This study published in The British Journal of Dermatology looks at treatment goals that have been developed to optimize daily clinical practice psoriasis care for patients using biologics.

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Background:
Treatment goals have been developed to optimize daily clinical practice psoriasis care, but have not yet been studied in real life.

Objectives:
To investigate to what extent treatment decisions made by dermatologists for psoriasis patients on biologics in daily clinical practice are already in accordance with the treatment goals without the active application of the treatment goals algorithm.

Methods:
Data were extracted from a prospective daily practice cohort of psoriasis patients on biologics. Analysis was done on effectiveness (Psoriasis Area and Severity Index score) and quality of life (Dermatology Life Quality Index questionnaire). Treatment decisions such as dosage adjustments, combination treatments, or switching therapy were compared to the treatment goals algorithm.

Results:
In 64% (253 of 395) of visits, physicians followed treatment goals algorithm. There were 162 (41%) visits in which there should have been a treatment modification according to treatment goals (group Modify) and a modification was indeed made in 59 of these 162 visits (36%). In 233 (59%) visits no treatment modification was necessary (group Continue) and therapy was indeed not modified in 194 of 233 visits (83%).

Conclusions:
Physicians acted in accordance with treatment goals in the majority of patient visits. In the patient group not achieving these goals, physicians should have modified therapy according to treatment goals but continued the same therapeutic regimen in the majority of visits. Optimizing therapy and defining barriers in the latter group might increase treatment results in daily practice psoriasis care.

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Pfizer Inc. announced today detailed results from the Oral treatment Psoriasis Trial (OPT) Retreatment study (A3921111), a Phase 3 study investigating tofacitinib for the treatment of adult patients with moderate-to-severe chronic plaque psoriasis. This three-period study showed that tofacitinib, as a 5 mg or 10 mg pill taken twice daily, met its two primary efficacy endpoints. The safety profile of tofacitinib in OPT Retreatment was consistent with previous studies and there were no new safety findings in this trial.

The first primary endpoint of OPT Retreatment evaluated the maintenance of clinical response in patients who remained on tofacitinib after an initial treatment phase compared to patients who were switched to placebo (withdrawal phase). The second primary endpoint examined patients who lost half of their original clinical response during the withdrawal phase, and measured the proportion of these patients who regained their original clinical response after restarting treatment with tofacitinib. Throughout the study, the efficacy response was measured by the proportion of subjects achieving a Physician’s Global Assessment (PGA) response of “clear” or “almost clear” skin and the proportion of subjects achieving at least a 75% reduction in the Psoriasis Area and Severity Index (PASI75), two commonly used measures of efficacy in psoriasis.

“Psoriasis is a chronic disease that affects approximately two-to-three percent of people worldwide, and there are times when patients with psoriasis may need to stop and restart therapy for medical or non-medical reasons, such as elective surgery or receipt of live immunizations,” said lead investigator Robert Bissonnette, M.D., Innovaderm Research, Montreal, QC, Canada. “The OPT Retreatment data showed that patients who stayed on therapy with tofacitinib maintained their rates of response and for those who stopped therapy, a proportion of patients were able to regain their original clinical response when retreated with tofacitinib.”

Tofacitinib, an oral Janus kinase (JAK) inhibitor, is part of a new class of medicines in development for the treatment of moderate-to-severe plaque psoriasis. Top-line results from OPT Retreatment were previously announced in October 2013, and the detailed results of this study were shown today in an oral presentation during the 11th European Academy of Dermatology and Venereology (EADV) Spring Symposium in Belgrade, Serbia.

OPT Retreatment was a Phase 3 randomized, double-blind, three-period, parallel group, placebo-controlled 56-week study. This study evaluated the efficacy and safety of the withdrawal and retreatment with tofacitinib 5 mg and 10 mg twice daily compared to placebo in 674 adult patients with moderate-to-severe chronic plaque psoriasis. During the first period (24 weeks), which was a secondary endpoint of this study, patients were treated with either tofacitinib at a dose of 5 mg or 10 mg twice daily in a blinded manner. During this initial 24 weeks of treatment: 44% and 68% of patients who received tofacitinib 5 mg and 10 mg twice daily achieved at least a 75% reduction in the Psoriasis Area and Severity Index (PASI75), respectively, and 42% and 63% of patients who received tofacitinib 5 mg and 10 mg twice daily achieved a PGA response of “clear” or “almost clear” skin, respectively.

The patients who achieved a PASI75 and PGA response were then randomized to either continue tofacitinib or switch to placebo for 16 weeks or until they lost half of their original PASI response to treatment, whichever occurred first. During this withdrawal period: A statistically significantly greater proportion of patients who remained on both doses of tofacitinib maintained PASI75 and PGA responses relative to patients who were switched to placebo, and no patients experienced psoriasis rebound (rapidly spreading psoriasis after treatment withdrawal).

In the retreatment period, all patients resumed their original tofacitinib dose until week 56. After 16 weeks of restarting therapy with tofacitinib, the efficacy response was evaluated in the proportion of patients who lost half of their original PASI or PGA response during the withdrawal phase and showed that: 36.8% and 61.0% of patients who received tofacitinib 5 mg and 10 mg twice daily, respectively, achieved a PASI75; and 44.8% and 57.1% of patients who received tofacitinib 5 mg and 10 mg twice daily, respectively, achieved a PGA of “clear” or “almost clear” skin.

The most common adverse events for all study periods were nasopharyngitis and upper respiratory tract infection. There was one cardiac-related death that occurred during the OPT Retreatment study at the 5 mg dose. However, in the opinion of the investigator, there was not a reasonable possibility that this death was related to tofacitinib.

OPT Retreatment is one of five studies from the Phase 3 OPT Clinical Trial Program, one of the largest global clinical trial programs in moderate-to-severe chronic plaque psoriasis to date. The results from this study will be included in the planned tofacitinib psoriasis submission package to regulatory authorities in various markets. Pfizer currently intends to submit a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA) for the approval of tofacitinib for the treatment of adults with moderate-to-severe chronic plaque psoriasis by early 2015.

Is it common to have liver damage from the use medication?

I am new to the club and new to bogging.I am eager to learn more about the successes of others. I do have monthly injections for the pain but I don't know if this can be long term.

This study looked at the impact of psoriasis severity on family income, 83 psoriasis patients, treated at a Polish specialty clinic, were assessed for their financial and employment status.

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Background:
Psoriasis is a common disease and the costs of its therapy, medical care and loss of productivity are a major financial burden for patients and society. The financial status of psoriasis patients and its relationship with disease severity and quality of life (QoL) remains ill characterized.

Objective:
The aim of this study was to assess the economic status of psoriasis patients and to investigate its correlation with disease severity and its impact on QoL.

Methods:
A total of 83 (45 male) psoriasis patients, treated at a Polish specialty clinic, were assessed for their financial and employment status. QoL was measured with a generic (WHOQOL-BREF) and a skin disease-related QoL instrument (dermatology life quality index – DLQI). The effects of demographic and clinical variables, including disease severity measured by Psoriasis Area and Severity Index (PASI), on the family income of patients were analyzed by multiple logistic regression. The mediating effect of family income between PASI and QoL was assessed by using the Baron and Kenny's procedure.

Results:
Patients' family income correlate negatively with psoriasis severity (Spearman's rho = −0.356; P < 0.01). Disease severity in patients with a family income below the social minimum was significantly higher (PASI: 20.5 ± 12.2) than in patients with a higher family income (PASI: 11.7 ± 7.7, P < 0.001). We found that education, disease severity and age predict 50% of the variability in family income (P < 0.001). Disease severity showed the second strongest impact on income after education (P < 0.01). Family income was found to link disease severity to global QoL impairment (P < 0.05).

Conclusion:
Disease severity negatively affects the financial status of psoriasis patients, which in turn, is a mediator of global QoL impairment. Our findings are alarming and call for long-term solutions that equalize employment opportunities for patients with psoriasis.

This study looked at 106 people and looked at the use of Enbrel (Etanercept), Humira (Adalimumab) & Stelara (Ustekinumab) for treating psoriasis and concluded the patients were happy with Bio treatments.

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Background:
Although the effectiveness of biologics for psoriasis has been measured extensively with objective outcome measures, studies based on subjective, patient-reported outcome measures remain scarce.

Objectives:
To investigate satisfaction with medication, as measured by the Treatment Satisfaction Questionnaire for Medication (TSQM) for biologics in daily practice psoriasis care in the first 6 months of treatment; and to identify possible differences in satisfaction with medication between patients experienced (biologics-experienced) and inexperienced (biologics-inexperienced) in the use of biologics.

Methods:
TSQM baseline measurements were compared using measurements taken after 6 months, using the Wilcoxon signed-rank test for paired comparisons. Intention-to-treat with last observation carried forward (ITT with LOCF) and as-treated analyses were performed. The difference between biologics-experienced and biologics-inexperienced patients for TSQM was analysed using ITT with LOCF. At 6 months, outcomes for biologics-experienced and biologics-inexperienced patients were compared using the Mann–Whitney U-test.

Results:
One hundred and six patients were eligible for analysis, and treated with etanercept (n = 34), adalimumab (n = 49) or ustekinumab (n = 23). Fifty-four per cent of patients were biologics-inexperienced. A statistically significant improvement was seen in all domains of the TSQM (‘effectiveness’, ‘side-effects’, ‘convenience’ and ‘global satisfaction’) by comparison of months 3 or 6 with baseline (all P ≤ 0·02). After 6 months, biologics-inexperienced patients scored better on the ‘global satisfaction’ domain than biologics-experienced patients (P < 0·01).

Conclusions:
We provide a prospective, longitudinal analysis of TSQM for biologics in daily practice psoriasis care. High satisfaction rates were achieved. The ‘effectiveness’ and ‘convenience’ domains showed the most room for improvement.

This study suggest that iNKT cells may become useful targets for development of novel therapeutic approaches to psoriasis vulgaris.

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Background:
There have been extensive studies regarding which types of T lymphocytes are involved in psoriasis vulgaris (PV). However, it has remained unclear which types of T lymphocytes might directly contribute to psoriasiform epidermal and vascular hyperplasia.

Objectives:
To understand the role of T-cell receptor (TCR)Vα24+ invariant natural killer (iNK)T cells in the development of PV.

Methods:
Seventeen patients were enrolled in this study. Using biopsy samples of PV plaques, TCRVα24+ iNKT cells were investigated regarding their cytokine production to understand their roles in development of disease.

Results:
The number of interferon (IFN)-γ+ iNKT cells correlated with the length of the psoriasiform hyperplasia rete ridge and the Psoriasis Area and Severity Index. IFN-γ+ iNKT cells in psoriatic skin exhibited higher C-C chemokine receptor (CCR)5 expression, and the amount of C-C chemokine ligand (CCL)5, a ligand for CCR5, was increased in capillary veins of psoriasis plaques. CCR5+ iNKT-cell numbers significantly correlated with the number of capillary vein endothelial cells expressing CCL5 in PV. Furthermore, the number of CCL5+ capillary veins correlated with the maximum rete ridge length.

Conclusions:
IFN-γ/CCR5 expression in iNKT cells and CCL5 expression in vessels of dermal papillae correlate with the development of psoriasiform hyperplasia and microabscess. We propose that these iNKT cells may become useful targets for development of novel therapeutic approaches to PV.

Hi, I have come across this international survey which aims to increase understanding and knowledge of Autoimmune Arthritis, including Psoriatic Arthritis. I found the methodology and range of questioning very good, and raised some issues for me about why early sympyoms of my PsA were not picked up by professionals. I believe that contributing to this database of knowledge will only help to identify early symptoms for others in the future. The survey is very detailed, and takes about 30 minutes.


Early Symptoms of Autoimmune Arthritis: A Patient-Centered Research Study

LINK REMOVED


The Early Symptoms of Autoimmune Arthritis Study is organized and implemented by the International Foundation for Autoimmune Arthritis (IFAA) to address improper identification of early symptoms that may correlate with a delay in diagnosis. With a vast majority of patients affected, early symptoms that accompany a primary Autoimmune Arthritis diseasetic Arthritis.  are often comprised of extensive joint involvement, systemic features and other complications. Primary Autoimmune Arthritis is an umbrella term which includes the following disorders*: Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematosus, Sjögren’s Syndrome, and Adult Onset Still’s Disease.  IFAA has identified that current published symptoms of the primary Autoimmune Arthritis diseases, which are used for detection, referral, and diagnosis, are inconsistent and fail to include some of the most common early symptoms identified in patient self-reports of their individual early disease experience.

The aim of this study is to develop a comprehensive and consistent Early Symptom Patient Model (ESPM) for the above mentioned Autoimmune Arthritis diseases and for the group as a whole, by cross-referencing existing symptom publications and detection/diagnostic criteria with the empirical research obtained from the Early Symptoms of Autoimmune Arthritis: Patient-Centered Research Study.
In addition to these core objectives, a secondary focus will be to evaluate the pervasiveness of “Undifferentiated Autoimmune Disease” diagnoses in patients which later progress to a confirmed diagnosis of Autoimmune Arthritis.

Hi, I have just come across this site whilst trying to research the difference between dovobet/dovonex.

I have today been diagnosed with severe nail psoriasis on both my fingers & toes. I also have a few minor small plaques on my body.

My consultant, this morning has advised I take Acitretin but I need to have the blood tests first. So today he prescribed Dovobet , & without realising, I left the pharmacy with Dovonex.

Is there a major difference between the 2 & the outcomes expected ?

Should I go back & get it changed?

Thanks for any help

Hey guys!

How is everyone doing? My first post
I'm 21 years old, I've been diagnosed with psoriasis Feb 2014. I was living in Nigeria all my life, I moved to Toronto 4 years ago and ive been perfectly clean. Only recently I've been almost 80% covered with psoriasis. I can say I'm pretty lucky I do not have it on my face, I'm already very shy, the P on my face would have totally destroyed my confidence. I'm guessing my P got triggered due to the cold winter? but then why not 2-3 years ago when I moved? why now?

I've been going to the derm since Feb 2014, and have been using prescribed topical steroid creams, clobex spray and what not, all it did was burn a layer of my skin. I do not think it helped at all. Recently I started Homeopathy, I do see some changes but not significant enough. Apparently the process takes 3-6 months.

The derm suggested I do Phototherapy...3 times a week for 5 minutes each session. would you guys recommend this? is this a temporary solution? have any one of you tried this? I heard it might trigger sun burns and even skin cancer.

Thanks for reasding guys!

Tl;dr- would you guys recommend phototherapy?

Doctors at The University of the Philippines Manila – Philippine General Hospital say that Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.

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Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors.

Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling.

Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient’s condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued.

Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive.

Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.

Gosh, all these symbols! All I know is that this is causing me much distress.  Doctors suggest steroids but didn't realise it was everywhere -have gone down that route -it's now getting difficult to control -people making comments at work!  I know I shouldn't but scraping off with my nails - relief instant but pain afterwards.  It's on my face!

Hi, first post to this forum. My son has Chrons and Psoriasis and Psoriatic Arthritis. I do think there is a link, but have no knowledge of any formal tests or official info on it. I just think so.

Hi everyone, this is worth a look.



"Uniting the world of autoimmune arthritis diseases under one 'virtual' roof.

"WAAD" is a Virtual Event held annually on May 20th.  To accommodate all people, the "virtual doors" open at 6am ET/USA May 19th & close on May 21st at 5am ET/USA, allowing all people to participate in live events during May 20th in their own time zone.

THIS IS AN ONLINE EVENT.  ANY PERSON IN THE WORLD CAN ATTEND WORLD AUTOIMMUNE ARTHRITIS DAY AS LONG AS THEY HAVE INTERNET SERVICE."

Yes Jim it's a study, but you may like this one. It was published in The British Journal of Dermatology

This observational study recorded data on quality of life, treatment efficacy and drug dosing in patients suffering from psoriasis treated with Fumaderm® under conditions of daily practice in 78 dermatological centres.

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Patients and methods:
In this prospective, multicenter, non-interventional trial we included adult patients with severe plaque psoriasis under outpatient conditions receiving Fumaderm® according to the current summary of product characteristics for systemic treatment of psoriasis. At baseline and after 3, 6 and 12 months the dosing regimen under daily conditions, dermatology life quality index (DLQI), and clinical efficacy with the psoriasis area and severity index (PASI) were documented.

Results:
A total of 249 patients were included. The mean DLQI score at study entry was 9.95, the mean PASI was 16.8. The average treatment dose of Fumaderm® was 2.8 tablets daily. More than 70% of patients were treated with 1 to 3 tablets daily and <30% were treated with a dose ranging from 4 to 6 tablets daily. DLQI and PASI improved in the entire study population by 67.2% and 66.6%, respectively. Specifically, when analyzing patients who started Fumaderm® within 4 weeks before baseline the mean DLQI score decreased from 11.8 to 2.9 (75% reduction) and the mean PASI score from 19.84 to 7.35 after 12 months (63% improvement).

Conclusion:
This is the first field study analyzing the use of Fumaderm® and the improvement of quality of life in patients with psoriasis under daily outpatient conditions. The improvement of DLQI obtained with Fumaderm® was comparable to the improvement observed in patients with psoriasis treated with modern biologics. Importantly, in most patients with good clinical response the treatment dose was 1 to 3 tablets daily.

Hi
I have been on Fumaderm for about 6 weeks now and though my progress is slow I was wondering if anyone has experienced a rash when taking it?

Looby

Following on from this post Amgen's Brodalumab Phase II Data Amgen And AstraZeneca Announce Positive Results From Phase 3 Study Of Brodalumab (AMG 827) In Patients With Moderate-to-Severe Plaque Psoriasis.

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Amgen (NASDAQ: AMGN) and AstraZeneca today announced that the Phase 3 AMAGINE-1TM study evaluating brodalumab in patients with moderate-to-severe plaque psoriasis met all primary and secondary endpoints for both evaluated doses. Brodalumab is the only investigational treatment in development that binds to the interleukin-17 (IL-17) receptor and inhibits inflammatory signaling by blocking the binding of several IL-17 ligands to the receptor. Primary endpoints were patients achieving at least a 75 percent improvement from baseline in disease severity at week 12, as measured by the Psoriasis Area Severity Index (PASI 75), and patients achieving clear or almost clear skin at week 12 according to the static Physician Global Assessment (sPGA 0 or 1).

A significantly higher proportion of patients treated with brodalumab achieved a PASI 75 response (primary endpoint), as well as PASI 90 and PASI 100 responses at week 12 (secondary endpoints) compared to placebo. Results showed that 83.3 percent of patients in the 210 mg group and 60.3 percent of patients in the 140 mg group achieved PASI 75 responses compared to placebo (2.7 percent). Results also showed that 70.3 percent of patients in the 210 mg group and 42.5 percent of patients in the 140 mg group achieved PASI 90 responses compared to placebo (0.9 percent). Further, 41.9 percent of patients in the 210 mg group and 23.3 percent of patients in the 140 mg group achieved PASI 100 responses compared to placebo (0.5 percent). Of the 661 patients enrolled in this study, 46 percent reported prior biologic use and 28.7 percent weighed more than 100 kilograms (kg) at baseline (mean weight for the study population was 90.8 kg).

A PASI score is a measure of psoriatic plaque redness, scaling and thickness and the extent of involvement in each region of the body. Treatment efficacy is often measured by the reduction of PASI from baseline (i.e., a 75 percent reduction is known as PASI 75, a 90 percent reduction is known as PASI 90 and PASI 100 is total clearance of skin disease).

The most common adverse events that occurred during the placebo-controlled period in the brodalumab group (more than 5 percent of participants) were nasopharyngitis, upper respiratory tract infection and headache. Serious adverse events occurred in 1.8 percent of patients in the 210 mg group and 2.7 percent of patients in the 140 mg group compared to 1.4 percent for placebo during the placebo-controlled period.

"Data from the AMAGINE-1 study suggest that brodalumab may offer a new level of efficacy for patients with moderate-to-severe plaque psoriasis, a disease that affects more than 100 million people globally," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "This is the first read-out from our Phase 3 psoriasis clinical program and we look forward to obtaining additional Phase 3 data from our two head-to-head studies versus ustekinumab later this year."

Hi Everyone,

Has anyone else experienced tremendous all over body itchiness approximately 3 weeks after their Stelara injection? I have no visible P and no rash of any kind but this itching starts suddenly about 3 weeks after my Stelara injection and lasts for about 1 month, gradually improves until my nest injection when the cycle starts all over again!
My GP has tried giving me oral medications to stop the itching but nothing provides relief!
Has anybody else had this experience?

Hi Everyone,

I was happy to find this group. Psoriasis can be very isolating, even when you're clear the worry of side effects and when your P will reappear is always with you.
I have been battling this monster for 12 years and am currently having success with Stelara.
I have tried pretty much everything else, topicals, light therapy, methotrexate, cyclosporine, embrel and remicade if anyone has any questions.

More new treatments on the horizon for people with psoriatic arthritis, this one is from Covagen a privately held Swiss Biotech company.

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Switzerland, May 5, 2014 – Covagen today announced it has initiated a Phase Ib/IIa study with COVA322, a bispecific TNF/IL-17A inhibitor. COVA322 is Covagen’s lead bispecific FynomAb® developed for treatment of patients with rheumatoid arthritis, psoriatic arthritis and other inflammatory diseases. The trial will enroll 39 patients with psoriasis and evaluate safety as well as biological activity of COVA322. Enrollment in the trial and dosing of COVA322 has begun for the first cohort of patients.

“With COVA322, Covagen has moved its first proprietary FynomAb into the clinic,” said Mathias Locher, Ph.D., chief development officer of Covagen. “COVA322 has a novel mechanism of action by simultaneously inhibiting both TNF and IL-17A. This dual inhibition has the potential to result in superior efficacy compared to current treatment options for rheumatoid arthritis, psoriatic arthritis and other inflammatory diseases.”

Julian Bertschinger, Ph.D., chief executive officer of Covagen added: “We believe this first clinical study with COVA322 in psoriasis patients may indicate its significant potential to improve the treatment of inflammatory diseases and help to validate the capabilities of our proprietary bispecific FynomAb platform. We expect to have top-line data in the first quarter of 2015.”

The primary aim of the Phase Ib/IIa trial is to evaluate the safety, tolerability and pharmacokinetics of a single ascending dose of COVA322. The randomized, double-blind, placebo-controlled, multi-center study will be conducted in Germany in 39 patients with psoriasis. Secondary endpoints include readouts on psoriatic skin lesions as well as biological responses measured in skin biopsies.