This study looked at the impacts of gene polymorphisms on Methotrexate in Chinese psoriasis patients.

Quote:

---

Background:
Methotrexate (MTX) is the first‐line treatment for psoriasis in China. The metabolic processes of MTX include various proteins and genes. Previous studies have shown that gene polymorphisms had significant impacts on the efficacy of MTX. However, the influence of gene polymorphisms has not been reported in the Chinese psoriatic patients.

Objective:
The aim of this study was to verify the impacts of candidate genes polymorphisms on the effectiveness of MTX in a Chinese psoriatic population.

Methods:
In this study, we enrolled 259 psoriasis patients from two clinical centres. Each of them received MTX treatment at 7.5‐15 mg/week for at least 8 weeks. Patients were stratified as responders and nonresponders according to whether the Psoriasis Area and Severity Index score declined more than 75% (PASI75). According to previous reports, 16 single‐nucleotide polymorphisms (SNPs) were selected and genotyped for each patient using the Sequenom platform. Fisher’s exact test, the χ2 test, Mann‐Whitney tests, and ANOVA analyses were used for statistical analysis.

Results:
Among 259 patients, there were 182 males and 77 females, 63 patients with psoriatic arthritis and 196 patients without arthritis phenotype, and the age of all patients ranged from 19 to 70 years (49.7±13.6). The baseline PASI value of patients was 13.8±8.5, and 33.2% of patients achieved a PASI75 response after MTX treatment. Patients carrying the ATP‐binding cassette subfamily B member 1 gene (ABCB1) rs1045642 TT genotype were associated with more severe psoriasis skin lesion (P=0.032). Furthermore, the ABCB1 rs1045642 TT genotype was found to be more frequent in nonresponders (P=0.017), especially in moderate‐to‐severe patients (P=0.002) and patients without psoriatic arthritis (P=0.026) after MTX treatment.

Conclusion:
We have demonstrated for the first time that polymorphism of the ABCB1 rs1045642 TT genotype is predictive of a worse clinical response of skin lesions to MTX therapy in a Chinese psoriatic population.

This study evaluated the effectiveness, safety, and drug survival of Otezla (apremilast) at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice.

Quote:

---

Background:
Little has been published on the real‐world effectiveness and safety of apremilast in psoriasis.

Objectives:
To evaluate the effectiveness, safety, and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice.

Methods:
Retrospective, multicenter study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018.

Results:
We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI‐75 (≥ 75% reduction in PASI score) and 26.5% achieved PASI‐90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems.

Conclusions:
Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.

I’ll be taking my third dose tonight and just wondering when I could be seeing results? Pretty sure my dermatologist said it could take 3 months but obviously I want instant results (yes I’m impatient!). Luckily I’ve had no side effects. My slight concern is my GP may not do my 4 week blood test due to the coronavirus but guess have to see when the time comes.

Taltz is now approved by the FDA (U.S. Food and Drug Administration) for use in children over 6 years.

Quote:

---

Eli Lilly announced today the U.S. Food and Drug Administration (FDA) has approved a supplemental Biologics License Application (sBLA) for Taltz® (ixekizumab) injection, 80 mg/mL for the treatment of pediatric patients (ages 6 to under 18) with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Xeljanz (Tofacitinib) is sometimes precribed to treat psoriatic arthritis.

The UK have issued a drug safety update for it's use:

Quote:

---

Tofacitinib: New measures to minimise risk of venous thromboembolism and of serious and fatal infections.

Caution should be used in patients with known risk factors for venous thromboembolism in addition to the underlying disease. Patients older than 65 years of age are at an increased risk of serious infections and should be treated with tofacitinib only if there is no alternative treatment.

After starting this thread Covid-19 (aka Coronavirus) and psoriasis and one member saying they have been advised to stop Cosentyx I thought it would be a good idea to run a poll about psoriasis treatments and covid.

Some treatments can weaken our immune systems and I wondered how many people will be thinking of stopping their treatment during the threat of covid-19.

*I have not found any official advice about stopping a treatment, but you should all discuss the matter with your own healthcare professional if you have concerns.

This poll is open to guests and our members are welcome to vote and post in this thread too if they wish.

Hi all, l've had a thought recently about my upcoming meds.

I am due to start Skillarence next month which as you know has an effect on your immune system. Will this make me more susceptible to complications from the coronavirus?

However I also read that a lot of the fatalities come from an overreaction of the immune system causing widespread inflammation, so conversley if Skillarence is supposed to help reduce inflammation will it actually help prevent complications by reducing the likelihood of the immune system overreacting?

Does all of that make sense or am i barking up the wrong tree with this?

Hi..my name is Mary from New York. Have had psoriasis since 1980 but it got better as I got older. 2 months ago I had a horrible flare up and have eczema as well. I’m 68 and can’t believe this! Dr. gave me creams,etc. My hands cleared up with the steroid cream but had to stop for 2 weeks and it is back. Can start again this week. It’s the itch that’s driving me nuts. Any suggestions? Thanks everyone.

I have seen a few posts on Psoriasis Club recently about the ongoing Covid-19 virus. We do have a thread in the members only board [Group Specific] and most members seem to be saying carry on as usual.

However it is something that is going to get asked so let's have this thread where we can put information for those with psoriasis.

First off I should point out that none of us at Psoriasis Club are medical professionals and you should follow the advice from your own healthcare system, we are just people like you living with psoriasis.

I have spent a lot of time looking for information as it's starting to worry some of our members, and as far I can see there is no reason for anyone taking a treatment for their psoriasis to stop.

Yes we have a recognised immune problem and this can be made worse with some treatments, but as far as I can find the recommendation is to continue with our current treatments.

I will continue to monitor the Covid-19 and Psoriasis news and update this thread if I have anything official to tell you.

*Members are welcome to post in [Group Specific] if they have any supported official information about Covid and Psoriasis, but I will close this thread and update it if necessary to avoid it getting information overload.

• Inflammatory rheumatism and autoimmune diseases are not among the proven risk diseases to date.
  
• Do not change the treatment for your disease ; it does not increase the risk of getting the infection.
  
• Some treatments used in inflammatory rheumatism (hydroxychloroquine, JAK inhibitors, corticosteroids) have even been used or proposed for their potential anti-viral effect and to treat excess inflammation in severe forms of pneumonia complicating COVID-19.
  
• Any suspension of your usual treatment would expose you to a flare-up of your rheumatism and thus to an episode of frailty.
  

Quote:The recommendations of the ResoPso association, which are addressed to the patients receiving immunomodulatory treatments prescribed in chronic inflammatory dermatoses including psoriasis are the following:

For patients currently under treatment, the French Dermatology Society (Société Française de Dermatologie) recommends in a recent press recent press release "not to interrupt these treatments for a PREVENTIVE purpose".

As far as our group is concerned, and in accordance with the position of the scientific societies involved in the prescription of immunomodulators, it is not advisable to stop a treatment in progress that is well tolerated.

This decision must however be pondered according to the specific pathology, its severity, its control, its risk of relapse, the age and comorbidities of the patient.

It is up to the healthcare professional to assess the situation on a case-by-case basis, in consultation with his patient, and to decide whether to suspend the immunomodulatory treatment temporarily or pursue the treatment.

Quote:To date, the BAD is not aware of any good evidence that people taking drugs that target the immune system are at a greater risk of getting COVID-19 or of having a more severe form of the illness to inform this decision.

What happens if my patient wishes to pause therapy?

When providing advice take the following into consideration:

The views and concerns of the patient

The baseline risk of the person for developing significant COVID infection (for example age >70, co-morbidities)

The need for the drug (or drugs) and likely outcome if stopped (including how easily the treatment could be re-started, alternative options that may be acceptable to the person in this context e.g. topicals, and the clinical impact of a disease flare)

This will be my new thread for my journey on Tremfya.

I've had 3.5 years on Cosentyx but it's now failed in it's job at keeping the psoriatic arthritis away. You can read that journey here: Cosentyx for psoriatic arthritis Fred's journey

Tremfya is only prescribed for psoriasis in France at the moment but it is going for approval to treat psoriatic arthritis soon and I will be one of the first trying it for psoriatic arthritis.

Unlike other bio's Tremfya doesn't have a loading dose as such, you take 1 shot of 100mg followed by another at week 4. Then the maintenance dose is 100mg every 8 weeks. I have been doing bio's for well over 10 years now so it will be a simple task doing the shots myself.

It comes in two types of shot. A pre filled Syringe and an Auto injector (Pen). I prefer using the syringes as seen in this image.



Psoriatic arthritis is more important to me but I shall be using the score systems on Psoriasis Club to keep track of my progress.

Pscore

PsAscore

Psoriasis score: 8

Psoriatic arthritis score: 14

Psoriasis on one of my skins:


Psoriatic arthritis middle finger:


Annoying red itchiness on forearm


Notes for reference: Before taking my first shot I feel like I have a mild cold and a bit of upset stomach. Also the annoying red itchiness has come back again. I'm putting this here so I know I had those problems before starting Tremfya.

I will do regular updates and you are welcome to post in this thread, but please keep it On Topic.

Hello. I am posting a broad question but hope some of you can help. I'm now on Tremfya  (after taking all else with no help and got all side effects - mostly upped respiratory infections.)
Psoriasis now is painful psoriatic arthritis and autoimmune issues such as lupus.
I started Tremfya on Sunday. I cannot lift my head from my pillow because of severe exhaustion!. When I do get up I have extreme lower back and leg pain.
I don't want to give up. I'm hoping a second dose in a few weeks will bring clear skin as less pain.  I just want to know if anyone else felt these "side effects" when first taking Tremfya. The nurse at Jannsen had nothing to tell me except I would get a letter from them. 
I'm ending day 3 feeling extreme fatigue, pain and still growing New placque. Not what I expected.
Your help.is appreciated.Thank you.

I was just reading TL's comment about anti drug antibodies in response to biological drugs here: RE: Cosentyx for psoriatic arthritis Fred's journey and it's interesting.

I had often thought my body somehow just gets used to my current treatment and it stops working, but I never understood (and still don't really) exactly what was going on. But there is a lot out there about "Anti drug antibodies" and it does make some interesting reading.

Here is how I see it.

#1 My body is making too much of one cell and I get psoriasis, then as it gets worse I also get psoriatic arthritis.

#2 I take a treatment that bombards me with a cell to try and slow down the process and I feel better.

#3 My body then starts to fight against the treatment as it now sees it as a threat.

So eventually there is a high likelihood that my body will eventually get used to the treatment and stop it working.

Thoughts anyone ?

Hi All,

Just a few weeks i ago i was so optimistic with my Cosentyx treatment that i started a topic on whether or not i could reduce dosage from 300mg to 150mg per month.
I asked this here because i am using this under no supervision. (No biologics available in my country, local dermatologists google it right in front of me).

However in the past 4 weeks i've noticed returning signs of my psoriasis starting with my fingernails.
Now i have numerous small patches which to the unaware eye seem harmless. But i (we)'ve seen this before, and we know which direction this is heading because it is slowly but surely increasing.

I take my shots at the hospital because i receive it in a "solution" not in a pen or injection. So the injection has to be made.
I had been travelling in November and took that months shot 2 weeks late. This happened again in December, 2 weeks late for my shot.
So 6 week gaps between the two. And as of last month i had closed it back to 4 weeks.

I'm regretting being so supine about it since now i am unsure if the cosentyx it self is losing its effectiveness or if it is because of my large gaps.
I'm also wondering if it is possible to do the Loading Phase again, perhaps slightly less than the first time but adding another 2 shots to my next month.

If any of you have ever "reloaded" i'd love to hear your thoughts.

hi there, I have been on Otezla now for around 3 years and now have a Lymphocyte count of 1.0.  I have no idea what that means other than I cannot be prescribed the recommended non biological.  Has anyone else experienced this, any advice appreciated, with thanks for your time reading.

This study suggests improved collaboration between rheumatologists and dermatologists is needed for patients with psoriatic arthritis.

Quote:

---

Background:
Psoriatic arthritis (PsA) is a chronic and debilitating disease that can be managed by different clinical specialists.

Objectives:
The objective of the LOOP study was to evaluate the impact of clinical specialty setting on the time to diagnosis and treatment of patients with PsA. Clinical disease activity and disease burden were also compared between clinical settings.

Methods:
LOOP was a cross‐sectional, multicentre, observational study conducted in 17 countries in Western and Eastern Europe, the Middle East, Latin America, and Asia. Adult patients (≥18 years) with a suspected or established diagnosis of PsA who were routinely visiting a rheumatologist, dermatologist or non‐rheumatology/non‐dermatology physician were enrolled. All patients were assessed by both a rheumatologist and a dermatologist.

Results:
Of 1483 enrolled patients, a total of 1273 had a confirmed diagnosis of PsA. There was no significant difference in the median time from onset of inflammatory musculoskeletal symptoms to PsA diagnosis between patients enrolled by rheumatologists and dermatologists (6.0 vs. 3.9 months). However, the median time from diagnosis to first treatment with a conventional synthetic disease‐modifying anti‐rheumatic drug (csDMARD) was significantly shorter in the rheumatology setting compared with the dermatology setting (0 vs. 2.0 months; P < 0.001). In addition, disease activity was significantly higher in the dermatology setting compared with the rheumatology setting.

Conclusions:
Differences in the management and clinical status of patients with PsA were observed between the rheumatology and dermatology settings. Importantly, median time from diagnosis to first csDMARD was significantly shorter in the rheumatology setting, and patients in the dermatology setting had higher disease activity. These data show the importance of improved collaboration between rheumatologists and dermatologists.

The European Commission (EC) have approved the use of Stelara (ustekinumab) in age 6+ for the treatment of psoriasis.

Quote:

---

Janssen Pharmaceutical today announced that the European Commission (EC) has approved the expanded use of STELARA® (ustekinumab) for the treatment of paediatric patients (ages 6–11) with moderate to severe plaque psoriasis. Ustekinumab was previously approved for use in adolescent and adult patients with plaque psoriasis, aged 12 years and older, and is now the first available biologic treatment in this patient population to selectively address the IL‑23/IL‑12 pathway, an important therapeutic target for the condition.

In one third of the 14 million cases in Europe, psoriasis begins in childhood. Psoriasis is an immune-mediated inflammatory disease that affects the skin, resulting in areas of red or inflamed skin covered with silvery scales, which are known as plaques. The condition can have a profound, long-term impact on the psychological health and overall quality of life for children. The development of paediatric psoriasis is also associated with high incidence of low self-esteem, and it can have long-term ramifications into adulthood and beyond.

“This latest EC approval is a significant milestone for young children struggling to cope with the symptoms of psoriasis,” said Lloyd Miller, Vice President, Immunodermatology Disease Area Leader, Janssen Research & Development, LLC. “We’re delighted that this therapy, which has a well-established safety and efficacy profile in adults with plaque psoriasis and other immune diseases, is now expanded to children as young as six who are living with this chronic disease.”

The EC approval is based on results from the Phase 3 CADMUS Jr study, building on the prior Phase 3 CADMUS study, which found ustekinumab improved the signs and symptoms of plaque psoriasis, as well as health‑related quality of life (HrQOL), in paediatric patients aged six to 11 years old. The primary endpoint was the proportion of patients who achieved a physician’s global assessment (PGA) score of Cleared (0) or Minimal (1) at week 12. Secondary endpoints included the proportion of patients achieving improvements in psoriasis area and severity index of ≥75% (PASI 75), ≥90% (PASI 90), and change from baseline in Children’s Dermatology Life Quality Index (CDLQI)* at week 12.

In the study, 44 patients (aged 6–11 years) from nine countries were enrolled and treated with at least one injection of ustekinumab. At baseline, the mean duration of psoriasis was 3.5 (standard deviation 2.49) years. At week 12, subjects treated with ustekinumab showed clinically meaningful improvements in their psoriasis and HrQOL. At week 12, 77.3% (95% confidence interval [CI]: 62.2%, 88.5%) achieved PGA 0/1, 84.1% (95% CI: 69.9%, 93.4%) achieved PASI 75, and 63.6% (95% CI: 47.8%, 77.6%) achieved PASI 90. The mean change from baseline in CDLQI was -6.3 (95% CI: -8.29; -4.28, lower is better). All patients were followed for up to 52 weeks after the first administration of ustekinumab. Improvements in PGA 0/1, PASI 75, PASI 90 and CDLQI were maintained through to week 52 (75.6%, 87.7%, 70.7%, and 58.3%, respectively).

Safety data from CADMUS Jr were consistent with the known safety profiles reflected in respective current prescribing information labels and ustekinumab was generally well‑tolerated by paediatric patients with plaque psoriasis. Overall, 34 patients had more than one adverse event (AE; [77.3%]) and three had more than one serious AE (6.8%). One patient had a serious infection (mononucleosis), 29 had infections (65.9%), and 12 had infections requiring treatment (27.3%). In general, the AEs and other safety data reported up to one year in two paediatric patient studies (CADMUS and CADMUS Jr) were similar to those seen in previous studies in adults with plaque psoriasis.

This study suggests the use of Methotrexate for psoriasis was not associated with an enhanced risk for cutaneous malignant melanoma (CMM)

Quote:

---

Background:
Cutaneous malignant melanoma (CMM) is a highly immunogenic tumor. Patients with an impaired immune system have an enhanced risk for CMM and a worse prognosis. Methotrexate (MTX) is an anti‐inflammatory and immunosuppressive drug frequently used for treating patients with psoriasis. An association between MTX and risk of CMM has previously been demonstrated in patients with rheumatoid arthritis.

Objectives:
To investigate if MTX increases the risk of CMM among patients with psoriasis.

Methods:
A nested case‐control investigation from a Swedish cohort of psoriasis patients was conducted. Data were obtained from available Swedish registers and included 395 previously cancer‐free psoriasis patients with a first CMM in the time period January 1, 2010 to December 31, 2016. Ten randomly selected cancer‐free psoriasis patients were matched per case with respect to age (same birth year) and sex. The accumulated MTX‐doses in both groups was obtained. Crude odds ratios (ORs) for the proportion of MTX in the respective group using conditional logistic regression analyses was conducted.

Results:
Of 395 psoriasis patients with CMM, 97 (25%) had filled any prescription of MTX. Among 3950 controls, the corresponding number was 954 (24%). In a conditional logistic regression analysis, no association between MTX‐exposure (ever use) and risk for CMM were observed (OR 1.0 [95% CI, 0.8‐1.3]). Moreover, no indication of a dose‐response association was observed.

Conclusions:
In this Swedish nested case‐control study, the use of MTX was not associated with an enhanced risk for CMM. These findings are reassuring to dermatologists in everyday clinical practice.

Got approved for Cosentyx through my insurance and they have a program where it sounds like I won't have to pay anything... almost unbelievable in the corporate ruled ruthless capitalist USA. I'm sure the time will come when I need to pay for some lawyers second vacation home... but really, anyone have any advice? Tried the creams and salt baths, messed around with the diet but nothing seems to help much. Had some luck with laying out in the sun a lot during the Summer but where I live it rains half the year. What should I do friends?

This study suggests starting with more aggressive protocols and increasing rapidly dosage progression to prevent Adaptation Factor (AF) may increase NB‐UVB response.

Quote:

---

Background:
In the biologic era, Narrow Band Ultraviolet B (NB UVB) phototherapy stillremains a valuable, effective, inexpensive, safe anti‐psoriatic treatment Patients can lose response to NBUVB over time due to photoadaptation.This phenomenon is the tendency of the skin to respond to ultraviolet (UV) exposure by undergoing changes that may result in a decreased future response to an equivalent dose of radiation, thus leading to the need for an increased exposure during phototherapy course.

Aim:
To characterize and quantify the determinants of photoadaptation in NB UVB treated psoriatic patients.

Methods:
We enrolled 57 adult patients with moderate plaque psoriasis. Patients underwent 24 sessions of NB UVB phototherapy delivered thrice a week. Dosing was started with 70% of the Minimal Erythema Dose (MED) with percentage based dose increments every two treatments. MED as well as change in the erythema and Melanin Index (MI) were measured at baseline and at the end of phototherapy course. Moreover, an Adaptation Factor (AF) was calculated for each patient.

Results:
AF was not influenced by both baseline MED and skin type. We found a weak correlation between higher cumulative dosages and the initial MED (Spearman's rho = 0.32, p= 0.0154) as well as with the mean initial MI (Spearman's rho = 0.25, p = 0.0624, statistically borderline). Clearance and mean number of treatments were correlated (Spearman's rho = 0.48, p < 0.001).

Conclusion:
Photoadaptation is a physiological skin response that negatively influence NB‐UVB responsiveness and is not predictable by the baseline MED and skin type. Thus, starting with more aggressive protocols and increasing rapidly dosage progression to prevent AF may increase NB‐UVB response.

This survey explored whether plasma derived EV microRNAs could serve as biomarkers for psoriatic arthritis.

Quote:

---

Background:
Psoriatic arthritis (PsA) develops in ~30% of patients with psoriasis. The diagnosis of PsA is challenging and there are no reliable molecular markers in clinical use. MicroRNAs are short noncoding regulatory RNAs, which can be actively packaged into extracellular vesicles (EVs) and secreted to the circulation.

Objectives:
To explore whether plasma‐derived EV microRNAs may serve as biomarkers for PsA in patients with psoriasis.

Methods:
Plasma samples were obtained from patients with cutaneous‐only psoriasis (PsC) and patients with psoriasis and PsA. Plasma EVs were isolated using miRCURYTM Exosome Isolation Kit. RNA sequencing was used to identify differentially expressed EV miRNAs in the discovery phase (PsC, n=15; PsA, n=14). In the validation phase (PsC, n=29; PsA, n=28), 41 selected miRNAs were analysed in plasma EVs by qPCR. The association of the identified miRNAs with PsA was assessed by logistic regression analysis.

Results:
RNA sequencing identified 19 plasma EV miRNAs with significantly different levels between PsA and PsC in the discovery cohort. Significantly lower levels of plasma EV let‐7b‐5p and miR‐30e‐5p in PsA vs. PsC were confirmed in the validation cohort, and their decreased levels were found to be associated with the presence of PsA. ROC analysis revealed an AUC of 0.68 (95% CI 0.53‐0.83) for let‐7b‐5p and 0.69 (95% CI 0.55‐0.84) for miR‐30e‐5p.

Conclusions:
Circulating EV microRNA levels are altered in patients with PsA as compared with PsC. Findings of this exploratory study suggest that circulating EV microRNAs may serve as biomarkers for arthritis in psoriasis patients.