Journal of Psoriasis and Psoriatic Arthritis最新文献

Background: Achieving ≥90% improvement in Psoriasis Area and Severity Index (PASI90) is achievable with newer biologic therapies, such as ixekizumab. Standard of care payment systems such as the Merit-based Incentive Payment System (MIPS) responder criteria could lead to under treatment and lower quality of life (QoL) outcomes compared with PASI90.

Objective: Show PASI90 is a higher standard than MIPS and is associated with greater improvements in QoL and other PRO outcomes.

Methods: Patients with moderate-to-severe psoriasis meeting PASI90 and MIPS criteria were compared in 3 phase 3 clinical trials of the interleukin-17A inhibitor ixekizumab (pooled UNCOVER-2/3 and IXORA-S). Patients satisfying MIPS criteria met either static Physician Global Assessment score ≤2, body surface area <3%, PASI <3, or Dermatology Life Quality Index ≤5. Improvements in QoL were compared between patients meeting PASI90 and MIPS criteria.

Results: All PASI90 responders were also MIPS responders (PASI90 responders). Not all MIPS responders met PASI90 (MIPS-only responders). Significantly larger change from baseline improvements for all health (skin pain, Itch NRS, DLQI, PtGA, WPAI-PsO work productivity loss, and WPAI-PsO activity impairment) and quality of life (EQ-5D 5L VAS and acute SF-36 PCS/MCS) outcome measures were observed in the PASI90 responders vs the MIPS-only responders.

Conclusion: PASI90 is a higher standard of response than MIPS and is associated with greater improvements in health and quality of life outcome measures.

Background: Palmoplantar pustulosis (PPP) is a chronic skin condition characterized by sterile pustules on the palms and soles. This condition is more commonly reported among women and smokers causing considerable discomfort and interference with daily activities. Although there are various off-label treatment options available for PPP, there remains a demand to identify more effective and safer treatments.

Objective: To review the patient demographics and treatment patterns of our PPP patient population.

Methods: A retrospective chart review was performed at a dermatology office with two locations in Ontario, Canada.

Results: We identified 71 adult PPP patients. A third of patients did not return for follow up after diagnosis. Among those who returned for follow-up, 20% were managed with topical therapy alone. Of our patients who took systemic treatment for PPP, apremilast, followed by ustekinumab and guselkumab, had the greatest retention of therapy.

Conclusion: Targeting PDE4, IL-12/23 and IL-23 provided some benefit for our patients with PPP leading to greatest retention of therapy over time. Further investigation is required into the cause for high no-show rates and the search for effective and safe treatment options.

Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.

Background: Psoriasis is a chronic skin condition with significant effects on quality of life, including impacts on emotional health. However, these experiences are not always addressed in clinic visits, despite their potential for significant effects on daily life. This study is part of a larger project on the effects of psoriasis on quality of life. The current information was analyzed separately because the amount of information on emotional impacts mentioned by participants was so significant that it warranted a separate analysis to thoroughly assess these experiences. Objective: To describe emotional consequences of psoriasis for patients and their family members. Methods: This project was conducted at an academic medical center in Utah. Experiences were discussed in interviews and focus groups with 25 patients and 11 family members. Thematic analysis was used to determine themes and subthemes. Results: This study sheds light on the damaging effects of psoriasis on emotional well-being, illustrating the challenges patients face from internal conflict, consequences for family members trying to cope with psoriasis in a loved one, and judgment from others who do not understand psoriasis and its challenges. Conclusion: Living with psoriasis leads to emotional consequences that may be left unaddressed in clinic visits, yet these experiences contribute significantly to quality of life. The stories told through this study can help clinicians understand how to identify and address emotional concerns to improve care for psoriasis patients and, as a result, improve quality of life for both patients and their families.

Psoriatic onycho-pachydermo-periostitis (POPP) is an unfamiliar and poorly recognised condition first described in 1989 by Fournie et al. It is a variant of psoriatic arthritis comprising the triad of onycholysis, soft tissue thickening and radiographically apparent periostitis. Whilst typically affecting the great toe, any of the digits of the hands and feet may be affected. A 'drumstick' appearance to the digits of the foot is the most common clinical presentation and can be extremely painful. Nail changes are another hallmark of POPP and can be mistakenly diagnosed as fungal infection leading to lengthy periods of incorrect treatment. In this article, we will outline the clinical presentation, imaging features, pathogenesis and treatment options for POPP. Currently, the existence of POPP is not widely known. Awareness of this unusual condition will allow early appropriate treatment and can aid in the diagnosis of indeterminate seronegative disease.

Background: Interleukin (IL)-23 antagonists have shown great efficacy with minimal side effect profile in clinical trial data for the treatment of moderate to severe plaque psoriasis. As of yet, there have been no published data regarding real-world patients who have received tildrakizumab therapy. Objectives: To analyze real-world efficacy and safety of tildrakizumab in patients with moderate to severe plaque psoriasis. Methods: A retrospective chart review was performed at a large urban academic medical center for all patients treated with tildrakizumab for moderate to severe plaque psoriasis. Demographic information, Psoriasis Area and Severity Indexs(PASIs) from initial presentation and 12-month follow-up, comorbidities, and any possible adverse events were collected and analyzed statistically. Results: 30 patients on tildrakizumab therapy were included in the analysis. Overall, the mean ± standard deviation of the PASIs was 15.8 ± 11.8 at initial visit and 1.5 ± 2.9 at 12-month follow-up (P < .001). No serious adverse events were reported. Conclusions: Tildrakizumab has shown efficacy in clinical trials and this real-world cohort for the treatment of moderate to severe plaque psoriasis with a good safety profile. Future studies should be done to assess the efficacy of tildrakizumab compared with other IL-23 inhibitors.

Background: Seasonal variability in psoriasis severity may be related to changes in unintentional or intentional exposure to ultraviolet radiation (UVR), or more intensive medication use during summer. Objective: Change in psoriasis severity for placebo-randomized subjects in clinical trials of moderate-severe psoriasis, as a function of estimated change in ambient UVR exposure, allows assessment of temporal changes in UVR on psoriasis without confounding from therapies that are prohibited during trial conduct. Methods: Placebo-randomized subject data, including dates and PASI for baseline and Week 16 visits, and approximate investigator location, pooled from the placebo-controlled double-blinded periods (Weeks 0-16) of 3 moderate-severe psoriasis clinical trials, were accessed through the Vivli data platform. Investigator locations were geocoded and linked to estimated mean daily ambient erythemally weighted UVR for the months corresponding to baseline and Week 16, using data from the Ozone Monitoring Instrument on board the NASA EOS Aura spacecraft. Results: Simple linear regression of percentage PASI change for 542 placebo-treated subjects with non-missing observations yielded a beta coefficient for percentage change in UVR of -0.009 (standard error = 0.008), with p = 0.243 and adjusted R ² = 0.0007. Lack of statistical significance was observed across multiple regression analyses adjusting for baseline covariates and for interaction terms, and for mean difference in percentage change UVR for PASI50 responders versus non-responders. Conclusion: Multiple analyses failed to provide evidence that temporal variations in ambient UVR are associated with variations in psoriasis severity.

Background: Generalized pustular psoriasis (GPP) is a rare, systemic disease characterized by persistent or recurrent flares of painful neutrophilic pustules. There is limited real-world evidence characterizing patients with GPP. Objectives: To establish the distinguishing characteristics of GPP relative to plaque psoriasis, and help inform future treatment decisions and improve patient outcomes. Methods: North American adults with GPP or plaque psoriasis (without pustules) identified from CorEvitas' Psoriasis Registry were included in this dataset. Registry enrollment data, including patient sociodemographics, disease characteristics, medication use, and patient-reported outcome measures were compared for patients with GPP vs those with plaque psoriasis. This study was descriptive, and no hypothesis tests were performed. Results: In this sample, patients with GPP (N = 60) reported greater median (interquartile range) pain (20 [3-62] vs 5 [0-35]), fatigue (44 [15-73] vs 20 [4-50]), and itch (59 [10-85] vs 22 [5-70]) than those with plaque psoriasis (N = 4894). Descriptively, patients with GPP also reported more anxiety and depression (EQ-5D-3L: 38% vs 26%) and had more treatment experience (≥2 previous systemics: 15% vs 7%). Conclusions: A greater degree of symptom severity and impact on quality of life was reported by patients with GPP compared with plaque psoriasis in this sample. Importantly, patients with GPP had more treatment experience, suggesting that current treatment options do not adequately resolve the disease-highlighting the need to develop more effective GPP treatments.