Psoriasis (Auckland, N.Z.)最新文献

Purpose: Psoriasis vulgaris is a chronic systemic inflammatory disease that imposes a significant physical, emotional, and social burden on affected individuals. There is a growing recognition of the importance of comprehensive monitoring and management to optimize treatment outcomes, particularly with the advent of advanced systemic therapies. This study aims to characterize the prevalence of laboratory monitoring and associated costs in persons with psoriasis undergoing systemic treatment. A specific focus was placed on the differences by treatment modality, patient characteristics, and economic burden to the payers.

Patients and methods: A retrospective longitudinal analysis was conducted using German health insurance data from the DAK-Gesundheit. The study population included persons diagnosed with psoriasis who received systemic therapies between 2016 and 2020. Laboratory service utilization and costs were assessed during the initiation and course of treatment, factoring in demographic parameters and comorbidities.

Results: Among 62,063 persons with psoriasis, 8018 (12.9%) were identified as having received systemic treatment, which of 92.5% utilized at least one laboratory service. The average annual laboratory monitoring cost per person was higher for those on biologic therapies (57.88 €) compared to systemic treatments (23.70 €). Laboratory service utilization and costs were associated with the comorbidity index (CCI) and age.

Conclusion: Biologic therapies for psoriasis induce considerably higher monitoring costs than non-biological systemic drugs. Age and CCI were main predictors for higher utilization of laboratory services, indicating a medical rationale to perform more lab screenings in risk groups for safety events. The laboratory costs add to the higher drug costs of biologicals but need to be related to the benefits from treatment. Furthermore, the monitoring costs are far lower than the drug costs and thus may not be major decision drivers.

Purpose: Elderly patients with age ≥65 years represent an increasing percentage of the population with moderate-severe psoriasis. The definition of "frail elderly" is not easily framed, generally meaning a patient with unstable homeostasis. To date, there is no study in the literature examining possible differences between frail and non-frail elderly with psoriasis being treated with tildrakizumab.

Patients and methods: The present multicentre retrospective study evaluated the effectiveness, drug survival and safety up to 2 years of treatment with tildrakizumab in the elderly (≥65 years) comparing frail and non-frail patients. Frail patients were defined as those with: i) 2 major comorbidities, or 1 major comorbidity and low economic level ii) and/or 2 of the following 5 parameters: weight loss, weakness, sluggishness, low activity level, and exhaustion.

Results: A total of 217 patients aged ≥65 years were enrolled, of whom 89 (41%) were grouped in the frail patient category. In the entire population, 2-year drug survival was ≥80%, and PASI 90 and ≤2 was achieved in 75% and 87.5% of patients, respectively. No difference in effectiveness or safety was found between frail and non-frail populations. Adjusting for baseline characteristics at Cox-regression, frail patients did not show a greater risk of discontinuation (HR 0.51, p=0.091).

Conclusion: Tildrakizumab showed good safety and effectiveness at 2 years in the elderly population with or without frailty, confirming it as a possible treatment of choice in psoriatic patients with significant comorbidities and older frail patients who deserve systemic treatments.

Moderate to severe psoriasis has been reported as an independent risk factor for IgA nephropathy (IgAN). IgAN is characterized by episodic microscopic hematuria, which can progress to end-stage renal disease (ESRD). Managing therapeutic interventions for psoriasis patients requiring dialysis due to ESRD presents significant challenges. We present a case of severe plaque psoriasis in a patient concurrently diagnosed with IgAN who is dependent on hemodialysis. Over the past two months, his condition has worsened without any identifiable triggers. Physical examination revealed generalized scaly plaques on the scalp, trunk, and extremities, resulting in a Psoriasis Area Severity Index (PASI) score of 19.2. Laboratory tests confirmed end-stage renal insufficiency, with no other abnormalities detected. Consequently, the patient was prescribed subcutaneous secukinumab following a standard regimen. He achieved complete resolution of symptoms after eight weeks of treatment and experienced no recurrence during a one-year follow-up. His kidney-related parameters remained stable during secukinumab therapy. To summarize, this case report discusses a patient with severe psoriasis who also has concurrent IgAN and ESRD, successfully treated with secukinumab. It reinforces the rapid efficacy and enduring safety of secukinumab in managing psoriasis in hemodialysis-dependent patients with IgAN comorbidity. Zeno Fratton et al has reported that an interleukin (IL)-17A/F inhibitor effectively treats moderate-to-severe psoriasis in patients with chronic kidney disease (CKD). However, further studies are necessary to develop evidence-based guidelines for biologic selection within this vulnerable population.

Erythrodermic psoriasis (EP) is an uncommon and severe form of psoriasis, which exhibits a Th1/Th17/TNF inflammatory pattern. Most patients with EP experience systemic symptoms that necessitate systemic treatments. These treatments include conventional systemic drugs (such as acitretin, cyclosporin A, and methotrexate), biologics (including IL-17, IL-12/23, and TNF-α inhibitors), and small molecule drugs (such as apremilast and JAK inhibitors). Evaluating the severity of EP is critical for determining appropriate treatment strategies. According to an innovative EP severity evaluation approach, patients exhibiting two or more clinical features-fever, exudation, or lymphadenopathy-are classified as having moderate-to-severe EP, while those with one or none of these symptoms are categorized as having mild EP. Mild EP can often be managed with monotherapy using acitretin, methotrexate, or biologics, such as IL-17 or IL-12/23 inhibitors, excluding TNF-α inhibitors. For moderate-to-severe EP, cyclosporine A and biologics, particularly IL-17 or IL-12/23 inhibitors, are recommended. Combination therapies are considered when monotherapies prove ineffective. These may involve combining a biologic with a conventional systemic drug or using two to three conventional systemic drugs together to enhance efficacy. Supportive care plays a critical role in alleviating the discomfort associated with skin lesions and other complications. Additionally, treatments should be tailored to address specific comorbidities, often requiring multidisciplinary collaboration. In our comprehensive review, we summarized the current evidence on therapeutic options for EP, including details on dosages, treatment durations, efficacy, and adverse events. Additionally, we incorporated new evidence on the use of acitretin, biologics, and JAK inhibitors for EP. We also introduced, for the first time, a practical management algorithm based on severity evaluation to guide the appropriate treatment of EP.

Introduction: There is a dispute as to whether patients with psoriasis have impaired kidney function. We aimed to assess several recognized and experimental markers of glomerular filtration and tubular function in such patients to find out whether they have decreased kidney function.

Methods: The study involved 60 patients with psoriasis and 30 volunteers without dermatoses. The following molecules were analyzed by ELISA: serum creatinine, cystatin C, beta-trace protein, albumins, uromodulin; urinary albumins, cystatin C, alpha-1-microglobulin, beta-2-microglobulin, uromodulin, klotho, and fatty acid-binding protein 1, and nephrin.

Results: The following absolute values of markers concentrations were measured in patients, respectively: serum-1.13 (0.6-1.9)mg/dl, 4.511 (2.356-10.31)mg/l, 19.8 (2.8-48)ng/mL, 4.2 (1.9-8.85)g/dl, 212.3 (32.35-583.9)ng/mL, urine-5 (3-39)g/dl, 24096 (79.94-99020)ng/mL, 0.9342 (0.2088-6.213)ng/mL, 22.65 (0.85-105.8)ng/mL, 6.388 (0.8960-15.94)ng/mL, 0.08 (0.002-0.387)ng/mL, 1.773 (1.706-2.146)ng/mL, 0.128 (0.095-0.298)ng/mL. The patients had significantly lower serum albumin concentration (p<0.001) and higher urinary albumin (p<0.05), significantly higher serum cystatin C (p<0.01), and absolute urinary nephrin (p<0.05). There was no difference between patients and controls in terms of serum creatinine or beta trace protein concentration (p>0.05). There were no significant differences in the concentration of the tubular markers (urinary cystatin C, alpha-1-microglobulin, beta-2-microglobulin, klotho, and fatty acid-binding protein 1) between patients and controls, except for serum and urinary uromodulin, which were significantly lower in patients (p<0.01, p<0.001, respectively). We found no significant correlations between the investigated markers' concentration and clinical or demographic parameters (p>0.05).

Discussion: Despite the differences between patients and controls in terms of glomerular filtration markers, the median values of markers' concentration were within normal limits. Based on the assessment of the markers, it does not seem that impaired glomerular and tubular function occurs more frequently in patients with psoriasis. Nevertheless, due to the higher prevalence of diabetes mellitus and arterial hypertension in psoriatics and nephrotoxic properties of antipsoriatic drugs - caution must be exercised and easy screening tools should be considered.

Purpose: Epidemiological and health care data on generalized pustular psoriasis (GPP) show large differences in literature. This study assessed GPP epidemiology, comorbidities and health care in Germany.

Patients and methods: Nationwide population-related German claims data were analyzed using different case definitions for internal validation.

Results: In 2019, the prevalence of GPP in Germany in adults ranged from 8 to 39 and incidence from 1 to 15 persons per 100,000. Prevalence was higher in women and increased with age. Thirty-three percent had at least one other psoriatic ICD-10 code. People with GPP had significantly more skin diseases as well as cardiovascular and mental diseases than persons without psoriasis/GPP. The average annual drug costs per capita were € 2050 and were highest in those receiving biologicals (€ 15,524). Marked differences in treatment by specialist were observed.

Conclusion: Acknowledging that the observed frequency or costs associated with GPP may be underestimated due to a few inherent limitations is important. Differences in GPP coding behavior and diagnostic accuracy may contribute to variations in epidemiology. The high disease burden is reflected by high annual costs and by significant comorbidity.

Purpose: Tobacco smoking is an unhealthy behavior associated with the onset, severity, and treatment response of psoriasis. However, evidence regarding the impact of tobacco smoking on the relapse of psoriasis remains limited. This study aims to examine the relapse condition in psoriasis patients and explore the association between tobacco smoking and psoriasis relapse.

Patients and methods: We conducted an observational study with 551 psoriasis patients recruited from 2022 to 2024 in Shanghai Skin Disease Hospital. A structured questionnaire and physical examination were used to collect data at baseline, week 12, week 24 and week 48. PASI50 and PASI75 were used to evaluate the improvement of psoriasis patients after treatment at week 12, and disease relapse was defined as the loss of 50% PASI improvement during clinical remission after the achievement of PASI50 or PASI75 at week 12.

Results: 75.7% of the 551 psoriasis patients were males, with an average age of 45.8 years, and 282 (51.2%) were tobacco smokers. 41.2% and 61.6% of psoriasis patients with PASI50 achievement at week 12 encounter disease relapsed at week 24 and 48, respectively, while for patients with PASI75 achievement at week 12, the relapse rate was 27.6% and 51.7% at week 24 and 48, respectively. Logistic regression indicated that patients with tobacco smoking had a higher relapse rate, especially among those with PASI75 achievement at week 12. The odds ratio was 2.10 (95% CI: 1.17-3.78) and 1.84 (95% CI: 1.07-3.14) at week 24 and week 48 respectively, even after adjusting for potential confounding factors. Moreover, patients with longer smoking duration and more daily cigarette consumption had higher relapse rate.

Conclusion: Tobacco smoking was positively correlated with the relapse, especially among those with longer smoking duration and more daily cigarette consumption. Therefore, patients with psoriasis should quit smoking to reduce the risk of relapse.

Background: Many adalimumab biosimilars have been approved for the same indications as their originator (Humira ^®). However, data on their efficacy and safety in children with psoriasis are scarce.

Objective: To assess the effectiveness and safety of adalimumab biosimilars in a group of adalimumab-naïve patients and another group of patients who switched from originator adalimumab to biosimilars. The co-primary endpoints were the PASI absolute mean, PASI 75, and PASI 90 at 16, 24 and 52 weeks.

Methods: In this 52-week, multi-center, non-interventional, observational, retrospective study, patients starting biosimilars in routine practice after January 2022 were enrolled at 10 sites across Italy, Portugal, and France. Disease activity scores such as the Psoriasis Area Severity Index (PASI) and safety data were captured during 12 months following adalimumab biosimilar initiation.

Results: A total of 102 pediatric patients with psoriasis receiving adalimumab biosimilar therapy either as naïve (n = 72) or switching from originator adalimumab (n = 30) were enrolled. Median absolute PASI remained low at weeks 16, 24, and 52 in both groups (naïve 5.4, 4.3, 2.8; switching 2.6; 2.0; 1.4 respectively). PASI 75 response at weeks 16, 24, and 52 was observed in 41.7, 55.0, and 77.8% of patients in the naive group and 82.8%, 86.2%, and 92.6% of patients in the switch group. PASI 90 response at weeks 16, 24, and 52 was achieved by 23.3%, 26.7%, and 46.3% of patients in the naïve group and 58.6%, 65.5%, and 55.6% of patients in the switch group. Three patients discontinued biosimilars after the switch due to loss of efficacy. No emergency room visits or hospitalizations were observed during the study period and none of the patients experienced serious adverse effects.

Conclusion: Adalimumab biosimilars showed a favorable effectiveness/safety profile in childhood psoriasis. Switching from reference adalimumab to biosimilars did not impact effectiveness and safety. A likelihood of discontinuation was noted in patients who switched from Humira to biosimilars.

Purpose: Psoriasis profoundly impairs patients' social, emotional, and physical condition, impacting on their overall well-being. Tildrakizumab is an interleukin-23p19 inhibitor labelled for the treatment of moderate-to-severe plaque psoriasis. The main objective of this study was to assess the effect of tildrakizumab on the overall well-being of people with psoriasis. Effectiveness, quality of life (QoL), symptomatology, treatment satisfaction, and the impact of psoriasis on the patients' partners were also evaluated.

Patients and methods: POSITIVE is a 24-month observational study in adults with moderate-to-severe psoriasis treated with tildrakizumab in a real-world setting (ClinicalTrials.gov ID: NCT04823247). Outcome measurements included the 5-item WHO Well-being Index (WHO-5), Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index-Relevant (DLQI-R), Treatment Satisfaction Questionnaire for Medication (TSQM-9), and FamilyPso. We report 52-week (W52) interim data (N = 400; observed cases).

Results: Mean ± 95% CI WHO-5 score increased from 53.8 ± 2.2 at baseline to 66.0 ± 2.3/65.7 ± 2.7 at W28/W52 (p < 0.0001, both). Mean ± 95% CI PASI decreased from 13.1 ± 0.8 at baseline to 1.7 ± 0.3/1.5 ± 0.3 at W28/W52 (p < 0.0001, both). At W28 and W52, 85.8%/54.8% and 88.4%/56.8% of patients achieved PASI ≤ 3/≤ 1. Mean ± 95% CI DLQI-R score decreased from 12.6 ± 0.8 at baseline to 3.3 ± 0.6/3.1 ± 0.6 at W28/W52 (p < 0.0001, both). At W52, mean ± 95% CI TSQM-9 domain scores were 77.4 ± 3.2 for effectiveness, 81.5 ± 2.6 convenience, and 81.1 ± 2.6 global satisfaction. Mean ± 95% CI total FamilyPso decreased from 1.3 ± 0.1 at baseline to 0.7 ± 0.2 at W52 (p < 0.0001). At the point of this analysis, 24.0% of patients had ≥1 adverse event (AE). Only one patient discontinued due to a treatment-related AE.

Conclusion: Tildrakizumab successfully contributes to value-based long-term health care for moderate-to-severe psoriasis by increasing patient wellbeing, QoL and clinical outcomes while showing very good safety and tolerability.

Purpose: The management of psoriasis has undergone substantial evolution; however, the long-term prescription trends remain ambiguous. This study utilised a comprehensive data set of psoriasis drug prescriptions in Germany from 2010 to 2022, with the objective of evaluating the evolution of treatment modalities over time.

Methods: A retrospective longitudinal claims data analysis on systemic biologicals, non-biologicals, and topical treatments for psoriasis was conducted covering prescription rates, medical costs from the payer's perspective, and defined daily doses (DDDs).

Results: Psoriasis prevalence increased slightly from 2.6% in 2010 to 2.7% in 2022. During this period, the proportion of persons receiving prescriptions rose from 55.0% in 2010 to 57.4% in 2022. By 2022, 46.2% of these persons received topical treatments, 13.0% systemic glucocorticosteroids (SCS), 6.7% non-biologicals, and 6.2% biologicals. Compared to 2010, the use of biologicals increased by 449.8%, SCS by 12.6%, non-biologicals by 13.9%, while topical treatments decreased by 3.2%. The annual cost per person treated with a biologic decreased from €16,315 to €13,412, while non-biologic and topical therapy costs increased slightly. Adalimumab was the most frequently prescribed systemic drug, followed by ustekinumab and secukinumab. The highest mean costs per-person were for ustekinumab (€19,717) and risankizumab (€16,986).

Conclusion: In more than a decade, the use of innovative systemic drugs, especially biologicals, in Germany has increased substantially. Despite their high cost, biologic expenses per person have slightly decreased over time.