantly increased risk of reactivating latent TB. Consequently, international guidelines recommend TB screening and preventive treatment before starting anti-TNF therapy. These recommendations have extended to IL-12/23, IL-17, IL-23 and TYK2 inhibitors under a caution principle, despite their different mechanisms of action. However, current evidence suggests that some of these agents are arguably not associated with an increased risk of TB reactivation or development of TB disease after infection, which calls for a critical reassessment of these guidelines. We have conducted a literature search evaluating the risk of TB reactivation associated with these innovative therapies, integrating findings from both randomized clinical trials and real-world evidence. The identified evidence is limited but the low number of identified cases of reactivation with IL-17 and IL-23 inhibitors prompts reconsidering the need for preventive treatment for latent TB in all cases, regardless of biologic class or individual patient's risk of TB reactivation or drug toxicity. This review, along with the clinical insight of a panel of experts on behalf of the SPIN-FRT, led to the development of these consensus recommendations for managing psoriasis treatment in patients with latent TB infection or at risk of TB infection, who are receiving or are intended to receive biologic and non-biologic targeted therapies. These recommendations highlight the need for updates to the existing guidelines, aiming to provide a more differentiated approach that reflects the evolving landscape of psoriasis treatment and its implications for TB management.

Treatment of psoriasis in patients with chronic infection

Treatment of psoriasis in patients with chronic infection

P05 Evaluation of changes in serum cytokine (TNFα, IFNα2, IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-23, IL-33, and MCP-1) values in biologic-naive psoriasis patients during biologic agent use

Abstract Psoriasis is an immune-mediated chronic inflammatory skin disease. Proinflammatory cytokines have an important role in the pathogenesis. Current treatments mainly act on TNF-α, IL-12, IL-17 or IL-23 pathways. It is thought that determination of cytokine levels before treatment can be used as useful biomarkers for monitoring disease activity and personalized treatment selection. The aim of this study is to contribute to the establishment of biomarkers that can help predict disease severity, treatment response and disease prognosis in patients with psoriasis and also compare healthy controls. We analysed the changes in serum levels of cytokines (TNFα, IFNα2, IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-23, IL-33, MCP-1) before and 4 months after treatment with biological agents in 40 bio-naive psoriasis patients and 15 healthy subjects. Flow cytometry method [LEGENDplex™ Multi-Analyte Flow Assay Kit Human Inflammation Panel 1, 13 Plex with V-bottom Plate (BioLegend, San Diego, CA, USA)] was used for the determination of cytokine levels. Clinical and demographic information, including PASI (psoriasis area and severity index) and DQLS (Dermatology Quality of Life Scale) scores were recorded. In addition, acute phase reactants (CRP, ESR, ferritin, albümin) were measured before and after 4 months of treatment. The data obtained were analysed using NCSS 2007 software. PASI and DQLS scores at the fourth month of treatment were found to be significantly lower compared with the onset (P = 0.000, P = 0.0001, respectively). When cytokine values were analysed; IFN-γ levels of the patients increased after treatment (P = 0.007). Pre-treatment IL-33 and IL-1β levels of the patients were lower than healthy subjects (P = 0.045), but there was no difference between the mean levels of these cytokines before and after treatment. Among the biologic agents, IL-17A levels were found to be lower only in patients using secukinumab (P = 0.022). Pre-treatment and post-treatment IL-17A difference of the secukinumab group was higher than the other drugs (P = 0.004, P = 0.009), while no statistical difference was observed between the other biologic agents (P > 0.05). There was no correlation between age at disease onset, PASI and DQLS and cytokine levels. The ESR, CRP, and ferritin values of the patients were higher than the healthy controls before treatment (P = 0.011, P = 0.022, and P = 0.037, respectively). However, only ESR decreased after treatment in psoriasis patients (P = 0.027). In this study, no significant differences were found in serum cytokine levels. However, the literature shows that while serum levels may remain unchanged, tissue levels can be significantly different. Future studies should include cytokine analyses in both serum and tissue levels.

P126 Psoriasis on black skin: the Nigerian factor, diagnosis, care and treatment

Abstract Psoriasis is one of commonest skin disorders on black skin: it is a condition in which skin cells build up and form scales it is an auto-immune condition that is inherited from either parents or predominantly connected to the genes. It could be itchy, scaly and could lead to depression if proper medical care is not taken. Psoriasis patients could have other systematic skin infections or allergic reactions. Most could have Asthma, sinusitis and allergic Rhinitis. Mostly unidentified in the Nigerian factor or misdiagnosis could be quite common and mostly associated with spiritual folklore. Data reported on SSBC skin care clinics Kaduna for psoriasis patients from 2017 to 2024 as 64 patients. These cases were identified and treated by a skin care consultant and a Dermatologist. Men are more in number than women but a few children also recorded. The treatment of psoriasis patients is in sessions whether it is hives or less affected of which the weather plays an important role. The northern parts of Nigeria has more psoriasis cases due to Natural predicaments, the disorder remains a rare milder disease overall 80.3% Psoriasis and 13. 2 had family history. The Northern central region of Nigeria has an average, population of psoriasis patients and is most common with fulani’s. The fulani’s or Peuhul speak Fulde and are biracial. This common factor of being biracial, fair skin, normadic in nature contributed more to the prevalence of psoriasis with the Hausa fulani’s. Change of environment, weather and food could also be one of the triggers of psoriasis. The patients in some cases treat themselves without proper treatment. Also some patients believe only in traditional medicine. The essence of finding a dermatologist could be another defeating factor that could lead to other health issues inclusive. Psoriasis medications is a continuous process, one of which is light therapy, multivitamins and good diet. The most important is the dermatologist diagnosis, modalities and medication. 13% (124/11 015) study of the Nigerian population shows male prepoderance: with a male-to-female ratio of 1.34:1 majority in the fourth decade of life. Psoriasis is a family thing extending to generations within the family but may occur differently on each of the family trees. Data are as follows: (i)Psoriasis by wk Jacyk-1981; (ii)Dr Yaya Kaduna State Nigeria 2022 cited; (iii)SSBC skin care and Kaduna 2917–2024; (iv)Psoriasis treatment via integrated Medicine: WSDH Guinea 2023 by Dr Maimuna Sani stores, Kaduna state Nigeria; and (v)Study 19 April 2013.

Efficacy and Safety of Biologic Therapies for Treatment of Psoriasis: A Systematic Review and Observational Meta-Analysis

Abstract Background Psoriasis is a chronic, systemic, immune-mediated inflammatory skin disease of unknown etiology, however, several cytokines were reported to share in the pathogenesis of psoriasis as IL-12, IL- 23 and TNF-α. Biologics targeting these cytokines showed effective results in treatment of psoriasis patients. However, long term efficacy and tolerability of these agents is still questionable. Objective To compare the efficacy and safety of anti-TNF alpha, anti IL12/23, anti IL17, anti IL23 in moderate to severe psoriasis over long periods of treatment in order to complete the efficacy and safety profile of biologic therapies. Patients and Methods We searched ClinicalTrials.gov register (www.clinicaltrials.gov) up to July 2022 with the following search terms: psoriasis AND one by one each biologic therapy name listed in types of interventions. Results Regarding rate of PASI 75 at year 1, IL-12/23 inhibitors have a greater probability of achieving a PASI 75 response than anti-TNF alpha, with the pooled PASI 75 estimate at 84% and 76.18%, respectively. While, regarding rate of PASI 75 at year 2, 3, 4 and 5, there are no studies that assess the PASI 75 at year 2 or more for anti-TNF. The PASI 75 at years 2, 3, and 5 for IL- 12/23 inhibitors appeared to be stable at about 80 %, while it reached 91% at year 4. Rate of serious infections was 2.9% and 2.4% with anti-TNF alpha and IL-12/23 inhibitors respectively. There was showing no significant difference in the risk of serious infection between the two classes. In the current study, the rate of malignancy showed no-significant difference in psoriatic patients as patients receiving anti-TNF-alpha had 3.7% rate while in patients receiving IL 12/23 inhibitors the rate was 3.9%. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023. Conclusion In the current meta-analysis we compare the efficacy and safety of anti-TNF alpha and anti IL12/23 in moderate to severe psoriasis over long periods of treatment in order to complete the efficacy and safety profile of biologic therapies. IL-12/23 inhibitors have a greater probability of achieving a PASI 75 response than anti-TNF alpha. There was no significant difference in the risk of serious infection or rate of malignancy between the two classes. Moreover, there was insignificant risk of MACEs with IL12/23 inhibitors and a slight increased risk with anti-TNF alpha. There was significant rate of common adverse events in patients receiving anti-TNF-alpha compared to patients receiving IL 12/23 inhibitors.

Efficacy and Safety of Secukinumab in the Treatment of Psoriasis in Patients with Skin Phototypes IV to VI.

There is a paucity of data on the treatment of psoriasis in patients with skin of color – a diverse population among whom variations in clinical features and higher quality of life impact have been reported. This single-center, open-label clinical study evaluated the safety and efficacy of secukinumab in the treatment of moderate-to-severe plaque psoriasis in adults with Fitzpatrick skin types IV-VI. A total of 20 male and female subjects (ages ≥ 18, BSA ≥10%, PASI Score ≥ 12, IGA ≥ 3) completed this study. The total study duration was 28 weeks. During the treatment period, subjects received secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4, then monthly through week 20. 73% of patients achieved at least 90% improvement in PASI score (PASI90) at week 16 compared to baseline (P=0.0592). There was a statistically significant proportion of patients achieving PASI75, IGA of clear or almost clear, and a change from baseline in DLQI total score at weeks 12, 16, and 24. A statistically significant reduction in IGAxBSA-75 score was achieved between week 16 and baseline. The sample size was small and underpowered to detect statistically significant changes in some endpoints. Furthermore, the study period was interrupted by the COVID-19 pandemic, which contributed to numerous missing data points. Secukinumab 300 mg administered monthly was safe, well-tolerated, and efficacious in treating skin of color patients with psoriasis and improving health-related quality of life. Larger studies involving skin of color populations with psoriasis are warranted. J Drugs Dermatol. 2024;23(8):600-606. doi:10.36849/JDD.8128.

Characterization of psoriasis patients in special body areas: real-world evidence from the Chinese Psoriasis Standardized Diagnosis and Treatment Center

Background While extensive research has provided a wealth of information on psoriasis in general, there remains a critical gap in understanding the unique characteristics of psoriasis in special body areas, such as the scalp, nails, palms, and genitals. Objective To investigate the characterization and treatment of psoriasis patients in special body areas. Methods The study was a retrospective analysis of patients with psoriasis enrolled in the Psoriasis Standardized Diagnosis and Treatment Center Project between January 2020 and September 2021. Results The study encompassed 346 patients, 81% of them had psoriasis in at least two special body areas, with the nails as the most common area. Patients with genital psoriasis reported higher Dermatology Life Quality Index (DLQI) scores. A higher propensity for scalp and palmoplantar psoriasis was noted in patients with genital psoriasis. The proportion of patients treated with biologics rose, as the number of specific areas involved increased. Conclusions Patients with genital psoriasis are more likely to have scalp and palmoplantar psoriasis. This study highlights the significant escalation in the proportion of biologics when the involvement of special body areas was ≥2.

Real-life data over 36 weeks of guselkumab treatment in psoriasis patients: A single-center study from Turkey.

Psoriasis is an important health problem responsible for morbidity and workforce loss. In recent years, anti-IL-23 drugs have become essential in psoriasis treatment. This study aimed to investigate the efficacy and safety of guselkumab therapy, recently used in Turkey, by examining real-life data over 36 weeks. A total of 39 psoriasis patients (>18 years old) who received guselkumab treatment between December 2021 and December 2022 in the dermatology department of our hospital were included in the study. Patients" ages, sexes, body mass index (BMI), comorbidities, duration of illness, drugs used before guselkumab treatment, clinical response to guselkumab treatment, and side effects, if any, were recorded. Psoriasis Area and Severity Index (PASI) scores at baseline and Weeks 4, 12, 24, and 36 were evaluated, as well as the Dermatology Life Quality Index (DLQI) at the beginning and end of the study. The PASI scores at Weeks 4, 12, 24, and 36 and the DLQI at Week 36 decreased statistically compared with baseline (p < 0.05). The PASI score at baseline and Weeks 4, 24, and 36 did not differ between groups based on IL-17 use (p > 0.05). No significant correlation was observed between BMI, disease duration, and PASI scores at baseline and Weeks 4, 12, 24, and 36. No side effects were observed in any of the patients during treatment. This study includes real-life data on the use of guselkumab therapy for psoriasis in the Turkish population. Based on the results, guselkumab is a highly effective and safe treatment.

Use of biologic treatment in psoriasis patients with HIV: A systematic review

Use of biologic treatment in psoriasis patients with HIV: A systematic review

IL-17A inhibitors alleviate Psoriasis with concomitant restoration of intestinal/skin microbiota homeostasis and altered microbiota function.

Disturbed gut microbiota and associated metabolic dysfunction exist in Psoriasis. Despite the growing use of interleukin-17 inhibitor (anti-IL17) therapy, the effect of anti-IL17 on gut/skin microbiota function is not fully understood in patients with Psoriasis. Therefore, we explored whether Psoriasis is associated with alterations in selected gut/skin microbiota in a study cohort, and a longitudinal cohort study to reveal the effects of IL-17A inhibitor treatment on gut microbiota in Psoriasis. In a case-control study, 14 patients with Psoriasis and 10 age, sex and body mass index-matched Healthy Controls were recruited. Longitudinal mapping of the gut microbiome was performed using 16S rRNA gene sequencing. Mouse models were used to further study and validate the interrelationship between the skin microbiome and the gut microbiome in Psoriasis. PICRUST2 was applied to predict the function of the bacterial community. In Psoriasis patients, gut microbiota dysbiosis was present with increased heterogeneity: decreased Bacteroidota and increased Firmicutes as well as Actinobacteriota predominating in Psoriasis. Escherichia-Shigella enrichment was associated with reduction in serum levels of total bile acid and markers in Apoptotic pathways. After IL-17A inhibitor treatment in Psoriasis patients, longitudinal studies observed a trend toward a normal distribution of the gut microbiome and modulation of apoptosis-related metabolic pathways. Results from a mouse model showed dysregulation of the skin microbiota in Psoriasis characterized by Staphylococcus colonization. The psoriatic gut/skin microbiota exhibits loss of community stability and pathogen enrichment. IL-17A inhibitors restore microbiota homeostasis and metabolic pathways, reduce pro-inflammatory cytokine expression, and alleviate symptoms in patients with Psoriasis.

Bimekizumab Efficacy in Patients with Moderate to Severe Plaque Psoriasis and Hypertension, Elevated Body Mass Index, or Hyperglycemia: Results Through 3 years of Treatment in 5 Phase 3/3b Trials

Introduction: Patients with moderate to severe plaque psoriasis have a higher risk of cardiometabolic comorbidities than the general population.1,2 Here, response to bimekizumab (BKZ) in psoriasis patients with hypertension, elevated body mass index (BMI), or hyperglycemia at baseline is reported through 3 years of treatment.&#x0D; Procedure/study: Data were pooled from the following trials: BE SURE, BE VIVID, BE READY, their open-label extension (OLE) BE BRIGHT, and BE RADIANT.3–7 Included patients received BKZ 320 mg every 4 weeks (Q4W) to Week 16, then Q4W or Q8W in the maintenance period and on OLE entry. All received BKZ Q8W from Week 64 (BE RADIANT)/OLE Week 48 (BE BRIGHT) or next scheduled visit (dose groups were combined in this analysis). Psoriasis Area and Severity Index (PASI) ≤2, ≥90% improvement from baseline in PASI (PASI 90), and PASI 100 responses were evaluated in patients with psoriasis and concurrent hypertension (systolic &gt;130 mmHg or diastolic &gt;85 mmHg), elevated BMI (&gt;30 kg/m2), or hyperglycemia (≥140 mg/dL or ≥7.8 mmol/L), based on objective laboratory measurements at baseline. Data are reported using modified non-responder imputation: patients who discontinued due to lack of efficacy or treatment-related adverse events were considered non-responders at subsequent timepoints; multiple imputation was used for all other missing data.&#x0D; Results: Of 1,107 BKZ-randomized patients who entered the OLEs, 546, 493, and 81 had hypertension, elevated BMI, and hyperglycemia at baseline, respectively. At Week 16, 91.3% of all BKZ-treated patients had PASI ≤2; high response rates were also observed in patients with hypertension (88.9%), elevated BMI (87.8%), and hyperglycemia (87.7%). At Year 3 (OLE Week 96), PASI ≤2 response rates were 91.3% (all patients), 90.0% (hypertension), 89.4% (elevated BMI), and 91.1% (hyperglycemia). At Week 16, 90.9%/65.5% of all BKZ-treated patients achieved PASI 90/100; high responses were also observed in patients with hypertension (89.0%/62.8%), elevated BMI (87.6%/60.3%), and hyperglycemia (86.4%/64.2%). At Year 3, PASI 90/100 response rates were 90.7%/70.0% (all patients), 89.3%/66.3% (hypertension), 89.2%/66.2% (elevated BMI), and 87.9%/57.7% (hyperglycemia).&#x0D; Conclusion: High levels of complete/near-complete skin clearance achieved at Week 16 were durable through 3 years’ BKZ treatment in psoriasis patients, including those who had baseline hypertension, elevated BMI, or hyperglycemia.&#x0D; Funding: UCB Pharma.

Serum lipidomic study of long-chain fatty acids in psoriasis patients prior to and after anti-IL-17A monoclonal antibody treatment by quantitative GC‒MS analysis with in situ extraction

BackgroundLong-chain fatty acids (LCFAs) are involved in regulating multiple physiological processes as signalling molecules. Gas chromatography–mass spectrometry (GC–MS) is widely used to quantify LCFAs. However, current quantitative methods for LCFAs using GC–MS have demonstrated complicated issues. Psoriasis is a chronic inflammatory skin disease, and its pathogenesis may be related to the overproduction of interleukin-17A (IL-17A). Clinical efficacy of anti-IL-17A monoclonal antibody (mAb) treatment in psoriasis patients has been demonstrated. Recent studies suggest that LCFAs play varying roles in the pathogenesis of psoriasis. However, more comprehensive research is needed to illuminate the mechanism of LCFAs in psoriasis.MethodsThe established in situ derivatization method for analysing LCFAs with a GC–MS platform was utilized to conduct serum lipidomics analysis of healthy volunteers and psoriasis patients receiving pretherapy and posttreatment with of anti-IL-17A mAb. Imiquimod (IMQ)-treated wild type (WT) and T-cell receptor delta chain knock-out (Tcrd−/−) mice were used to investigate the correlation between IL-17A and abnormal changes in LCFAs in psoriasis patients.ResultsA rapid and sensitive in situ extraction derivatization method for quantifying LCFAs using GC–MS was established. Serum lipidomic results showed that psoriasis patients had higher levels of saturated fatty acids (SFAs) and ω-6 polyunsaturated fatty acids (PUFAs) but lower levels of monounsaturated fatty acids (MUFAs) and ω-3 PUFAs than healthy individuals, indicating impaired serum LCFA metabolism. Anti-IL-17A mAb treatment affected most of these LCFA changes. Analysis of LCFAs in IMQ-treated mice showed that LCFAs increased in the serum of WT mice, while there were no significant changes in the Tcrd−/− mice. SFAs increased in IMQ-treated WT mice, while MUFAs showed the opposite trend, and PUFAs did not change significantly.ConclusionsThis study presented a dependable method for quantifying LCFAs that enhanced sensitivity and reduced analysis time. The lipidomic analysis results showed that anti-IL-17A mAb not only ameliorated skin lesions in psoriasis patients but also affected abnormal LCFAs metabolism. Furthermore, the study indicated a potential correlation between IL-17A and abnormal LCFA metabolism in psoriasis patients, which was supported by the alterations in serum LCFAs observed in IMQ-treated WT and Tcrd−/− mice.

Pharmacogenetic biomarkers for secukinumab response in psoriasis patients in real-life clinical practice.

Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation. To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting. We studied 180 SNPs in patients with moderate-to-severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed. A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR-146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83-0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes. We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non-response to this drug in patients with plaque psoriasis.

187 Bimekizumab treatment in psoriasis patients: A mechanistic understanding of the durable clinical response

187 Bimekizumab treatment in psoriasis patients: A mechanistic understanding of the durable clinical response

Cellular Mechanisms of Psoriasis Pathogenesis: A Systemic Review.

Psoriasis is a common inflammatory skin disease characterized by abnormal proliferation of epidermal keratinocytes and massive infiltration of inflammatory cells. Many kinds of cells, including keratinocytes, T lymphocytes, dendritic cells, neutrophils, and macrophages, are reported to play critical roles in the pathogenesis and progression of psoriasis. However, to date, the role of each kind of cell in the pathogenesis and development of psoriasis has not been systematically reviewed. In addition, although antibodies developed targeting cytokines (e.g. IL-23, IL-17A, and TNF-α) released by these cells have shown promising results in the treatment of psoriasis patients, these targeted antibodies still do not cure psoriasis and only provide short-term relief of symptoms. Furthermore, long-term use of these antibodies has been reported to have adverse physical and psychological effects on psoriasis patients. Therefore, gaining a deeper understanding of the cellular and molecular pathogenesis of psoriasis and providing new thoughts on the development of psoriasis therapeutic drugs is of great necessity. In this review, we summarize the roles of various cells involved in psoriasis, aiming to provide new insights into the pathogenesis and development of psoriasis at the cellular level and hoping to provide new ideas for exploring new and effective psoriasis treatments.

Monocyte to high-density lipoprotein cholesterol ratio decreased in patients with psoriasis treated with ixekizumab.

Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammatory biomarker which has been associated with cardiovascular diseases. To study MHR in patients with psoriasis treated with biological agents. Between April 2019 and August 2022, MHR was retrospectively evaluated in patients with psoriasis before and 3 months after treatment with infliximab, adalimumab, etanercept, ixekizumab, secukinumab, and ustekinumab in a university hospital in Ankara, Turkey. This study included 128 patients, 53 females and 75 males. 39 (30.5%) patients were treated with infliximab, 26 (20.3%) with adalimumab, 8 (6.3%) with etanercept, 18 (14.1%) with ixekizumab, 12 (9.4%) with secukinumab, and 25 (19.5%) with ustekinumab. The median MHR was 0.0127 (0.0086-0.0165) in females and 0.0146 (0.0119-0.0200) in males (p = 0.011). The median MHR decreased after treatment with adalimumab, ixekizumab, secukinumab, and ustekinumab, whereas it increased after treatment with infliximab and etanercept (p = 0.790, p = 0.015, p = 0.754, p = 0.221, p = 0.276, p = 0.889, respectively). MHR significantly decreased in patients with psoriasis after treatment with ixekizumab. Since high MHR levels have been associated with poor clinical outcomes in patients with cardiovascular diseases, ixekizumab might have a positive impact in the treatment of psoriasis patients who had cardiovascular diseases. We suggest that MHR may be useful both in establishing appropriate biological agent treatment and in the follow-up of patients with psoriasis treated with biological agents.

Statins and psoriasis: Position statement by the Psoriasis Task Force of the European Academy of Dermatology and Venerology.

Psoriasis is associated with an increased mortality risk, with cardiovascular disease being the leading excess cause (in a dose-response manner with psoriasis severity). Statins have demonstrated a reduction in all-cause mortality with no excess of adverse events among the general population. The underuse of interventions in cardiovascular prevention, such as statins, for patients with psoriasis may be the result of an insufficient evaluation. To provide the dermatologist with a tool for systematizing the treatment of dyslipidemia in psoriasis, which generally escapes the scope of dermatological practice, and to facilitate decision-making about the referral and treatment of patients. The Psoriasis Task Force of the European Academy of Dermatology and Venereology performed this two-phase study to achieve a consensus and create recommendations on the use of statin therapy in patients with psoriasis. The first phase included a systematic review to identify a list of outline concepts and recommendations according to guidelines. The second phase consisted in a two-round Delphi study to evaluate those recommendations not literally taken from guidelines. A list of 47 concepts and recommendations to be followed by dermatologists involved in the treatment of patients with moderate-severe psoriasis was created. It included six main concepts about cardiovascular risk and psoriasis, six items related with the role of low-density lipoprotein cholesterol (LDL-c) and the benefits of statin treatment in psoriasis patients, eight recommendations about how cardiovascular risk should be assessed, three on the role of non-invasive cardiovascular imaging, three on LDL-c thresholds, eight key points related to statin prescription, 10 on statin treatment follow-up and three on patient referral to another specialist. The application of this position statement (close final list of concepts and recommendations) will help dermatologists to manage dyslipidemia and help psoriasis patients to reduce their cardiovascular risk.

Use of Systemic Therapies for Treatment of Psoriasis in Patients with a History of Treated Solid Tumours: Inference-Based Guidance from a Multidisciplinary Expert Panel.

Patients with treated solid tumours (TSTs) are a highly heterogeneous population at an increased risk for malignancy compared with the general population. When treating psoriasis in patients with a history of TSTs, clinicians are concerned about the immunosuppressive nature of psoriasis therapies, the possibility of augmenting cancer recurrence/progression, and infectious complications. No direct, high-level evidence exists to address these concerns. We aim to provide a structured framework supporting healthcare professional and patient discussions on the risks and benefits of systemic psoriasis therapy in patients with previously TSTs. Our goal was to address the clinically important question, "In patients with TSTs, does therapy with systemic agents used for psoriasis increase the risk of malignancy or malignancy recurrence?" We implemented an inference-based approach relying on indirect evidence when direct clinical trial and real-world data were absent. We reviewed indirect evidence supporting inferences on the status of immune function in patients with TSTs. Recommendations on systemic psoriasis therapies in patients with TSTs were derived using an inferential heuristic. We identified five indirect indicators of iatrogenic immunosuppression informed by largely independent bodies of evidence: (1) overall survival, (2) rate of malignancies with psoriasis and systemic psoriasis therapies, (3) rate of infections with psoriasis and systemic psoriasis therapies, (4) common disease biochemical pathways for solid tumours and systemic psoriasis therapies, and (5) solid organ transplant outcomes. On the basis of review of the totality of this data, we provided inference-based conclusions and ascribed level of support for each statement. Prior to considering new therapies for psoriasis, an understanding of cancer prognosis should be addressed. Patients with TSTs and a good cancer prognosis will have similar outcomes to non-TST patients when treated with systemic psoriasis therapies. For patients with TSTs and a poor cancer prognosis, the quality-of-life benefits of treating psoriasis may outweigh the theoretical risks.

Paradoxical Reactions to Anti-TNFα and Anti-IL-17 Treatment in Psoriasis Patients: Are Skin and/or Gut Microbiota Involved?

Psoriasis is a chronic, immune-mediated, inflammatory disease primarily affecting the skin. It is currently coming to light that patients with psoriasis have disrupted intestinal barrier andoften suffer from comorbidities associated with the gastrointestinal tract. Moreover, there is growing evidence of both cutaneous and intestinal paradoxical reactions during biologic treatment in patients with psoriasis. This review focuses on barrier defects and changes in immune responses in patients with psoriasis, which play an important role in the development of the disease but are also influenced by modern biological treatments targeting IL-17 and TNFα cytokines. Here, we highlight the relationship between the gut-skin axis, microbiota, psoriasis treatment, and the incidence of paradoxical reactions, such as inflammatory bowel disease inpatients with psoriasis. A better understanding of the interconnection of these mechanisms could lead to a more personalized therapy and lower the incidence of treatment side effects, thereby improving the quality of life of the affected patients.

Evaluation of Self-Esteem Status and Common Psychiatric Conditions in Psoriasis Patients Before and After Treatment with Biological Drugs

Background: Skin diseases have many negative effects on self-esteem and quality of life. Psoriasis has several psychological and social impacts on self-esteem. This study was performed to compare the effects of psoriasis on Self-Esteem Status before and after the treatment with biological drugs.&#x0D; Methods: In this prospective cross-sectional descriptive study, patients with psoriasis referred to two hospitals in Tehran, Iran, were studied. Demographic data were recorded, and disease information was collected through the Psoriasis Area and Severity Index (PASI) score. The self-esteem status was determined using the standardized Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck questionnaires. Data were analyzed by Pearson correlation and t-score tests.&#x0D; Results: The severity of the disease decreased significantly after treatment with biological drugs. Scores related to depression, anxiety, somatization, interpersonal sensitivity, hostility, morbid anxiety, paranoid thoughts, and psychosis decreased after treatment. Self-esteem increased after treatment. The more severe the disease, the less the patients’ self-esteem increased after treatment with biologic drugs (p&lt;0.000). According to the Eysenck measurement index, people with higher socioeconomic levels significantly increase self-esteem after treatment with biological drugs. According to the General Symptom Index (GSI), socioeconomic status has no significant effect on self-esteem.&#x0D; Conclusion: Treatment of psoriasis patients with biologics can reduce the severity of their disease and improve mental disorders in these patients. This treatment also increases their self-esteem and generally improves their quality of life of these patients.