Following on from Skyrizi gets positive opinion from CHMP Skyrizi (risankizumab) has been given the go ahead from NICE (National Institute for Health and Care Excellence) in the treatment of moderate to severe plaque psoriasis.

Quote:

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Risankizumab is recommended as an option for treating plaque psoriasis in adults, only if: The disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and the company provides the drug according to the commercial arrangement.

Stop risankizumab treatment at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as:

A 75% reduction in the PASI score (PASI 75) from when treatment started or

A 50% reduction in the PASI score (PASI 50) and a 5‑point reduction in DLQI from when treatment started.

If patients and their clinicians consider risankizumab to be one of a range of suitable treatments, including guselkumab, secukinumab and ixekizumab, the least expensive should be chosen (taking into account administration costs, dosage, price per dose and commercial arrangements).

When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate.

When using the DLQI, healthcare professionals should take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any adjustments they consider appropriate.

These recommendations are not intended to affect treatment with risankizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations:

Risankizumab is proposed as an alternative to other biological therapies already recommended by NICE for treating severe plaque psoriasis in adults. Evidence from clinical trials shows that risankizumab is more effective than adalimumab and ustekinumab. Indirect comparisons suggest that risankizumab is likely to provide similar health benefits compared with guselkumab, and better PASI response rates compared with many other biologicals.

For the cost comparison, it is appropriate to compare risankizumab with guselkumab. The total costs associated with risankizumab are similar to or lower than those associated with guselkumab. Therefore, risankizumab is recommended as an option for use in the NHS for severe plaque psoriasis that has not responded to systemic non-biological treatments, or if these are contraindicated or not tolerated.

Some of our members got together and decided the Dermatology Life Quality Index (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.

Psoriasis can have a huge impact on ones quality of life, and it is important to discuss with your dermatologist/doctor how it affects you. By keeping a score you will be able to see how your quality of life changes each month, this information can be helpful to monitor your treatment and to have some information for your next dermatology/doctor appointment.

Anyone can use it and members can add their score to their profile or keep a note of it in their personal notepad.

You can find it in the top menu next to the NO LINKS ALLOWED or just click here PQOLS

Lilly says that Taltz beats Tremfya in a head to head trial achieving skin clearance at week 12.

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Eli Lilly announced today Taltz® (ixekizumab) met the primary and all major secondary endpoints up to week 12 in the Phase 4 IXORA-R study, which evaluated the efficacy and safety of Taltz versus TREMFYA® (guselkumab) in people living with moderate to severe plaque psoriasis (PsO). The IXORA-R trial is the first completed head-to-head (H2H) trial between an IL-17A inhibitor and an IL-23/p19 inhibitor using the Psoriasis Area Severity Index (PASI) 100 score as the primary endpoint.

At 12 weeks, Taltz met the primary endpoint by demonstrating superiority in the proportion of patients achieving complete skin clearance compared to TREMFYA as measured by PASI 100. In addition, Taltz met all major secondary endpoints up to week 12, which include superiority over TREMFYA in the proportion of patients achieving PASI 75 at Week 2, PASI 90 at Weeks 4 and 8, PASI 100 at Weeks 4 and 8, static Physician's Global Assessment (sPGA) 0 at Week 12 and PASI 50 at Week 1. Lilly plans to share results on the remaining key secondary endpoint of proportion of patients achieving PASI 100 at 24 weeks in 2020.

"Completely clear skin and rapid relief of symptoms are possible for many people living with moderate to severe plaque psoriasis, and should be two topics dermatologists discuss with their patients," said Andrew Blauvelt, M.D., M.B.A., dermatologist and president of Oregon Medical Research Center in Portland, OR. "Head-to-head data like these are important and will help inform individual treatment goal discussions between healthcare providers and their patients."

A total of 1,027 patients with moderate to severe plaque psoriasis were enrolled in the study to evaluate the efficacy and safety of Taltz compared to TREMFYA. Participants were randomized to receive Taltz (160 mg at Week 0, followed by 80 mg at Weeks 2, 4, 6, 8, 10, and 12, then 80 mg every 4 weeks) or TREMFYA (100 mg administered by subcutaneous injection at Week 0, Week 4 and every 8 weeks thereafter) for a total of 24 weeks, with the primary analysis conducted at 12 weeks.

"Lilly's goal is to raise the treatment bar for people living with psoriasis," said Lotus Mallbris, M.D., Ph.D., vice president of immunology development at Lilly. "And research shows that patients want clear skin and rapid improvements. We're pleased to see that Taltz helped more people achieve 100 percent skin clearance compared to TREMFYA at week 12. These positive results reinforce that Taltz is an important treatment option for people with this disease."

In IXORA-R, the safety profile of Taltz was consistent with previously reported results. No new safety signals were detected.

Lilly plans to submit detailed data from the IXORA-R study for disclosure at scientific meetings and in peer-reviewed journals. 

This study suggests patients unlikely to respond to Ilumya / Ilumetri (tildrakizumab) could be identified by week 8, and those likely to achieve a PASI  >90 response could be identified as early as week 4.

Quote:

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Background:
Two randomized controlled trials (reSURFACE 1 and 2) have demonstrated the effectiveness of tildrakizumab, a high‐affinity, humanized, IgG1κ, anti‐interleukin‐23 monoclonal antibody, for treating moderate‐to‐severe plaque psoriasis in the first 28 weeks.

Objectives:
To examine the efficacy of tildrakizumab and its impact on quality of life (QoL) in patients with different levels of week‐28 Psoriasis Area and Severity Index (PASI) improvement.

Methods:
Patients treated with tildrakizumab 100 mg or 200 mg from baseline to week 28 were pooled from reSURFACE 1 and reSURFACE 2 and classified into five mutually exclusive week‐28 PASI improvement groups for each dose: PASI 0‐49, 50‐74, 75‐89, 90‐99, and 100. Mean PASI improvement and Dermatology Life Quality Index (DLQI) 0/1 over time were examined for each group.

Results:
Of 1,156 patients, 575 were in the 100‐mg and 578 in the 200‐mg cohorts, respectively. At week 28, 8.3%, 14.3%, 23.8%, 30.4%, and 23.1% in the 100‐mg and 4.0%, 18.1%, 19.6%, 29.1%, and 29.3% in the 200‐mg cohort achieved PASI <50, 50‐74, 75‐89, 90‐99, and 100, respectively. Patients with PASI <50 at week 28 could be identified as early as week 8, and those with week‐28 PASI ≥90 had approximately 50% PASI improvement by week 4. Among patients achieving PASI >50 at week 28 who continued the same dose of tildrakizumab to week 52, mean PASI improvement was maintained or improved over time. Similar results were observed for both doses. Higher proportions of patients achieved DLQI 0/1 in higher week‐28 PASI groups, and DLQI 0/1 was maintained or improved to week 52. However, not all patients with PASI 100 had DLQI 0/1.

Conclusion:
Patients unlikely to respond to tildrakizumab could be identified by week 8, and those likely to achieve a PASI >90 response could be identified as early as week 4. Week‐28 PASI improvement level correlated with QoL improvement.

Hello, I just joined the group a few minutes ago.  I am so glad to have found this forum so I don't feel so alone now.  I also have Multiple Sclerosis.  With the MS and the psoriasis both being an autoimmune disease it complicates the way in which the psoriasis can be treated. 

I am married and we have three children - all grown and 2 grandchilddren with the youngest graduating from high school this year.  So this coming year they will both be in college.  My husband and I are both retired.  We sold our home a couple of years ago to downsize and are in an apartment at this time.  We have not decided whether to stay in Raleigh, NC or move to another area.  We really like the Ashville area but have lived in Raleigh for about 17 years now so I really don't know if I want to move to another area.  It's harder after you get older to think about adjusting to a new place and having to find new doctors, dentist, church, etc. so we may just stay put. 

My husband is a golfer and fly fisherman so he has really enjoyed being able to do both since retirement.  I love any type of craft.  I crochet, knit,  and sew.   I love to take old vintage linens. especially the white ones, and recycle them into new items.  I also love to watch Turner Classic Movies.  I prefer the old movies to the new ones.  Much less violence and profanity.

That's pretty much my profile at this time and I look forward to being a part of the group.

Nomorepeggy

Hello All,

I have had Psoriasis in one form or another since I was about 5 years old.  Back then, it was on my ankles.  I went away after several years.  Then in my early teens, I got it on my knees for several years before it went away.  Then in my mid twenties I got it on my knuckles and have had it for several years.  I am not 57 and about 4 years ago I started getting it on the side of one of my fingers and now the palm of my right had, unfortunately I am right handed.  I have been dealing with it and hoping it would disappear after a couple of years but it has been getting larger and larger.  Up until a few weeks ago the fold lines of my hand did not have plaques.  But then they started getting it.  Now my entire palm and the skin will crack in those folds.  As some of y'all know, that is pretty painful.  I cannot do much around the yard anymore because of it.  Every time someone wants to shake my hand I really hate it.  I really wish that social norm would just go away.  So the past two weeks I started taing Glutamine and using Coal Tar.

Just joined. For years I've used the clear tape, hadn't had a flare up in years. I have small patches on my shoulder and arm and a different type on my elbows. the patches on my arm are red and raw and very itchy in this heat. I can't remember what they are called. I'm pretty sure antibiotics caused this bad flare up. I stopped taking them a couple weeks ago, just when this flare up started. I am currently trying cbd cream. I am here to read and learn. 

Hi there,
I am new but old here as in the last time I posed ( under a diff name ) was back in 2011. I have very bad guttate and plaque p which can cover up to 75% of my body. I have had this disease since I was 13- I’m 36 now.
I had been keeping my p under control for 8years with Fumaderm. I found it a wonder drug. I had the usual side affects but managed them by taking my full dose which was 8x 120 mg at night before bed. I would have very predicable flushes, cramps and “toilet rushes” in the morning and the rest of the day would be a clear skin pleasure. Exactly this time last year I fell pregnant whilst on Fumaderm _ planned / not planned but very welcomed and naturally had to come off Fumaderm.  My skin flared badly and quickly. I had two lengthy sessions of light treatment to see me through what was otherwise a healthy pregnancy but as soon as I stopped, My skin flared massively again. Having returned to my dermatologist 6weeks post partum  I’m now on skilarence. I turned down Sterala as I was so confident in Fumeric acid \ DMF . I’m now 6 weeks into treatment and I only see mild improvement. I’m also experiencing little or no side affects ... So much so that I actually went and tried some of my old stash of Fumaderm to see if it would work but little reaction to it as well.

I’m on 5x120 this week moving to 6x 120 next week. I expected to see a better result by now and wonder does the lack of side affects indicate that this time it’s not going to work for me   

I’ll keep you updated as I move through this journey.

Thank you for the amazing content - this is an invaluable resource.

Arls x

Probably a long shot but has anyone tried both Tremfya and Cosentyx for psoriatic arthritis ?

I'm very pleased with Cosentyx for the psoriatic arthritis and it is still in remission, but it's not keeping the psoriasis away and I still need the occasional use of a topical to keep it under control. I have decided Taltz is not worth me trying next, but am tempted to switch to Tremfya after reading this: Tremfya going after psoriatic arthritis

But there is nothing better than hearing it from the horses mouth so to speak, so has anyone tried both and if so which was best for psoriatic arthritis Tremfya or Cosentyx ?

Hi, 

I was prescribed the following and wondered if anyone has tried the same :-

Psoriderm cream 225ml
          distilled coal tar 6% w/w
          lecithin 0.4% w/w
(Use once or twice daily)

Psoriderm emulsion 40% w/v bath additive 200ml
          distilled coal tar
(Use as needed)

Psoriderm scalp lotion shampoo 250ml
          distilled coal tar 2.5% w/v
          lecithin 0.3% w/v
(Use as a shampoo, daily if necessary)

I’ve had a pamper using all Psoriderm products today.
Not much to report as this is the first time I’ve ever used it (and found out I had psoriasis yesterday).
The packaging is nice. The bottles themselves are somewhat reminiscent of the 1940’s.

It stung a little in some areas as I applied it. 
I smell. The house smells. Everything smells. I’ve made no attempt to get rid of the smell as of yet. I read in some other parts of the internet that using a strong smelling shampoo after masks said smell. Though I fear this could be counterintuitive. 

I hope to update this thread with my progress as I go.

Hello!

I’m new here. I’m not sure if I’m doing any of this right. Bare with me!

I don’t really have a history with psoriasis and the story of how I got here started yesterday when I was told by an Advanced Nurse Practitioner that the dandruff I have and the weird blotches I thought was ringworm and had been covering in anti-fungal cream are, in fact, psoriasis. (Woo! ) I deduced it was inverse psoriasis and scalp psoriasis.

I was prescribed Psoriderm cream, bath lotion and shampoo.
Had my first Psoriderm Pamper earlier today. (I was absolutely in the bath more than the recommended five minutes. Which is probably why it was starting to sting a little bit. Applying the cream to some parts stung too. Is this normal? Or the kind of not normal that people generally ignore and just carry on with?)
I smell. The house smells. My hair smellllllllllllllllllllls. 
I have a date next week, how do I make it going away? Haha.
Worse still, I work for a large postal delivery service, let’s call it Moyal Rail. If it starts to rain, is the smell going to be even stronger?! Am I going to be the stinky postie?! 

I started to google and came across this forum. I already can’t find the post I originally saw about Psoriderm. Ha. I’ll go through the history once I’ve managed to navigate the forum a bit better. 

I have rambled far too much. 

Hello! Thanks for letting me join. I will endeavour to scour the forum for advice on being less smelly and hopefully how to be more comfortable in and with my own body.


TL;DR - Hi, I’m new.

With the current heatwave I have noticed the little bit of psoriasis I have on my shins is itching a lot more. I notice it the most when I go outside and when I come back inside it seems to calm down. I've never really thought about it before, but this heatwave is definitely making it itch more.

Anyone else noticed a difference to psoriasis in hot weather ?

Just curious if anyone has ever heard of this.

I keep seeing an ad for it. It states that it's FDA-approved Psoriasis Laser Treatment. It also says that in clinical trials, most people saw at least 75% improvement and even 95% clearance in just 4 weeks.

It says the psoriasis can come back (well DUH!) but that you can have treatments again.

Upon further reading, it's basically UV treatment but directed right on spots where there is psoriasis. I guess it's been around for awhile but I've never seen it discussed so was just wondering.

Hi all and thankyou in advance for a great website.
I have been on a lot of different medicines and just started on Skilatence which is the way I found you.
I look forward to reading your experiences and look forward to share with like minded people that know what it is like to suffer and survive this illness.

Hi There all !

I'm Marco from Italy , 46 years old.
I'm fighting with psoriasis since 1984....
I have taken Neotigason for many years ( last ten years ) and this year after a blood check i have stopped it definitively.
Triglycerides and high ferritin inside liver. Hepatic Steatosis reversible.
I knew the side effects of Acitretin....
This week on wednesday i have started Skilarence and i will tell you my experience. First 3 days no side effects.
Two weeks ago i have started a diet to lower triglycerides and help liver. No alcohol.
My psoriasis is only on the legs and elbows , for luck nowhere else.
Let's hope.....

Thanks to all the persons of this great forum

Scotland are starting a three year dermatology project thanks to an £8.5 million EU funding.

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A Glasgow nurse is leading a project across Scotland aimed at improving dermatology services including Greater Glasgow and Clyde.

The project, which aims to develop a range of nursing education and training resources designed to help standardise clinical practice, is part of ‘The Co-operation and Working Together (CAWT) Acute Hospitals Services Project’ and has received funding from the European Union (EU).

Approximately £8.5 million has been awarded through the EU’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB) as part of a three-year dermatology project which links into the Scottish Government’s Modern Outpatient Programme.

The project is an initiative which aims to minimise unnecessary hospital visits and ensure that patients are seen by the right person, in the right place, at the right time. 

Two dermatology improvement nurses, one from Glasgow and one from Tayside, are leading the project in Scotland and are being supported by the Modern Outpatient Programme.

Over the three years of the project, the nurses will test and evaluate new methods of working, run practical clinical sessions, and develop training materials to help support and educate dermatology nurses in the future.

Health Secretary Jeane Freeman said:  “This project will help us to further develop dermatology services across Scotland’s NHS, helping to reduce waiting times and improve patients’ outcomes. I look forward to seeing the results.”

Dr Fiona Macdonald, the Modern Outpatient Programme’s Clinical Lead for Dermatology, said: “Dermatology nursing and specialist nursing has been a core part of Dermatology for many years.

“Dermatology is a specialty with a huge demand and is also a significant part of the Primary care workload.

“It is essential that all nurses qualifying over the next few years have a general knowledge of core aspects of Dermatology, but we also need to acknowledge and plan for future vacancies due to retirement and so on, as well as expansion where it will be appropriate for the service.

“This project will help us to establish the training that is required and to consider how we address these training needs. 

“The nurses have mapped out the existing dermatology services for every NHS Board in Scotland, and will use their findings to determine what kind of skills nurses will need in the future.

“At the end of the project, we want to be able to provide a programme of basic dermatology training for all nurses; specialist training for dermatology nurses; and advanced training at degree or masters level for highly qualified nursing specialists.

“Developing a common set of training materials will help us to standardise and enhance training for a range of clinical professionals, and will help patients access the services they need.”

Gina McIntyre, CEO of the Special EU Programmes Body, said: “This highly innovative EU INTERREG VA funded project will deliver real efficiencies in vital health and social care services for the benefit of thousands of people on a cross-border basis.

“This collaborative approach to deliver services will enhance access to the essential medical care used in the treatment of a wide-range of illnesses.”

This study doesn't mention psoriasis but as it mentions "Corticosteroids were taken in 18/21 patients on low‐dose Methotrexate (MTX)" I thought it may be of interest to some of our members that use it.

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Objective:
Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown.

Methods:
We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease.

Results:
After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low‐dose MTX; 75% high‐dose MTX). Death occurred in 34% of cases (19% low‐dose MTX; 75% high‐dose MTX, p<0.01). All eight patients on high‐dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low‐dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides.

Conclusions:
Serious Strongyloides infection can occur with low‐dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low‐middle‐income countries will increase exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low dose MTX therapy, particularly if combined with additional immunosuppression.

This study looked at the long term risk of malignancy in Korean adult patients with psoriasis.

Quote:

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Background:
The association between psoriasis and risk of malignancy has not been thoroughly evaluated in a large longitudinal cohort of Asian population.

Objective:
To determine the long‐term risk of malignancy in Korean adult patients with psoriasis.

Methods:
We conducted a nationwide population‐based prospective cohort study with a 15‐year observational period. During the baseline period (1997‐2000), total 1,773,786 Korean subjects who received health insurance from the National Health Insurance System were enrolled and 5,788 subjects were defined as a psoriasis group. The number of new‐onset malignancy was collected during the observational period (2001‐2015).

Results:
Patients with psoriasis had a higher adjusted hazard ratio (aHR) for development of overall malignancy (aHR 1.08, 95% confidence interval [CI] 1.00‐1.18) and gastric cancer (aHR 1.31, 95% CI 1.08‐1.58) compared to controls. The risks of non‐Hodgkin lymphoma and non‐melanoma skin cancer were significantly increased only in patients with psoriasis who received systemic treatments (aHR 2.86, 95% CI 1.07‐7.61 and aHR 3.93, 95% CI 1.47‐10.47, respectively).

Conclusion:
Psoriasis is associated with long‐term risk for overall malignancy in Koreans, which was primarily driven by the increased risk of gastric cancer.

This study aimed to assess whether genetic variants in the protein‐coding region or untranslated regions of the IL17A gene are associated with response to IL17A inhibitors in patients with psoriasis.

Quote:

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Background:
Genetic predictors for treatment response could optimize allocation of biological treatment in patients with psoriasis. There is minimal knowledge about pharmacogenetics of anti‐IL17 agents.

Objectives:
To assess whether genetic variants in the protein‐coding region or untranslated regions of the IL17A gene are associated with response to IL17A inhibitors in patients with psoriasis.

Methods:
This was a multicenter European cohort study investigating pharmacogenetics of IL17A inhibitors in patients with psoriasis. Patients with plaque psoriasis treated with secukinumab or ixekizumab in daily practice were included. For all participants, the protein‐coding region and untranslated regions of the IL17A gene were analyzed using Sanger sequencing. Identified genetic variants were tested for association with response to secukinumab/ixekizumab, measured as ∆PASI, after 12 weeks (primary outcome) and after 24 weeks (secondary outcome). Association was tested using a linear regression model with correction for baseline PASI as a fixed covariate, and for biological naivety and body mass index as additional covariates.

Results:
In total, 134 patients treated with secukinumab or ixekizumab were included. Genotyping of the cohort identified genetic variants present in untranslated regions and intronic DNA, but not in the protein‐coding region of the IL17A gene. Five genetic variants in non‐coding DNA with a known or suspected functional effect on IL17A expression were selected for association analyses: rs2275913, rs8193037, rs3819025, rs7747909, rs3748067. After 12 weeks, 62% of patients achieved PASI75 and 39% achieved PASI90. At week 24, PASI75 and PASI90 response rates were 72% and 62%, respectively. No associations were found between the five genetic variants and ∆PASI, PASI75 or PASI90 after 12 and 24 weeks of anti‐IL17A treatment.

Conclusions:
Response to IL17A inhibitors secukinumab and ixekizumab cannot be explained by genetic variation in the protein‐coding and untranslated regions of the IL17A gene. Pharmacogenetics of IL17A inhibitors in the treatment of psoriasis requires further exploration.

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