Psoriasis (Auckland, N.Z.)最新文献

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.

Purpose: Psoriasis is a common chronic inflammatory skin disease. Acupoint injection is reported to be used for the treatment of psoriasis, however its mechanism is not yet clear. The study aimed to investigate the efficiency of combined treatment including acupoint injection in the treatment of psoriasis.

Patients and methods: Here, we compared the efficacy of multiple immune intervention therapy (MII, acupoint injection with BCG-PSN combined with thymosin enteric-coated tablets, levamisole, intramuscular injection with BCG-PSN) to NB-UVB and acitretin for psoriasis. One thousand two hundred patients with moderate-severe psoriasis vulgaris were randomly treated with MII, NB-UVB or acitretin. For another 53 patients treated with MII, the T cell subsets and TCR repertoire analysis were investigated with sequencing and flow cytometry.

Results: The effective rate in MII treated group was similar to acitretin-treated group in 3 months (P > 0.05), though lower than in subjected treated with NB-UVB (P < 0.05). MII treatments maintained a longer remission of both PASI25 and PASI75 in comparison to the treatment with either NB-UVB or acitretin in following 5-year follow-up. Moreover, the relapse rate was lower in MII treatment than in either NB-UVB (P < 0.0001) or acitretin treatment (P < 0.0001), accompanied with longer remission duration (MII vs both NB-UVB and acitretin, P < 0.0001). Meanwhile, MII treatments markedly increased Treg cells (P = 0.04), while decreasing the number of both Th1 (P < 0.001) and Th17 cell (P = 0.01), along with decreased secretion of IFN-γ (P = 0.03) and IL-17 (P = 0.02). Multivariable Cox regression analysis demonstrated that MII significantly reduced psoriasis relapse risk versus NB-UVB (58.7% reduction; HR = 0.413, 95% CI: 0.329-0.517, P < 0.001) and acitretin (65.3% reduction; HR = 0.347, 95% CI: 0.276-0.435, P<0.001).

Conclusion: Acupoint injection combined with BCG-PSN, thymosin enteric-coated tablets and levamisole treat psoriasis and prevent relapse of psoriasis, via modulation of Treg/Th1/Th17.

Background: Plaque-type psoriasis (PSO) is a chronic inflammatory systemic skin disease. Psoriatic arthritis (PsA) is a frequent component requiring early treatment to prevent joint damage. Guidelines recommend differentiated drug decisions for both conditions.

Objective and methods: Descriptive analysis of drug choices for patients with PSO with or without additional PsA of the German Psoriasis registry PsoBest from 2007 to 2022.

Results: The analysis comprises data of 17,310 patients with PSO: 18,6% with additional PsA (PSO+PsA), mean age 47.6 (± 14.8) years, 58.8% male, mean duration of PSO 16.4 years in patients without PsA (PSO-PsA; ± 14.3), 20.6 years in PSO+PsA (± 15.3, p < 0.001). PSO-PsA and PSO+PsA patients showed a marked burden of disease: PASI (15.7 (± 10.1) and 13.9 (± 10.6, p < 0.001)); DLQI (11.7 (± 7.2) and 12.3 (± 7.6; p < 0.001)). Before registry entry, 47.0% of patients received no systemic antipsoriatic treatment. Prior systemic medications were mainly non-biologics (40.4%), 12.6% were biologics, with a significantly higher rate in PSO+PsA patients (24.7% vs 9.8%). At registry baseline, the majority of the patients received non-biologic treatment (55.9%), with significantly higher rates for PSO-PsA patients (55.9% vs 34.8%). Biologics were used in 43.9% of all patients, with a significantly higher rate in PSO+PsA patients (65.9% vs 38.8%). Three hundred and three (9.4%) of PSO+PsA patients received treatments at baseline with approval for PSO, but not explicitly for PsA. Those patients had minor active joint involvement.

Conclusion: Early and effective treatment of PsA is crucial to prevent persistent damage of the joints. Although most patients received recommended systemic treatment for PSO+PsA, there is a small number of patients with prescriptions addressing mainly the inflammation of the skin and not explicitly PsA. To choose recommended medication for both entities we need to regard the entire systemic inflammation and interdisciplinary co-working should be implemented.

Background: Pustular psoriasis (PP) is a systemic inflammatory disease that rarely occurs in children but adversely affects their quality of life.

Objective: This study aimed to evaluate the clinical characteristics, treatment, prognosis, and epidemiology of PP in pediatrics.

Methods: A single center retrospective study on 41 children diagnosed with PP was conducted in a university-affiliated referral hospital between January 2010 and May 2022. The demographics, clinical characteristics, treatment, and prognosis were evaluated in the descriptive analysis. To further investigate the effect of different acitretin-based treatments on the prognosis, 38 patients were included in the subgroup analysis. Patients who received acitretin alone were designated as the Acitretin group, while those who received acitretin combined with intravenous immunoglobulin, ciclosporin, or steroids (or any combination of these agents) were identified as the Combination group.

Results: A total of 41 patients were enrolled in the descriptive analysis. Of these, 65.8% (27/41) were male, and the mean age of onset was 3.2 ± 3.2 years. Among the patients, 63.4% (26/41) presented with pustules, and over half experienced fever and elevated C-reactive protein (CRP) levels. In the subgroup analysis, the CRP level was significantly higher in the Combination group (59.69 ± 43.74 versus 26.35 ± 19.67 mg/dL, P = 0.006), indicating that patients had more severe inflammatory conditions. Nevertheless, there was no significant difference in the remission rate between the Acitretin group and the Combination group.

Conclusion: Pediatric PP is a disease that often occurs in the pre-school period and predominantly affects males. It is characterized by typical skin lesions and systemic inflammatory reactions. Common comorbidities include nutritional disorders such as malnutrition and anemia. Combination treatment based on acitretin is recommended for children with PP and severe inflammation.

Psoriasis, a chronic inflammatory disease affecting approximately 3% of the global population, presents complex challenges that extend beyond its physical manifestations. This comprehensive review examines the multidimensional impact of psoriasis on patients' lives, encompassing physical, psychological, and social aspects. We analyze current therapeutic approaches, from traditional systemic treatments to cutting-edge biological therapies and emerging oral medications, evaluating their efficacy, limitations, and accessibility. The review explores how disease severity correlates with quality of life measures and psychological burden, noting the high prevalence of depression (20%), anxiety (21%), and suicidal ideation (0.77%) among affected individuals. However, emerging evidence suggests that clinical severity, as measured by PASI or BSA, does not always correlate with the psychoemotional burden experienced by patients, highlighting the need for a more comprehensive assessment of disease impact. We discuss the evolution of treatment strategies, highlighting recent developments in targeted therapies, including JAK inhibitors, particularly selective TYK2 inhibitors, and PDE4 inhibitors, which offer promising alternatives to traditional treatments. Additionally, we examine the role of various assessment tools and quality of life measures in evaluating treatment outcomes. The analysis emphasizes the need for a holistic approach to patient care that integrates medical interventions with psychological support, addressing both the visible and invisible burdens of the disease. This review underscores the importance of personalized treatment strategies that consider not only clinical efficacy but also patient preferences, accessibility, and long-term safety profiles.

Background: Psoriasis significantly impacts patients' mental health and social relationships, often leading to feelings of stigmatization and shame due to the visibility of skin lesions. This study aimed to identify factors influencing the quality of life in patients with psoriasis.

Methods: A cross-sectional study was conducted from November 2018 to December 2020, involving 100 patients treated for psoriasis. The research utilized the WHO Quality of Life Questionnaire (WHOQoL-Bref), the Psoriasis Area and Severity Index (PASI), the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Mini Nutritional Assessment (MNA). The analysis included demographic, clinical, and psychological variables to evaluate their impact on quality of life.

Results: The multivariate linear regression model revealed that significant independent predictors of quality of life included age (p=0.001), duration of disease (p=0.004), and nutritional status (p=0.002). In the physical domain, factors such as phototherapy (r=2.46) and anxiety levels assessed by the HADS anxiety subscale (r=-0.23) were particularly relevant. In the psychological domain, the presence of psoriatic arthritis (r=1.978), hand and foot psoriasis (r=2.34), and scores on the HADS anxiety (r=-0.212) and depression subscales (r=-0.226) were significant. Male gender (r=1.632) and depressive symptoms (r=-0.352) impacted the social domain. In the environmental domain, predictors included erythrodermic psoriasis (r=1.98), hand and foot psoriasis (r=2.312), phototherapy (r=1.877), PASI score (r=-0.04), and depression as measured by HADS (r=-0.228).

Conclusion: The primary predictors of quality of life in patients with psoriasis are the type of psoriasis, the presence of anxiety and depressive disorders, and treatment with phototherapy. However, the study's single-center design and relatively small sample size may limit the generalizability of the findings. Further multi-center studies are needed to confirm these results and broaden their applicability.

Psoriasis and atopic dermatitis (AD), once viewed as mutually exclusive diseases, are increasingly recognized to co-occur in complex inflammatory phenotypes. We present a 17-year-old male with multimorbid atopic conditions, including persistent atopic dermatitis, allergic rhinitis, and asthma, who developed new-onset psoriasis in the absence of previous biologic therapy. Initially misdiagnosed as exacerbated AD, he received ineffective treatment for one year. Treatment with secukinumab yielded limited improvement in psoriatic symptoms and eczematous lesions. AD and psoriasis significantly improved after adding dupilumab for 12 weeks; there were no documented side effects and a durable remission lasting 78 weeks. This case report underscores the importance of vigilance in patients with long-standing AD for newly emerging psoriasis and cautions against attributing all new rashes solely to chronic AD history. This case highlights the potential benefit of dual biologic therapy in managing concurrent type 2 inflammatory diseases and psoriasis, suggesting that a comprehensive immune-modulatory approach may be advantageous for patients with these coexisting conditions.

This narrative review examines critical considerations for biologic treatment in psoriasis patients, with a focus on infection risks, providing current recommendations and practical considerations for prevention, including vaccination, screening, and management strategies. Since type I (Th1) inflammation and type III (Th17) inflammation protect against intracellular and extracellular infections, respectively, it is logical that biologic treatments blocking these pathways may be associated with an increased risk of infection. It has been proven that TNF inhibitors are associated with an increased risk of latent tuberculosis (LTBI) and hepatitis B virus reactivation. However, not all biologics exert the same immunosuppressive effect, as IL-17 and IL-23 inhibitors may be associated with a lower risk of infection. In general, pre-treatment screening for reactivable infectious diseases is advised for all patients initiating biologic therapy. Vaccination schedules for patients with psoriasis under biologic treatment should mirror those of the general population, including annual influenza and COVID-19 vaccines. Live-attenuated vaccines are generally advised against in patients undergoing biologic treatment. However, some live-attenuated vaccines may be safely administered under specific circumstances with IL-17 or IL-23 inhibitors. Current guidelines and recommendations on this topic were initially designed for TNF inhibitors and later extrapolated to other classes of biologic agents. Thus, they should be revised to better align with the specific pathogenic mechanisms of drugs and clinical evidence, emphasizing individualized treatment approaches.

Introduction: Psoriasis is a chronic inflammatory skin disease significantly impairing quality of life. The introduction of biologic therapies, such as bimekizumab-a monoclonal antibody targeting IL-17A and IL-17F-has revolutionized treatment outcomes. This study investigates the effectiveness of bimekizumab in a real-world setting, focusing on the predictors of Early Super Response (ESR), defined as achieving PASI 100 by week 4, and evaluates the safety profile over a 48-week follow-up period.

Methods: A retrospective study was conducted on 109 psoriasis patients treated with bimekizumab at two Italian dermatology centers. Of these, 61 patients completed a 48-weeks follow-up. Baseline clinical and demographic data, PASI scores at multiple time points, and adverse events were collected. ESR predictors were analyzed using univariate and multivariate logistic regression models. Safety was assessed using Cox proportional hazards models to find predictive factors associated with the risk of adverse events (AEs).

Results: At week 4, 28.4% of patients achieved PASI 100. Baseline PASI (OR: 0.93, p = 0.029), absence of nail involvement (OR: 0.12, p = 0.003), and fewer biologic failures (OR: 0.14, p = 0.038) were independently associated with ESR status. Safety analysis revealed that 15.6% of patients experienced adverse events, with asthma/allergic rhinitis significantly associated with a higher risk (HR: 6.43, p = 0.012). Candidiasis (7.3%) and eczema (4.6%) were the most common adverse events.

Conclusion: Bimekizumab demonstrated significant effectiveness and an acceptable safety profile in a real-world setting. Baseline PASI, nail involvement, and prior biologic failures influenced early treatment response. Identifying predictors of ESR and adverse events can guide personalized therapeutic approaches, optimizing outcomes for psoriasis patients.