Efficacy of long-term Skyrizi (risankizumab) treatment for moderate-to-severe plaque psoriasis over 256 weeks.

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Background:
Psoriasis is an inflammatory skin disease that impacts a heterogeneous group of patients and can have multiple clinical manifestations. Risankizumab is approved for the treatment of moderate-to-severe plaque psoriasis.

Objectives:
To evaluate the long-term efficacy of risankizumab according to baseline patient characteristics, and for the treatment of high-impact disease manifestations (nail, scalp and palmoplantar psoriasis), through 256 weeks of continuous treatment in the phase 3 LIMMitless study.

Methods:
This subgroup analysis evaluated pooled data from patients with moderate-to-severe plaque psoriasis who were randomized to risankizumab 150 mg during two double-blind, phase 3, 52-week base studies (UltIMMa-1/2; NCT02684370/NCT02684357) and were enrolled in the phase 3 LIMMitless open-label extension study (NCT03047395). Subgroup assessments included the proportion of patients who achieved ≥90%/100% improvement in Psoriasis Area and Severity Index (PASI 90/100). Among patients with nail, scalp and/or palmoplantar psoriasis in addition to skin psoriasis, assessments included changes from baseline in and resolution of these three psoriatic manifestations.

Results:
Overall, a numerically similar proportion of patients (N = 525) achieved PASI 90/100 through Week 256, regardless of their baseline age, sex, body mass index, weight, PASI or psoriatic arthritis status. Patients with nail, scalp and/or palmoplantar psoriasis experienced substantial improvements in manifestation-specific indices (mean improvement from baseline to Week 256 of >81%, >94% and >97%, respectively); in patients with all three manifestations (N = 121), 44.6% achieved complete clearance of these manifestations at Week 256.

Conclusions:
Risankizumab demonstrated generally consistent efficacy through 256 weeks across patient subgroups and showed durable long-term efficacy for psoriatic disease manifestations.

This study looked at pharmacogenetic biomarkers for Cosentyx (secukinumab) response in psoriasis patients.

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Background:
Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation.

Objective:
To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting.

Methods:
We studied 180 SNPs in patients with moderate-to-severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed.

Results:
A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR-146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83–0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes.

Conclusion:
We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non-response to this drug in patients with plaque psoriasis.

Had my cataracts done recently and got some psoriasis on one eyebrow, I think the sticky tape to keep the eye shield in place has made it flare though it didn't in the first one.

Obviously I can't use anything near the eye at the moment so I'm trying the good old substitute of coconut oil, I'll see how it goes.

This study looked at the effectiveness and safety of Taltz (ixekizumab) over 5 years.

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Introduction:
Ixekizumab proved to be effective and safe for psoriasis treatment in several randomized clinical trials and real-life studies. Nevertheless, long-term real-world experiences are still lacking, with little data up to 4 years of treatment.

Objectives:
To analyse survival, effectiveness and safety of ixekizumab in a real-life cohort of patients affected by moderate-to-severe psoriasis or psoriatic arthritis up to 260 weeks (5 years).

Methods:
We included all patients treated with ixekizumab from December 2017 to March 2021. Drug survival (DS) was analysed in patients at risk for up to 5 years. Cox analysis was adopted to evaluate possible predictive factors of discontinuation. Psoriasis Area Severity Index (meanPASI and PASI100, 90, and ≤3) was used as outcomes of effectiveness on observed patients at 16, 52, 104, 156, 208 and 260 weeks. Logistic regression was performed to identify possible predictive factors of response.

Results:
DS was 65.5% at 260 weeks, with being a super-responder patient (achievement of PASI100 at 16 weeks and maintained at 28 weeks) correlated with less risk of discontinuation. PASI100, 90 and ≤3 was achieved by 54.1%, 60.5% and 73% of observed patients, respectively, at 16 weeks, and by 59.1%, 81.8% and 95.5%, respectively, at 260 weeks. High mean BMI was the only factor strongly associated with less achievement of the outcomes at the earlier time points: PASI100 at 16 weeks (OR 0.93, CI 0.87–0.98, p = 0.014) and at 104 weeks (OR 0.91, CI 0.84–0.98, p = 0.019), PASI90 achievement at 16 weeks (OR 0.94, CI 0.88–0.99, p = 0.028) and 104 weeks (OR 0.91, CI 0.83–0.99, p = 0.027), and PASI ≤3 (OR 0.86, CI 0.76–0.97, p = 0.018) at 104 weeks. No severe adverse events were observed.

Conclusions:
Ixekizumab showed high effectiveness and safety for up to 5 years, with survival of 2/3 of treated patients. Rapid response to treatment is predictive of long-term response.

This small study looked at dry eye syndrome (DES) in patients with psoriasis.

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Background:
Psoriasis is one of the most common dermatoses associated with a variety of comorbidities. There have been some reports on its possible association with ocular disorders however dry eye syndrome (DES) in such patients has been poorly investigated.

Objectives:
To investigate the frequency of DES symptoms in psoriatic patients, also regarding psoriasis severity in PASI, manifestation and therapy.

Methods:
40 patients with psoriasis and 40 volunteers without dermatoses were enrolled in the study. They completed Ocular Surface Disease Index (OSDI) questionnaire and were objectively examined by IDRA® device to perform automatic interferometry, automatic meibography of lower eyelid glands, non-invasive break-up time (NIBUT), blink quality and tear meniscus height.

Results:
Patients with psoriasis had statistically significantly thicker lipid layer (p = 0.0042 left eye, p = 0.0313 right eye) and greater loss of Meibomian glands compared to controls (p = 0.0128 left eye, p = 0.048 right eye). The patients had lower, although insignificantly, eye blink quality and tear meniscus height than the control group, as well as shorter NIBUT and higher score in OSDI. After the division of patients into two groups–with or without nails involvement/psoriatic arthritis/systemic treatment– we did not observe any significant differences between the groups. PASI did not correlate with any DES parameter.

Conclusions:
This is the first study of DES symptoms with an objective IDRA® analyzer. We managed to observe that patients with psoriasis have thicker lipid layer and higher Meibomian glands' loss in lower eyelids. Based on all assessed objective and subjective parameters psoriatics do not seem to have an increased risk of DES. The presence of psoriatic arthritis or nail involvement does not seem to be a predisposing factor for DES development. PASI probably cannot be a prognostic factor for any of the DES-associated parameters. Nevertheless, DES in psoriasis requires further research on bigger samples to establish reliable recommendations.

This study looked at T-lymphokine-activated killer cell-originated protein kinase (TOPK) as a possible new target for treating psoriasis.

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Background:
Psoriasis is an inflammatory skin disease. The pathogenesis of psoriasis has not been fully elucidated. T-lymphokine-activated killer cell-originated protein kinase (TOPK) activity increases in a proinflammatory environment, and inhibiting TOPK blocks inflammation. However, whether TOPK is involved in the pathogenesis of psoriasis remains to be identified.

Objectives:
We aimed to study the role of TOPK in psoriasis and attempted to find a drug targeting TOPK for the prevention and treatment of psoriasis.

Method:
Firstly, the expressions of TOPK in psoriatic patients, psoriatic cell and animal model were analysed by Gene Expression Omnibus database, immunohistochemistry (IHC) staining and western blot (WB). After inhibiting TOPK by chemical or gene knockout, the effect of TOPK on the development of psoriasis was verified in cell and animal model by WB, qRT-PCR, ELISA, haematoxylin–eosin (H&E) and IHC staining. Moreover, phosphoproteomic analysis was performed to explore the signalling pathways regulated by TOPK in the occurrence and development of psoriasis. Then, an in vitro kinase assay was performed to prove TOPK kinase activity was inhibited by worenine. Ultimately, WB, qRT-PCR, ELISA, H&E and IHC staining were used to verify the anti-psoriasis effect of worenine by inhibiting TOPK was in cell and animal model.

Results:
In this study, we found that TOPK was highly expressed in psoriasis patients, psoriatic cell and animal model, which suggests that TOPK might be associated with psoriasis pathogenesis. Interestingly, chemical or genetic inhibition of TOPK alleviated M5- and imiquimod (IMQ)-induced psoriasis-like dermatitis, which further confirmed the role of TOPK in promoting the development of psoriasis. Moreover, we determined that worenine inhibited TOPK kinase activity. In addition, worenine relieved M5- and IMQ-induced psoriasiform dermatitis by inhibiting TOPK activity.

Conclusions:
T-lymphokine-activated killer cell-originated protein kinase promotes the development of psoriasis. Therefore, TOPK might be a promising drug target for the prevention and treatment of psoriasis. Worenine alleviates psoriasiform dermatitis by inhibiting TOPK activity, providing new strategies for clinical intervention.

I'm suddenly getting itchy patches in many places, all at once.  I think it's the happy anticipation of adult children coming to stay with us for a couple of nights, trying to make everything ready combined with colder air outside and drier air inside from the furnace.  Whatever the cause, it's irritating.  

It'll soon be like living in a snow globe, all these little flakes falling to the floor or on the backs of chairs.

I believe stress, whether positive or negative, affects my skin.  

Does anyone else feel that way?

A prospective multicentre study of nail psoriasis in China. 

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Background:
Data on nail psoriasis (PsO) in China are scarce.

Objectives:
To provide nail PsO-related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally.

Methods:
From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment.

Results:
A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366).

Conclusions:
PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO.

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I might have posted about this before but I can’t find it - does anyone else suffer from psoriasis up their nose, especially in winter? I find it quite annoying and sometimes sore. You get extra skin growth like elsewhere but up your nose you can really feel it.
When I mention it to the derm they don’t have any advice and of course you can’t really use steroid cream on what they call mucous membranes. Moisturisers don’t do anything to help.

Hi,

My name is Kathy and I'm posting for my daughter. She has what I believe is some form of psoriasis. She has been to her GP about 6 times and 3 times to a Dermatologist who said she has atopic dermatitis but I would stake my life on the fact that he is wrong. I've known people with psoriasis and what she has is worse than anything I've ever seen. This morning her pajamas were stuck to her body from skin weeping and bleeding. Her acupuncture DR her body has damp heat. Last week her GP finally took blood and she is supposed to get the results in the next few days. I feel so helpless. Everything I've tried to do for her has not worked. Does anyone have any advice?

Do any other members of your family have psoriasis ?

Members and guests can vote in the poll above, and our members are welcome to post in this thread too if they wish.

Why does the Support Psoriasis Club keep showing that it has a new unread post when it doesn't?

A bit premature as it has to go through getting approval and such but thought I'd start the thread here. Let you know when I know.

So, first part of my journey is getting insurance approval and seeing what my costs (if any) will be. Different insurance than when I was on biologics before so a bit different process is involved.

Copy and paste the questions below and add your answers.

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What is your current treatment ?

How long have you been using it ?

Ease of use (1 low to 5 high) ?

Effectiveness (1 low to 5 high) ?

Do you pay for your treatment ?

Any side effects ?

I almost put this in the off topic section, but after thinking it over I believe it belongs here.  Feel free to move it Fred if you disagree.

I have noticed that my hair is thinning out. I have thin hair but a lot of it, or well normally that it. This past year or so I've noticed that there is more hair in my brush than there used to be. Now it is partly due to age I'm sure, although thinning hair does not run in my family. I also wear a CPAP mask so I'm sure having it rub across my head at night doesn't help. But I don't move around much when sleeping. I even wake up to change positions anymore (another wonderful thing I think I can thank old age for) so....

I have scalp psoriasis and tend to scratch WAY more than I should.    I'm wondering if anyone else who has or has had scalp psoriasis noticed any hair thinning and also what they (if anything) to help.

I figured it belongs here as anyone searching for information for thinning hair due to scalp psoriasis might find information here if anyone has any to share. I mean you wouldn't have had to have scalp psoriasis, just advice on what to do about thinning hair. I've thought of supplements, but not sure they're worth the $$.

I have osteoarthritis in my knees, they ache and sometimes hurt. But it usually is one where the knees are achy and stay that way for awhile, then may hurt but the hurt usually builds up and then fades after a bit.

A few years ago, my rheumatologist told me I had psoriatic arthritis. I had stiffness in my ankles, usually when inactive. I would stretch the ankle a little bit and it would start to feel better. Although uncomfortable, I wouldn't say it was super painful. I also wondered if I did in fact have psoriatic arthritis.

About a week ago, I was walking in the house and out of nowhere a pain shot through my ankle. It continued for about 10 steps and I thought great I sprained my ankle somehow. And then, it stopped. Since then, I can be walking and for no reason a searing pain will go through my ankle as I'm walking. Usually somewhere between 2-20 steps later it goes away. This is happening daily. I went shopping yesterday and did a lot of walking. It happened quite a few times but most of the time I was fine. So, I'm confused. I doubt it is a strain or injury as it wouldn't just go away if it were that. So that makes me think of arthritis, but it doesn't gradually come on or ache... it hurts like heck when it happens. Thought I'd see if it was a familiar thing to any of you. Going to the liver specialist today and asking for a referral to get it checked out. I think I want to try a new doctor for this one.

I'm beginning to use a Q-Tip cotton swab to apply steroid ointment to small-ish patches on my legs, rather than my fingertip.  It appears to work as well as trying to rub the ointment in with my fingers and protects the skin of the fingers from wearing thin or cracking over repeated application.

I'd been using Q-Tip to apply a milder ointment, off and on for a long while, between my toes.  Then last night, I thought why not use the Q-Tip to apply to patches that are easy to get to, such as on the legs?

Does anyone else use a Q-Tip this way?  Do you always apply ointment with your bare fingers?

Posted a long intro for backstory on my psoriasis.

Saw a dermatologist this week, actually was a good visit despite her solution for me to start methotrexate and the biologics. However I am far from ready for drugs, still hoping to find improvements and ideally remission naturally.

Been off my diet for a while now and off the diet for me is just eating chocolate and regular oats pretty often (baking cookies or banana bread, no refined sugar though), and the odd cheat meal from a restaurant, few pizzas, servings of french fries, dessert here n there otherwise my normal is gluten free, sugar free, processed food free, whole food diet. Lots of protein, healthy fat sources, carbs are brown rice, sweet potatoes, veggies, fruit. Been planning to get back to being very strict but been slacking. 

Anyways, derm was talking about the connection between strep and psoriasis. Wanted to test me for group a (throat) and group b (intestinal/colon) strep. She said if group a is present, then the plan is remove tonsils, if group b is present, go on penicillin (antibiotics). Well no group a for me but tested positive for group b.

I am kind of glad knowing there is possibly something that is a problem that can be targeted and corrected, but nervous to start on antibiotics. I definitely want to kill off the strep in my intestines. You see alot about psoriasis being related to the gut and fix the gut and yada yada which sounds good but what does fix the gut mean. Its kind of like the boogeyman, you don't know what is actually the problem and best solution. Is it the candida diet, is it a whole food diet, is it come sort of short term cleanse? Do you do it for 3 months, 6? What do you take, what do you eat, what DONT you eat. Theres alot of conflicting information available.

I had done strict diet for 5 months, including probiotics and even leaky gut supplements not long ago but didn't find any improvement at all and eventually started being less and less strict to where I am now. I would still say my diet is excellent but I feel like I could be better and more disciplined and focused.

So now I know I have to deal with this strep bacteria. Antibiotics are the easiest answer but I am just a bit concerned. Ive done antibiotics in the past and believe they played a big part and messing up my gut flora in the first place. Maybe I can do it right this time tho. I am looking for any feedback with anyone having similar experience.

Thinking I do the penicillin for 2 weeks, but also take a probiotic and eat completely clean (been wanting to commit to a diet again for 6 months, this is already 90% my diet but making it 100%). No chocolate, nothing like honey, just beef, chicken, quality fish, eggs, presoaked and drained brown rice, sweet potatoes, rutabagas, carrots, beets, presoaked and drained and fermented gluten free organic oats, fruits, homemade coconut milk yogurt, sauerkraut, nuts like cashews, walnuts, almonds, basically the candida diet in regards to spices and foods, little modified for myself. Reason I soak the rice and oats it to remove any possible pesticides or toxins and starch from the rice, i donno if anyone else does this. For the oats i've been wanting to start fermenting them using a probiotic powder (from a pill). Ive been thinking I should cut out coffee, just test it out, tho i love coffee.

So im probably gonna start this immediately, would be nice to hear from anyone with experience regarding antibiotics. Think it will make my psoriasis worse immediately? The idea is that this will start me on a complete reset to correct and fix my gut flora. As long as I prepare myself with an appropriate diet and supplement probiotic pills and foods and that doing so will allow my body to start healing more.

Planning to use the Renew Life brand 50 billion probiotic. Ill take as directed as well as use it to make fermented oat and coconut milk yogurt.

Thoughts?