Objective:  To describe the use of systemic therapy for psoriasis (biologic and nonbiologic classic drugs) in patients not adequately represented in randomized controlled trials (RCTs) and the risk of serious adverse events (SAEs) in these patients.

Design:  A registry inception cohort was used.

Setting:  Thirteen dermatology departments in Spain participated.

Patients:  A consecutive sample of patients treated with biologics and a systematic sample of patients treated with classic systemic therapy were evaluated. A total of 1042 patients (2179 person-years) were included.

Exposure: Inadequate representation in trials was defined as the presence of any of the following factors: elderly age (>70 years); type of psoriasis other than chronic plaque psoriasis; history of infection caused by hepatitis B, hepatitis C, or human immunodeficiency virus; history of cancer (excluding nonmelanoma skin cancer); and chronic renal or hepatic disease.

Main Outcome Measures:  Serious adverse events as defined by the International Conference on Harmonization were evaluated.

Results:  In all, 29.8% of patients receiving systemic therapy for psoriasis would not have been eligible for RCTs. These individuals had an increased risk of SAEs (incidence rate ratio, 2.7; 95% CI, 1.5-4.7). Patients exposed to biologics had an adjusted increased risk of SAEs (incidence rate ratio, 2.3; 95% CI, 1.1-4.8) that was similar in patients eligible and ineligible for RCTs.

Conclusions:  Patients ineligible for RCTs are an important proportion (30%) of those receiving systemic therapy for psoriasis. These patients have a higher risk of SAEs and should be closely monitored. Patients exposed to biologics (whether these patients are eligible for RCTs or ineligible) are susceptible to the same increase in risk of SAEs, but biologics add to a higher baseline risk in patients who are ineligible for RCTs. The risk-benefit ratio in ineligible patients receiving biologics might be different from the ratio in eligible patients.

Source: ama-assn

An expert in skin conditions has told a medical hearing he was “a bit shocked” to learn that another consultant dermatologist had prescribed a medication, normally given to adults only, to an 11-year-old boy with psoriasis.

The evidence was heard at the second day of a Medical Council inquiry into allegations of professional misconduct and poor professional performance against Dr Adam Jacobus Smith of the Whitfield Clinic in Waterford.

Dr Smith treated a boy with psoriasis and prescribed him Neotigason, described as “inappropriate” for children. Another patient, who was then 17, asked the consultant if using sunbeds would help his psoriasis. Dr Smith told him sunbeds could be “unsafe”, but that he could use them twice a week, for two weeks, and not return after that. Consultant dermatologist Dr Con Buckley told the inquiry he found it “extraordinary” that a dermatologist would “condone” the use of sunbeds, which were linked with skin cancer, to help any condition. The hearing continues today.

Source: irishtimes.com

well just to say my plaque psoriasis, is well on it,s way to turning into Erythrodermic, am very sore , and defo not feelin my best, but better note only 3 weeks till i go to the hospital, hopin he,s goin to take me off fumaderm, as i fink this as made it worse, don,t no what he will gave me this time , hope everyone else is feelin better than me have a lovely day

Thanks! I'm very excited to join the forum. Ive had psoriaisis since '97 and have been on every tx around, except Stellara. I currently have no insurance so my tx options are limited to steroid creams, prednisone and steroid injections every six weeks. Needless to say, I'm very uncontrolled and have total body coverage now. Look forward to meeting new friends!

Bariatric surgery (weight-loss surgery) for obesity has beneficial effects on psoriatic symptoms, show study results.

Psoriasis is more common and severe in people who are obese than in normal-weight individuals, explain Magdalena Farias (Pontificia Universidad Católica de Chile, Santiago, Chile) and team.

However, recent findings have suggested that in addition to dramatic weight loss, bariatric surgery also has beneficial effects on comorbidities such as psoriasis and diabetes.

To investigate the effects on psoriasis further, Farias and co-authors assessed symptoms and severity of psoriasis in 10 obese (mean body mass index [BMI]=38.8 kg/m2) patients before and after bariatric surgery (eight laparoscopic Roux-en-Y gastric bypass and two sleeve gastrectomy).

In total, 50% of the patients were receiving topical treatment for psoriasis before their surgery and 40% systemic treatment.

Following surgery, 70% of the patients had a remission of their psoriasis symptoms that was sustained for at least 6 months. In addition, three of the four patients on systemic drug therapy were able to stop their medication.

The impact of psoriasis on quality of life, as assessed by the Dermatology Life Quality Index, improved significantly from a score of 14.9 before to 5.0 after surgery.

Bariatric surgery also had a beneficial effect on other comorbidities in these patients, resulting in a 75% resolution of diabetes in those who had the condition before surgery, as well as a 100% resolution of insulin resistance, and a 57% resolution of hypertension. Weight loss was also highly successful, with participants achieving a mean weight loss corresponding to 88% of their pre-surgery excess weight at 1 year.

"Bariatric surgery for positive metabolic, skin, and quality of life results should be considered as a useful adjuvant therapy for obese patients with psoriasis," write Farias and co-authors in Obesity Surgery.

However, they concede: "These first results have to be confirmed by long-term controlled studies."

An interesting and positive study on Multiple Sclerosis.
751955  and article 740695
don't know if you can see it, but otherwise you can registrate for free if you want to.

Why MS, while this is a psoriasis forum?
Well, that is because MS is an auto immune disease (what a coincidence!) and because of the treatment with BG-12, in other words dimethylfumarate, another coincidence, which also works very good against psoriasis.

It appears from the study that BG-12 seems to work very well against the progress of MS. The rumor is heard that shortly there will be a publication in The Lancet on the treatment.
Could it be, that one of the best cures for psoriasis, comes in sideways by means of the doorway of MS?
Only time will tell.

Comparative Effectiveness of Commonly Used Systemic Treatments or Phototherapy for Moderate to Severe Plaque Psoriasis in the Clinical Practice Setting

Objective: To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis.

Design:  A cross-sectional design was used.

Setting: Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study.

Participants:  A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy.

Main Outcome Measures:  The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index.

Results:  The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency.

Conclusions: The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.

Source: ama-assn.org

Hi, I'm Dan and I have been a psoriasis sufferer for most of my life. I have been lucky in that my psoriasis is only mild and for the most part concealable. I've joined this forum to offer and share ideas, remedies and ideas with other sufferers of this condition.

Dan

Objectives:  To better define mechanisms by which etanercept (Enbrel) improves psoriasis and to gain insight into disease pathogenesis.

Methods:  We investigated the early biochemical and cellular effects of etanercept on skin lesions in responder patients prior to substantial clinical improvement (≤4 weeks).

Results:  By 1 week, etanercept acutely suppressed gene expression of the IL-20 subfamily of cytokines (IL-19, IL-20, IL-24), which were found to be predominantly epidermis-derived and which are implicated in stimulating epidermal hyperplasia. Additionally, by 1 week of therapy, suppression of other keratinocyte-derived products (chemokines, antimicrobial proteins) occurred, while suppression of epidermal regenerative hyperplasia occurred within 1-3 weeks. Th17 elements (IL-23p19, IL-12p40, IL-17A, IL-22) were suppressed by 3-4 weeks. In vitro, TNF-α and IL-17A coordinately stimulated the expression of the IL-20 subfamily in normal keratinocytes.

Conclusions:  Based on the rapid suppression of regenerative hyperplasia, chemokines, and other keratinocyte-derived products, including the IL-20 subfamily, we propose that epidermal activation is a very early target of etanercept. As many of these keratinocyte markers are stimulated by TNF-α, their rapid downregulation likely reflects etanercept’s antagonism of TNF-α. Additionally, decreased epidermal hyperplasia might result specifically from acute suppression of the IL-20 subfamily, which is also a likely consequence of etanercept’s antagonism of TNF-α. Thus, the IL-20 subfamily has potential importance in the pathogenesis of psoriasis and therapeutic response to etanercept.

Source: British Journal of Dermatology. onlinelibrary.wiley.com

Has anyone had any real success without any appreciable side effects
? Thanx, Marlin

psoriasisclub.org Hi, My name is Marlin, and I have Psoriasis Plaque BAD! I started getting it about 10 years ago,...and now my wife finally left me. Bout fed up feeling like a Leper, or a mangy dog. Seems as tho a Psoriasis person has 2 choices...Live with a Lousy Rash that irritates other people and try creams that dont work well...or take meds that threaten your very being by destroying organs etc. Anyhow,...I hope God has sent me to the right place for help. Here I am,...I'm reaching out...FINALLY

Hello My name is Emma and I have been diagnosed this week. On my various searches I found your forum.

I have had this for 2 years+ and have not gone to the doctors in that time as a) I thought it was something else and b) I have been too embarrassed. Over the last few months for so it has moved to my head and it's extremely itchy and have been feeling exhausted all the time which I have put down to my job. Previously it has been confined to my unmentionables and I put it down to being overweight (front and back, thought I had Hermaroids and thrush and trying to self treat). I went to the doctors on Wednesday and had a lecture about not going sooner and the embarrassment of being examined by a male doctor and a nurse whose intake a breath showed her disgust.

I don't have an intimate relationship with my partner which does not bod well as we are supposed to be getting married and want to have more children. I work nights in a highly stressful job, long shifts and plenty of stress however I do find this very enjoyable.

My boss has forced me to go to the doctors as she was worried that I was suffering from depression (was off for 4 months following my Dad's death last year). Feel embarrassed to talk to her about this new development. I just want to cry.

Any advice you can offer would be appreciated. I want to try and change my diet and an unsure how fast or what to cut out first. I want to get better and have a better standard of life.

Thanks in advance

Hello there everybody. My PPP has been a lot better since PUVA, which finished about two months ago It has cleared from my hands and my feet have been a lot more comfortable.

Alas, I got a very stressful long phone call last evening. I have been trying my best not to over-react to it and keep calm all day. I don't really want to put this in writing, in case it makes it "real", but I think that PPP is maybe beginning to reappear on my left foot. Can PPP really react this quickly? If it can, it's a real warning.

Thanks for being there. Susie

UPDATE: Some of our members got together and decided the DLQI used by dermatologists didn't give a good representation of how psoriasis affects our daily life, so we decided to make our own version and this is what we came up with:
https://psoriasisclub.com/psoriasisquali...score.html

XenoPort, Inc. (Nasdaq: XNPT) announced today that it was awarded U.S. Patent 8,148,414 for "Prodrugs of Methyl Hydrogen Fumarate, Pharmaceutical Compositions Thereof, and Methods of Use." The term of the patent extends until 2029, subject to potential Hatch-Waxman patent term extensions.

The patent is directed to the XP23829 compound, analogs thereof and formulations thereof. A related U.S. patent application directed to therapeutic uses of XP23829 is now pending.

XP23829 is a prodrug of methyl hydrogen fumarate, also known as monomethyl fumarate (MMF). In cell- and animal-based models, MMF has been shown to exhibit immuno-modulatory properties and inhibit damage from oxidative stress.

In XenoPort's preclinical animal studies that compared molar equivalent doses of XP23829 to dimethyl fumarate (DMF), another prodrug of MMF, XP23829 demonstrated a greater degree of efficacy in animal models of both multiple sclerosis (MS) and psoriasis. Toxicology studies conducted in two species showed that XP23829 caused less stomach irritation compared to DMF.

XenoPort intends to file an Investigational New Drug Application (IND) for XP23829 for the treatment of relapsing remitting MS with the U.S. Food and Drug Administration (FDA) in the second quarter of 2012 and expects to initiate human clinical trials later this year.

XenoPort owns all rights to XP23829.

Source: xenoport.com

Hi, I'm new to the forum and hope to contribute as well as learn from others.

I have had psoriasis since around age 15 and psoraitic arthritis since around age 23. I've tried many many drugs to help it including Humira which worked amazingly temporarily.

My reason for posting today is, I am always tired and drained feeling and I am wondering if this is caused by my psoriasis? I figure, if a cold or other sickness makes you feel week, then anything else stressing your immune system could do the same, right?

If this is why I always feel like this, is there anything I can do to help it?

Has anyone else noticed how stress affects their Psoriasis?

I have noticed that when i'm very stressed the Psoriasis becomes much more visable but when i'm feeling relaxed it almost disappears. Has anyone else had similar experiences?

Richard
25, Male

Dear All,

I just wanted to introduce myself and talk about my Psoriasis a little bit. It would be nice to have someone to speak with about it, if someone had the time.

I am 25 years old, male, working in a busy job in london but without too many life-responsibilities. I am not married and do not have children so life is sort of simple on the whole.

I was diagnosed with Psoriasis a few months ago although i noticed it first about 2 years ago localised on my elbows.

The psoriasis came to life when i was in a highly stressful sitaution at work. I tried to fight the stress and ignore it at first but i eventually quit my job and became unemployed for a few months. I was severely stressed due to work, i used to get stomache cramps and breathing problems in the evenings. In short i hated my job and my colleagues. It was my first encounter with stress but it was severe. I would say that i have not really been highly stressed since but i've noticed that since being very highly stressed in the past it can sneak up on me from time to time and it is something i try my best to control.

I've noticed that when i bcome stressed the Psoriasis tends to become worse. It shows on the back of my hands and knuckles. As of today i'm feeling quite chilled with everything and it's not showing on my hands and is only lightly on my elbows. I'm enjoying life, have a very nice job with great colleagues and a nice girlfriend.

From what i have noticed the Psoriasis is directly linked with my stress levels so i am always trying to keep my stress to minimum.

As already mentioned I am treating it by keeping a stress-free life but also:

- I am very active with exercise which i think helps. I go to the gym 3 times minimum a week and do a variety of weight lifting a long cardio sessions. I think this helps a lot and also helps to keep me stress free.
- I have not quit, but i have reduced my alcohol intake massively. I get drunk very rarely now and hardly ever socially drink. I do not drink with meals either.
- I have upped my water intake substantially and eat fruits regularly (not sure if this actually does anything though)
- In terms of medicine i take prescribed Dovonex Ointment for my elbows which i massage into my skin in the evenings
- I also take vitamins D, Evening Primrose Oil and Cystenine (in 1 tablet) (otherwise known at Skin, Hair and Nails) and i also take Omega Oils 3, 6 and 9. I also take vitamin c every two days. I have been taking these for about 6 weeks now and i think it is benefitting me somewhat.
- I have done a few sun bed treatments at my gym just to experiement what would happen but this seemed to make no difference.

Well that's all i have to say... I think that stress is the key here and it is this which causes outbreaks. So i'm going to try my best to live a stress free life... but obviously this is easier said than done...

Thanks if you read. I would love to have any comments!

Kindest Regards,

Richard

The second round of talks about the new Skin Tax is being discussed today by members of the European Parliament in Brussels. It’s estimated that Psoriasis costs businesses in each EU country over €97 Million in lost working hours, and the health systems another €853 Million. Taking into account other skin problems the total loss to the EU is estimated to be €232.7 Billion per year.

The new Skin Tax has been put forward as a cost cutting measure to help with the Euro Crisis, and the 751 members of the European Parliament have been asked to give suggestions for the new Skin Tax.

Today is the second round of discussions before the proposals accepted from the first round of talks are put to the vote.  The results of the vote will choose the top two proposals which will go forward to be discussed at the third and final round.

The proposals already accepted from the first round of talks are:

#1 Everyone over the age of 18 will have to pay a Skin Tax of €17 per annum.

#2 All people over the age of 16 with a skin complaint will have to pay a Skin Tax of €57 per annum.

#3 All adults will pay €5 per annum, children €1 per anum, pensioners and unemployed will be exempt, but people classified as obese will have to pay an extra €0.05 per kilo they are classified as overweight.

#4 A €2.50 Skin Tax charged to all adult visitors to the EU from a non-member country. It’s estimated that this option will bring in €200 Billion per annum with a bonus of another €1.3 Billion for this year’s Olympics in the UK.  

#5 Only people with healthy skin over the age of 18 and in work will pay a Skin Tax of €12 per annum. Those people with healthy skin not in work but over 18 will have to do 1 hour hospital community service per year.  

As a psoriasis patient the best option for you would be #5 as you wouldn’t have to pay any Skin Tax.

So what can you do?
Well you could talk to your local politician who has a seat on the European Parliament and try to swing him/her to Option #5.

But probably the best thing would be to make your voice heard at the online Skin Tax Poll which has been set up by FSTFA (free skin treatment for all) they have the 5 options above on the poll with the addition of their own choice which is “The Skin Tax proposals are against EU health regulation BF19353/E-section5D2”
EU regulations BF19353/E-section5D2 states that a Europe wide change in any form of funding for dermatologic healthcare, cannot be decided upon without full representation from a body of 5 dermatologists from each EU member country.

Leo Pharma, a global leader in dermatology preparations, has rolled out a first-of-its-kind support programme for psoriasis patients in the region starting next month.

Leo Pharma, makers of a new once-daily gel formulation for the treatment of scalp psoriasis, said that its programme MOMENT will be run across the UAE and the Gulf in partnership with psychologists and dermatologists.

“There are a sizeable number of psoriasis patients across the UAE and the Gulf region and MOMENT will address them on an emotional scale, a very imperative need considering the psychological impact of this skin disease on a person,” said Hisham Omar, general manager, Gulf Region, Iran, Yemen & Turkey, Leo Pharma.

“We believe that MOMENT is perhaps a first-of-its-kind support programme for psoriasis patients in the Gulf since such endeavours are largely unknown and are far and few in the region, he said, adding that the support programme had been running in other countries in the world and some parts of the Mena successfully.”

“Psoriasis being a life-long disease, national support groups play a very important role in engaging the patients on a psychological plane helping them manage their life on a day-to-day basis,” said Dr Hussain Abdel Dayem, consultant dermatologist at Al Noor Hospital, Abu Dhabi.

He said currently there are no national support groups for psoriasis patients in the UAE or the Gulf region.

“It is estimated that some 2.8 per cent of the UAE’s population has psoriasis affliction and support groups are a dire necessity. Psoriasis affects all ages and mostly among middle aged people, but we have even seen it among kids,” Dr Dayem said.

I'm saying nothing: https://psoriasisclub.org/showthread.php?tid=513