Journal of Psoriasis and Psoriatic Arthritis最新文献

Despite advancements in psoriasis therapeutics, biologic discontinuation and switching still happen frequently, with the most common reasons being lack of efficacy or treatment intolerance. Conventional teaching has been to switch out of the class (inter-class switching) for primary non-responders and to stay in the class (intra-class switching) for secondary non-responders. Previous real-world studies have reported success with intra-class switching within the IL-17 inhibitor class, but data have been limited to secukinumab, ixekizumab, and brodalumab. Using retrospective data from cases selected for moderate-to-severe psoriasis who failed prior IL-17 therapy, we report our real-world experience using bimekizumab in 50 patients who failed a prior IL-17 inhibitor, in which 82% achieved an IGA 0/1. By demonstrating achievement of stringent benchmarks, such as IGA 0/1 and sPGAxBSA 100 in these selected patients, we challenge the conventional teaching of primary vs secondary non-responders class switching, and have found bimekizumab to be a viable option in those who have failed IL-17 inhibitor therapy in the past.

Background: Psoriatic arthritis (PsA) exhibits heterogeneity across different populations. Given the limited research on PsA in Africa, this study aims to characterize disease features and various cardiovascular disease risk factors (CVRFs) in a cohort of patients with PsA.

Methods: We enrolled 110 patients fulfilling the CASPAR criteria. PsA. PsA-related parameters and various CVRFs were recorded. Radiographs of hands and feet assessed peripheral joint damages.

Results: The study population included 48 males and 62 females, with a mean age of 49.8 ± 12.5 years and a mean disease duration of 9 ± 7 years. The most common disease pattern was polyarthritis, followed by oligoarthritis, spondyloarthritis, and enthesitis. Dactylitis was reported in 33.9% of patients, while 7.6% carried the HLA-B27 gene. Psoriasis was observed in 74.5% of patients, with nail involvement in 30% of cases. Inflammatory bowel disease and uveitis were present in 4.5% and 1.8% of patients, respectively. 77% of patients had active disease. Radiographic joint damage was detected in 47.2% of patients and was significantly associated with disease duration, dactylitis, and biologic therapy use. In this cohort, 23.6% were obese, and 30% were smokers. Comorbidities such as diabetes, hypertension, hyperlipidemia, and gout were present in 22.7%, 19.1%, 29.1%, and 8.1%, respectively. Moreover, 57.3% of patients had two or more CVRFs and 9.1% had a cardiovascular disease.

Conclusion: This cohort suggested a female predominance, a lower prevalence of the HLA-B27 gene, a reduced frequency of extra-musculoskeletal manifestations, and a high prevalence of radiographic joint damage and CVRFs.

Background: Generalized pustular psoriasis (GPP) is a rare, serious, chronic, neutrophilic skin disease, distinct from plaque psoriasis, characterized by recurrent flares of cutaneous erythema and widespread sterile pustules. Patient-centric data on the quality of life (QoL) impacts of GPP remain limited.

Objective: To evaluate the physical and emotional QoL impacts of GPP.

Methods: We used a web-based survey and 90-minute telephone interviews with open-ended questions to evaluate the experiences of adults with GPP across China, Japan, the UK, and the USA. Quantitative measures included the Dermatology Life Quality Index (DLQI), Psoriasis Symptom Scale (PSS), and Worst GPP Pain Numeric Rating Scale (NRS).

Results: 21 participants completed the survey; 9 completed telephone interviews. The journey to diagnosis was complicated, with 48% of participants seeing ≥4 physicians before the diagnosis. Impacts of GPP on participants physical and mental QoL were substantial, such as the anxiety of not being able to plan life and work with confidence, both in general and during flares. The mean DLQI was 10.2, and the PSS and Worst GPP Pain NRS were highest in participants experiencing recent flares. Participants' biggest worries included risk of flares, distress from symptoms, inadequate treatment, and passing on the disease to their children. Limitations included a small sample size and short recall timeframe.

Conclusion: Participants reported multiple impacts of GPP on their daily lives even in the absence of acute flares, highlighting the need for greater disease awareness and understanding among healthcare professionals.

Objective: To assess the contributing factors and clinical characteristics of difficult-to-treat (D2T) psoriatic arthritis (PsA).

Patients and methods: This retrospective cross-sectional study included PsA patients from a tertiary care center. D2T PsA was defined as failure of at least 1 conventional synthetic DMARD (csDMARD) and 2 or more biologic/targeted synthetic DMARDs (b/tsDMARDs) with different mechanisms of action. Baseline demographics, disease duration, and domain involvement were compared across groups.

Results: A total of 150 PsA patients were included, with an equal gender distribution and a mean age of 55.9 ± 13.7 years. Patients with D2T PsA had a significantly younger age of onset for both psoriasis and PsA (both P < 0.001), and a higher prevalence of obesity (P = 0.018). Multidomain involvement was prominent, with 93.5% of D2T patients having 3 or more domains affected (P < 0.001). Axial disease, dactylitis, enthesitis, and nail involvement were all significantly more frequent in the D2T group (all P < 0.001). Multivariate analysis identified age, age of psoriasis onset, axial involvement, enthesitis, and nail dystrophy as independent predictors of D2T PsA.

Conclusion: D2T PsA is associated with early disease onset, obesity, and extensive multi-domain involvement, particularly axial disease, enthesitis, and nail changes. These findings suggest that specific clinical features and comorbidities may help identify patients at risk of developing D2T PsA. Early recognition of these factors may guide more personalized and aggressive treatment strategies to improve long-term outcomes.

Plaque psoriasis is a chronic skin disorder involving dysregulated inflammation. While numerous biologic therapies targeting inflammatory mediators have been approved for moderate-to-severe psoriasis, their safety profiles may include an increased risk of adverse events (AEs), such as infections, cardiovascular diseases, and malignancies. Because patients with psoriasis also have increased incidence of comorbidities, long-term real-world AE monitoring is critical to further evaluate the safety of biologic therapies postapproval. Brodalumab is a recombinant, fully human interleukin-17 receptor A antagonist indicated for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies. The safety profile of brodalumab has been established in clinical trials and industry-sponsored US pharmacovigilance reports. Herein, we summarize AEs reported in nonsponsored open-label and real-world studies of brodalumab. Across all studies, most common AEs were similar to those listed in the brodalumab package insert. While AEs of special interest were not reported comprehensively, their rates were generally low, with 3 cases of major adverse cardiac events, 2 cases of malignancy, 11 cases of depression, and no completed suicides in the overall safety population (N = 1701). There were 6 cases of serious infection and no serious fungal infections. Studies evaluating AEs of interest for brodalumab showed no causal link to suicide and no increase in risk of cardiac events or serious infection compared with other biologics. Together, these studies support a consistent safety profile of brodalumab in real-world use.

Background: Managing psoriasis in patients with a history of lymphoma presents a unique clinical challenge. Psoriasis is associated with significant comorbidities such as cardiovascular disease and inflammatory arthritis, making optimal treatment vital. Systemic treatments like biologic agents may help mitigate these sequelae of systemic inflammation. However, concerns about immunosuppression in the context of lymphoma recurrence and progression complicate therapeutic decisions. Purpose: This review aims to examine the role of IL-12, IL-17, IL-23, and TNF-α in psoriasis and explores the safety of biologic therapies in this population, with a focus on impact on lymphoma recurrence and progression. Research Design: A narrative review of the current medical literature was conducted. Study Sample: The analysis synthesizes evidence from preclinical studies, clinical trials, post-marketing surveillance registries, retrospetive cohort studies, and case reports concerning the use of biologic agents in psoriasis. Data Collection: Relevant literature was identified an analyzed to compare the mechanisms of action, degree of immunosuppression, and available safety data of different biologic agent classes. Results: Based on current evidence, we propose that IL-17 and IL-23 inhibitors as preferred options due to their targeted mechanisms and favorable safety profiles. In contrast, TNF-α inhibitors are less favored due to their comparatively greater immunosuppressive effects and potential association with lymphoma risk. IL-12/23 inhibitors are questionable given their potential impact on tumor immunosurveillance. Conclusion: For psoriasis patients with a history of lymphoma, IL-17 and IL-23 inhibitors represent the most suitable biologic options, while TNF-α inhibitors and IL-12/23 inhibitors should be used with caution. Clinical data overall remains limited, however, as lymphoma patients are routinely excluded from clinical trials. Further research is needed to clarify long-term safety and optimize treatment strategies for this high-risk population.

In this commentary, we discuss the role of pharmacy benefit managers (PBMs) on access to biologics for patients with psoriasis. We highlight structural and system level barriers to biologics access, as well as how PBMs work as intermediaries between insurers, pharmacies, and drug manufactures to influence prescription formularies and generate health savings. We also discuss how controversial PBM practices such as step therapy, prior authorizations, and spread pricing may limit access to biologics and potentially increase cost for patients. Finally, we highlight how dermatologists and national organizations such as the National Psoriasis Foundation can collaborate and advocate for legislative reforms to increase transparency among PBMs.

Background: Psoriasis is associated with increased risk of depression. Although cognitive behavioral therapy (CBT) is an evidence-based treatment, access remains limited.

Objectives: To evaluate the feasibility, acceptability, and preliminary efficacy of a smartphone-delivered, coach-led CBT program for depression among individuals with psoriasis.

Methods: This single-arm, 8-week pilot study (Mindset trial, NCT06216691) enrolled adults with psoriasis and at least mild depressive symptoms (PHQ-9 ≥5). Participants engaged in a smartphone-based CBT program guided by bachelor's-level lay coaches. Primary outcomes were feasibility as evaluated by module completion and acceptability as evaluated by the Client Satisfaction Questionnaire-8 (CSQ-8]) and User Version of the Mobile Application Rating Scale (uMARS). Secondary outcomes included changes in the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Appearance Anxiety Inventory, Skindex-16, and Psoriasis Symptom Inventory.

Results: Of 30 participants, 63.3% completed ≥4/8 modules and 43.3% completed ≥6/8 modules. Mean CSQ-8 and uMARS scores were 27.2 (SD 4.5) and 4.0 (SD 0.7), respectively, supporting high satisfaction. Statistically and clinically significant improvements were observed in PHQ-9 (mean change -4.4; Cohen's d = 0.92), GAD-7 (-2.8; d = 0.63), and Skindex-16 symptoms (5.0; d = 0.78), emotions (10.0; d = 0.95), and functioning (6.4; Cohen's d = 0.71) subscales as well as the Psoriasis Symptom Inventory (3.1; d = 0.43).

Conclusions: This study supports the feasibility, acceptability, and preliminary efficacy of smartphone-delivered CBT for individuals with psoriasis and depressive symptoms. Given the scalability of this model, future randomized trials are warranted to assess broader effectiveness in dermatology care settings.