Journal of Psoriasis and Psoriatic Arthritis最新文献

Background: Despite their impressive efficacy in phase 3 trials, biologic agents for psoriasis (PsO) may lose efficacy over time. The factors associated with loss of efficacy have yet to be fully elucidated.

Objective: We aimed to identify factors associated with PsO patients using multiple biologics in comparison to patients who used 1 biologic. We also reviewed the literature comparing the survival of different biologic agents for PsO.

Methods: We examined clinical data from 222 psoriasis patients at the University of California San Francisco, of whom 51 reported use of 3 or more biologics and of whom 171 reported use of only a single biologic agent at the time of enrollment into a research database from 2006-2020. This study was IRB-approved at UCSF (#10-02830) and all subjects provided written informed consent. We performed univariate and multivariate regression analysis to identify significant demographic features, clinical features, and co-morbidities associated with multi-biologic use. We performed a literature review of studies comparing psoriasis biologic survival at 1, 2, and 5 years and factors associated with single biologic failure.

Results: In univariate analysis, duration of PsO, initial presentation of PsO on the gluteal cleft, erythrodermic psoriasis, and acne were associated with using 3 or more biologics. In multivariate analysis, duration of PsO, erythrodermic psoriasis, and acne remained significant. Our review of biologic survival revealed differences according to biologic class.

Conclusion: We identified novel factors associated with multi-biologic use in PsO. Further studies in this area are needed to achieve a precision medicine approach.

Background: Patients and practitioners often consider the risk of side effects when starting a treatment for psoriasis and often consult reported adverse events (AE) in studies. However, most of these AEs are unrelated to treatment and patients consider what is the risk of an event should you not start a treatment. This is what would be observed in the placebo-arm of clinical trials.

Objective: To investigate the proportion of patients experiencing AEs during treatment with placebo in clinical trials.

Methods: We conducted a systematic literature search using PubMed, Embase and Web of Science databases for phase 3 randomized clinical trials that registered adverse events of using placebo vs biological agents for psoriasis. The search term was "Psoriasis AND (Phase III OR Phase 3)".

Results: Of 7142 screened articles, 54 were included in the metanalysis. The pooled proportion of placebo-treated patients experiencing any AEs was .52 (95% Cl: .51 to .53) after 12 weeks and .53 (95% Cl: .50 to .55) after 16 weeks. The pooled proportion of patients with any serious AEs was .02 (95% Cl: .01 to .02) and .03 (95% Cl: .02 to .03) after 12 and 16 weeks, respectively. The most common AEs in placebo-treated patients were infections, nasopharyngitis, and headache.

Conclusion: About half of the patients with moderate-to-severe psoriasis not starting an active treatment would experience disease events that would be categorized as AEs during a 12-16 weeks period.

Background: Specialty medications provide effective treatment with limited adverse effects to patients with psoriasis and psoriatic arthritis; however, variable coverage and high costs often create a barrier to treatment for patients with commercial health insurance.

Objective: We aimed to evaluate coverage of psoriasis and psoriatic arthritis specialty medications by commercial insurance companies.

Methods: We compiled data regarding specialty drug coverage for psoriasis and psoriatic arthritis using Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database and analyzed the data for any notable trends. The SPEC database lists coverage decisions for 158 specialty drugs by 17 of the largest US commercial health plans, as well as data regarding the types of evidence cited by these insurance plans when making coverage decisions.

Results: Our results showed that insurance plans tend to be more restrictive than the U.S. Food and Drug Association (FDA) label when covering medications for psoriasis and psoriatic arthritis. Furthermore, medications for psoriatic arthritis tended to be less restricted than for psoriasis, and medications were most commonly approved as second line agents for both indications.

Conclusion: Our analysis confirms that variability in insurance coverage exists for the indications of psoriasis and psoriatic arthritis.

Background: Psoriasis patients may seek information about the SARS-CoV-2 vaccine and their disease from social media platforms. Analyses of social media interactions may help guide dermatologists' educational efforts during this pandemic.

Objectives: This study analyzes social media interactions among patients with psoriasis and psoriatic arthritis regarding the SARS-CoV-2 vaccine to determine the misinformation circulating and the apprehension to receiving the vaccine.

Methods: Publicly accessible Facebook and Reddit groups regarding psoriasis and psoriatic arthritis were identified. Posts uploaded between March 1, 2021 and July 31, 2021 which contained information about the SARS-CoV-2 vaccine were extracted. First-order themes, sub-themes, sentiment scores and engagement scores were assigned to each post.

Results: 345 posts within the first-order theme of vaccination decision and 1379 posts within the first-order theme of vaccine reaction were analyzed. Within vaccination decision, common sub-themes for refusing the vaccine include fear of psoriasis flare up, vaccine is experimental, vaccine is unnecessary, vaccine is dangerous, and concern for reaction/vaccine efficacy while on psoriasis medications. 41.4% of posts contained positive sentiment; whereas, 38.3% contained negative sentiment. Within vaccine reaction, common sub-themes identified were no change to psoriasis, skin/joint flare up, skin flare up attributed specifically to stopping psoriasis medications, skin/joint improvement, and skin flare up but vaccine was worth it. 77.8% of posts contained positive sentiment; whereas, 6.2% contained negative sentiment.

Conclusions: Our study identified common SARS-CoV-2 vaccine concerns within the psoriasis community which should be used to guide educational efforts.

Background: Psoriasis is an immune-mediated disease associated with excess risk for cardiovascular disease (CVD). Guidelines recognize psoriasis as a CVD risk enhancer; however, psoriasis patients often do not have CVD risk factors identified nor managed.

Objective: This study examines strategies to improve CVD prevention care from the perspective of dermatologists and patients with psoriasis.

Methods: Qualitative interviews were conducted using the Consolidated Framework for Implementation Research to examine the perspectives of physicians (N = 16) and patients with psoriatic disease (N = 16) on barriers/facilitators to CVD prevention. Interviews were transcribed and coded using an integrated approach designed to enhance reliability and validity using NVivo software.

Results: We found three major themes suggesting areas to target for the future: (1) Appropriateness: perceptions of whether CVD care should be deployed in this setting by both clinicians and patients, (2) Feasibility: whether CVD prevention care could be integrated into the current structure of specialist practice, and (3) Care Coordination: an interest by all parties to better integrate a team approach in CVD preventative care to reduce duplicative efforts, work practically in an already existing system rather than reinventing the wheel, and progress with the patients' best interests in mind.

Conclusions: These findings will inform the design of a clinical trial comparing the effectiveness of specialist clinician implementation of CVD guideline-based prevention care in patients with psoriasis. Ultimately, this study aims to increase the lifespan and health of patients living with psoriatic disease by decreasing barriers to their receiving appropriate CVD prevention care.

Background: Numerous studies have documented an association between psoriasis and subclinical atherosclerosis.

Objective: We aimed to investigate the effects of psoriasis on the levels of N-terminal prohormone B type natriuretic peptide (NT-proBNP) and clarify whether this factor correlates with the evaluations of subclinical atherosclerosis, measured with mean intima-media thickness (MIMT) of the carotid artery.

Methods: Sixty-one psoriatic patients and sixty-one healthy, age and sex-matched volunteers were enrolled. MIMT was assessed via ultrasonography and serum NT-proBNP level were measured by electrochemiluminescence.

Results: Both NT-proBNP and MIMT were significantly higher in psoriasis patients. This remained true even after controlling for the effects of age and gender. MIMT was positively correlated with age and serum NT-proBNP level in both groups.

Conclusions: In conclusion, NT-proBNP levels may be used as a predictor of subclinical atherosclerosis in patients with psoriasis.