This study suggests there is no reason to exclude over 65s from Bio's in the treatment of psoriasis.

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Background:
The number elderly patients with psoriasis is steadily increasing in the Western world, nevertheless they are frequently excluded from biologic clinical trials and described as a high‐risk group for adverse events. Thus, there is lack of information concerning safety and effectiveness of available treatments for psoriasis in the elderly, particularly about new biologic systemic drugs.

Objective:
Our aim is to describe our experience with all biological therapies currently used in the elderly (> 65 years) psoriatic patients.

Methods:
A retrospective multicentric review of clinical records of all psoriatic patient aged 65 years or older actually receiving biological drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab pegol, ustekinumab or secukinumab) was undertaken.

Results:
Our study population included 266 elderly psoriatic patients actually receiving any biological therapy (Adalimumab 31,2%, Ustekinumab 28,9%, Etanercept 20,3%, Secukinumab 15%, Infliximab 3%, Golimumab 1%, Certolizumab pegol 0,6%). The PASI score at the baseline (week 0) ranged from 4–54; mean ±SD, 16,5±7,1, which changed after biologic administration to 3,7±8 at week 16, 1,6±2,1 at week 28 and 1,2±2,1 at week 52. Among 266 elderly psoriatic patients 25 adverse events were reported during the observation period. The most frequent events were infections with 12 (48%) reports, followed by malignancies with 4 (16%) reports.

Conclusions:
To date, our study represents the widest experience on the use of biological drugs in elderly psoriatic patients. We found that all biologics for psoriasis showed a great efficacy also in elderly people and the rate and the type of adverse effects were similar to the younger patients. In conclusion the age alone should not limit our therapeutic options. Further observational study using multiple data sources is needed to evaluate long‐term effectiveness and safety for elderly psoriatic patients.

Hello Everyone . I am currenty suffering Psoriasis for almost 7 months , I had used so many oinment ,Cream Salycic acid , Ketoconazole shampoo for flaky scalp but still keep going worsen . What would i do ? Iost my confident till now .. I am currently seeking job but because of my condition , i dont have any self confident to go my interview because of . Can you pls suggest how can i get rid this ??

Hi,

hello from Berlin, Germany.

I'm Claudia and I have my Psoriasis since I was 3 years old – and this is 46 years ago. Most time my psoriasis was on hands and soles – Psoriasis vulgaris palmoplantaris. 

The most effective way for relief was the Dead Sea – and now it's Cosentyx. I tried almost all medications. If you have german-related questions – feel free to ask (and other questions too) 

So hello to everyone in my boat. We all know the great fun we have with this horrible affliction so I'm here to share my experiences and treatments (and to learn anything new I can along the way)

I have had pretty much all available topical forms of creams and lotions, some success but not really any more than 2/10 - Moved on to light treatment twice, cleared me first time for around four months and second time for around six weeks. 

Acetretin, bloody awful to use for me, cracked lips and the feeling that the top couple of layers of skin was sliding across the others on my hands. 0/10 Hated it and didn't clear anything at all...

Next was Cyclosporin, this was a God send. Full clearance for just over two years when I started getting abnormal bloods (kidney) along with swollen gums, so I was taken off it. 10/10
Huge flare up 

Next on the list was Fumaderm. Had small improvement with this and the most mental hot flushes ever! Ladies, you have my sympathy. 3/10

Next was Methotrexate. Fairly good at keeping things under control but without actually clearing the red patches, and you can't drink!!!. Again, bad bloods (liver) had me off it within 14 months 6/10
Huge mega never been anywhere this bad flare up 

After almost 3 months without any treatment, I have just taken the first two injections on Consentyx last Friday. Fingers crossed this works as I'm running out of options... 

I will keep you up to date on how this goes, hope to see an improvement very soon (still in long sleeves and it's now June) 

This is the result of a phase 2 study on Tremfya (guselkumab) for use with psoriatic arthritis.

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Background:
Guselkumab, a human monoclonal antibody that binds to the p19 subunit of interleukin 23, has been approved for the treatment of moderate-to-severe psoriasis. Psoriatic arthritis is a common comorbidity of psoriasis with an umet need for novel treatments. We assessed the efficacy and safety of guselkumab in patients with active psoriatic arthritis.

Methods:
We did a randomised, double-blind, placebo-controlled, phase 2a trial at 34 rheumatology and dermatology practices in Canada, Germany, Poland, Romania, Russia, Spain, and the USA. Eligible participants were aged 18 years or older with active psoriatic arthritis and plaque psoriasis affecting at least 3% of their body surface area, with three or more of 66 tender joints and three or more of 68 swollen joints, who had an inadequate response or intolerance to standard treatments. We randomly assigned patients (2:1) via a central interactive web-response system using computer-generated permuted blocks with a block size of six, stratified by previous anti-tumour necrosis factor-α use, to receive subcutaneous guselkumab 100 mg or placebo at week 0, week 4, and every 8 weeks thereafter for 24 weeks. Patients, investigators, and site staff were masked to treatment assignment until final database lock at week 56. At week 16, patients with less than 5% improvement in swollen and tender joint counts were eligible for early escape to ustekinumab. At week 24, the remaining placebo-treated patients crossed over to receive guselkumab 100 mg at weeks 24, 28, 36, and 44 and guselkumab-treated patients received a placebo injection at week 24, followed by guselkumab injections at weeks 28, 36, and 44. The primary endpoint was the proportion of patients with at least 20% improvement at week 24 in signs and symptoms of psoriatic arthritis according to American College of Rheumatology criteria (ACR20) in the modified intention-to-treat population (ie, all randomly assigned patients who received at least one dose of study treatment). Safety analyses included patients according to the study drug received. This study is registered with ClinicalTrials.gov, number NCT02319759.

Findings:
Between March 27, 2015, and Jan 17, 2017, we randomly assigned 149 patients to treatment: 100 to guselkumab and 49 to placebo. 17 (35%) of 49 patients in the placebo group and ten (10%) of 100 patients in the guselkumab group were eligible for early escape to ustekinumab at week 16. 29 (59%) of 49 patients in the placebo group crossed over and received guselkumab at week 24. Three (6%) of 49 patients in the placebo group, one (3%) of 29 patients who crossed over from placebo to guselkumab, and six (6%) of 100 patients in the guselkumab group discontinued study treatment before week 44. 58 (58%) of 100 patients in the guselkumab group and nine (18%) of 49 patients in the placebo group achieved an ACR20 response at week 24 (percentage difference 39·7% [95% CI 25·3–54·1]; p<0·0001). Between week 0 and week 24, 36 (36%) of 100 guselkumab-treated patients and 16 (33%) of 49 placebo-treated patients had at least one adverse event. The most frequent adverse event was infection in both groups (16 [16%] of 100 patients in the guselkumab group vs ten [20%] of 49 patients in the placebo group). The prevalence of adverse events between week 0 and week 56 in guselkumab-treated patients (51 [40%] of 129) indicated no disproportional increase with longer guselkumab exposure. No deaths occurred.

Interpretation:
Guselkumab, a novel anti-interleukin 23p19 antibody, significantly improved signs and symptoms of active psoriatic arthritis and was well tolerated during 44 weeks of treatment. The results of this study support further development of guselkumab as a novel and comprehensive treatment in psoriatic arthritis.

Results from a phase 2 are in for Filgotinib JAK1 inhibitor for psoriatic arthritis.

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Gilead Sciences and Galapagos NV announced that the randomized, placebo-controlled Phase 2 EQUATOR study of filgotinib, an investigational, selective JAK1 inhibitor, in 131 adults with moderate to severe psoriatic arthritis, achieved its primary endpoint of improvement in the signs and symptoms of psoriatic arthritis at Week 16, as assessed by the American College of Rheumatology 20 percent improvement score (ACR20). There was an ACR20 response of 80 percent for filgotinib versus 33 percent for placebo (p<0.001). The ACR50 and ACR70 responses at Week 16 were also significantly higher for filgotinib versus placebo (ACR50: 48 percent for filgotinib versus 15 percent, p<0.001; ACR70: 23 percent versus 6 percent, p<0.01).

Filgotinib was generally well-tolerated in the EQUATOR trial, with no new safety signals observed and similar laboratory changes compared to those reported in previous trials with filgotinib in rheumatoid arthritis patients. The adverse event rate was similar in both groups with mostly mild or moderate events reported. There was one serious infection in the filgotinib group, a patient who experienced pneumonia with a fatal outcome. One other patient receiving filgotinib developed herpes zoster. There were no cases of opportunistic infection, tuberculosis, thromboembolism, or malignancy.

“The data from the EQUATOR study are very impressive and indicate that filgotinib has the potential to have a significant effect on signs and symptoms of psoriatic arthritis, a condition where there is still a high unmet medical need,” said Dr. Philip Mease, Director of Rheumatology Research, Swedish-Providence-St. Joseph Health Systems and Clinical Professor, University of Washington, Seattle, WA.

“We are pleased to report that filgotinib remains consistent in terms of activity and tolerability, now also in psoriatic arthritis,” said Dr. Walid Abi-Saab, Chief Medical Officer at Galapagos.

Detailed results from the EQUATOR trial will be submitted for presentation at a future scientific conference.

Hi all, not been here for a while so thought I would give you an update. 
GP gave me Betnovate cream to try and referred me to skin specialist, only had to wait 4 weeks, that's the good bit.
Was offered another cream or light therapy which I refused as all creams/ lotions have made me so sore,told her I do not want to try any more.
She said I couldn't have tablets or injections as not bad enough, even though been off work 2 weeks as feet and heels so sore cracking and bleeding, cannot wear shoes, and hands so sore, calves sore.
My psoriasis score is only 6 ish, although specialist didn't look everywhere, did quality of life questionnaire scored 30.
I was not happy, think specialist could see I was about to burst into tears so left room , came back and said I could do tests to see if I could have Methotrexate or Acitretin, meanwhile would you like to try Enstilar.
So had all blood tests done and chest X-ray same day, thinking when results are in I will get an appointment, 2/4 weeks. NO, 12 weeks next app.
On the up side 10 days using Enstilar I have no flaking and soreness gone on calves, knees and elbows.
Heels are still tender and cracked and psoriasis appearing on soles so still off work as cannot wear shoes.
Hands are still red and sore, it seems to be on every joint on my fingers, knuckles etc and palms now, which I never had 30 years ago.
According to leaflet I can only use for 4 weeks so I don't know what to do after that, think I will ring specialist.

I'm on year 14 of my 'journey' with psoriasis. It began on my scalp when I was 19 and has fairly randomly waxed and waned since then. I've had upwards of 60% body coverage at times but it typically hovers between 20-40%. Alcohol, stress, and the cold weather all exacerbate my condition. That being said I quit drinking, try to keep my stress levels low, and have managed to find a contractor to work for in the Florida Keys during the frigid Upstate NY winters.

I have tried a variety of topical ointments, but they did very little to help. After years of negative experiences with numerous dermatologists I decided to just live naturally and do the best I can. So I exercise and eat well and just do the best I can.

Any other questions feel free to ask.

About to start using Taltz.(which is waiting in the fridge and I get rid of this chest infection)
Is anyone else on this Biological Drug? If so, how are you doing? Thanks. 

In 2006 I had Sarcoidosis and Erythema nodosum and but 2010 was 94% recovered, but 5 months ago i walked into a shopping trolley and got a bruise on my leg and it never really recovered, the bruise went but the small cut soon expended into 50p shape itchy skin that never really healed, i just thought not much of it as it was just itch skin that looked like it was peeling but it never did.
Anyway, went to GP yesterday and he said it was Psotiasis

After doing google research i can see Sarcoid, Erythema nodosum, and Psotiais is all an autoimmune condition so my question is if I have had those threee things what could I potentially get next? has anyone had all 3 of these and what else have you got? so at least prepapred and also could insisit GP test or look into

Hello everyone !

I am new to this site and i want to say hello to you all!


I have psoriasis for 8 years and for the last year i was on cosentyx and i was clear 100%. 

Two months ago i found out that i had crohn desease and my dermatologist stopped the cosentyx because of that and now the psoriasis is back .She said i shoud get on 
otezla but i am afraid for the side effects .I dont know what to do...

So after an unsuccessful 3 and a half months on fumaderm I'm now trying methotrexate. I was given a test pack yesterday by my dermatologist which is x2 2.5mg pills. Was told to take them both at the same time and then get blood tested 3 days after and then 7 days after. If they come back fine then I'm all set to start properly in a couple of weeks.

So I'll be updating this thread every so often with how I'm getting on.

Took the test pills yesterday with no problems. I don't know if the dose was high enough to get side effects or even when they are likely to occur? I hear the next day?

So I have moderate psoriasis, mostly on my legs but small bits on my arms, back and scalp. Noticed a few months ago I keep getting small spots under my eyes. They don't scale or itch nor really look like psoriasis (though I imagine psoriasis in this area might appear different) and after a day or two they fade and disappear without any creams. But they keep reoccurring ever few days or so. Sometimes it's just one spot other times theres a collection.

Could it be psoriasis or is it something else? I suffer from hayfever and thought it was perhaps due to rubbing my itchy eyes but to rule this out I've been super conscious of not putting my hands near my eyes and I feel that I've stuck to this very well for a while, munless Im doing it in my sleep? Also I've had hayfever for years.. not sure why it would just start happening now...

I also don't always get the best sleep. Would a lack of quality sleep cause something like this perhaps?

Only other thing is perhaps it's sweat after sport and exercise. I will admit I don't always shower immediately after exercise so perhaps its sweat?


(not sure how to post pictures, sorry)

I have psoriasis in many places but it is different on my face (smooth but red and swollen) and my hands and feet to everywhere else.
My question is about the backs of my hands....the psoriasis seems so thick and dry (it's not spots but just a whole area) that aside from soaking my hands in coconut oil no emollients work as they don't seem to 'get through' the thick skin. Does anyone have any tips?

This study suggests Cosentyx (secukinumab) is the most cost effective when used as a first in line for psoriasis patients in Germany.

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Background:
Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin‐17A, has demonstrated strong and sustained efficacy in adults with moderate to severe psoriasis in clinical trials.

Objective:
This analysis compared the cost per responder of secukinumab as first biologic treatment of moderate to severe psoriasis, with adalimumab, infliximab, etanercept, and ustekinumab in Germany.

Methods:
A 52‐week decision‐tree model was developed. Response to treatment was assessed based on the likelihood of achieving a predefined Psoriasis Area and Severity Index (PASI) response to separate the cohort into responders (PASI ≥75), partial responders (PASI 50 to 74), and non‐responders (PASI <50). Responders at week 16 continued initial treatment, whereas partial responders and non‐responders were switched to standard of care, which included methotrexate, cyclosporine, phototherapy, and topical corticosteroids. Sustained response was defined as 16‐week response maintained at week 52. A German health care system perspective was adopted. Clinical efficacy data was obtained from a mixed‐treatment comparison; 2016 resource unit costs from national sources; and adverse events and discontinuation rates from the literature. We calculated cost per PASI 90 responder over week 16 and week 52, as well as cost per sustained responder between weeks 16 and 52.

Results:
Secukinumab had the lowest cost per PASI 90 responder over 16 weeks (€18,026) compared with ustekinumab (€18,080), adalimumab (€23,499), infliximab (€29,599), and etanercept (€34,037). Over 52 weeks, costs per PASI 90 responder ranged from €42,409 (secukinumab) to €70,363 (etanercept). Likewise, secukinumab had the lowest cost per sustained 52‐week PASI 90 responder (€22,690) compared with other biologic treatments. Sensitivity analyses, excluding patient copayments, showed similar results.

Conclusions:
First biologic treatment with secukinumab for moderate to severe psoriasis is cost‐effective, with lowest cost per responder compared with other biologic treatments in Germany.

Hi,

I'm affected mostly by Psoriasis, but I feel the onset of the arthritis coming on.  My doc suggested  Methotrexate  2 yrs ago.  After some research I decided it sounded too scary.  About a month ago I went back and knowing how much the Psoriasis had progressed, knowing I would take him up this time.   It's the 4th Friday and tonight I am stopping Methotrexate.  I was seeking info as too whether there would repercussions and if so what can I expect?  how long should I continue the folic acid?

Results after 3 wks are encouraging.  I know this must do wonders for many folks.  However, I am finding the side effects too much.  It's not only the 24 to 36 hour hangover as we call it, but my eyes tear for 72 hours, and I feel depression is slinging back.  It would appear this treatment is not for me.   I will be reaching out to my dermatologist for other solutions.

I look forward to reading about others' experiences and solutions.  How others have coped and what avenues have served them best, as I know we (here) all deal with it.

Regards

Tdj

Hello. I have just been diagnosed with psoriasis at 50, prescribed Acitretin: pick the medicine up tomorrow as it wasn't in stock today and I am worrying about the side effects. I have psoriasis really badly on my scalp, all over my face bar my chin (it is red and blotchy and then goes deep red and blotchy and my eyelids peel constantly), both arms, less prominent on my chest and back and a dozen or so plaques on my legs. I literally woke up on 08 March with sore  red eyes and by 21 March I was covered. I am worried about the fact Acitretin can make the rash worse: I feel that if it does get worse  I won't be able to cope with it. I am using protopic on my face and diprosalyic acid on my body as well...will those topical ointments help to stop my psoriasis worsening when I start the Acitretin? 
Does anyone have any experience about whether the worse it is to start with the worse it gets? 
I am due to go on holiday for a short break on 21 May to Cyprus, booked before this happened, but am wondering if this is a good idea..the dermatologist was very laid back and said go if you want to but he also did not mention much about the medication making things worse initially. Does anyone think it might be advisable not to go?
I have already had two weeks off sick whilst waiting for a diagnosis because commuting in to London in the cold weather was unbearable and people were staring at me as my face peeled (and someone on the train asked if I had scarlet fever). I only started my job 6 months ago and am dreading taking more time off but equally am concerned about working if it makes my psoriasis even worse. Sorry to be so negative but I am really concerned and welcome any advice from others who have experienced Acitretin. Oh and really worried about hair loss...it has already got thinner with the scalp psoriasis.

Hello and glad I found this group.  My name is Bob and am 46 , live in Chicago area and was diagnosed with psoriatic arthritis 5 years ago.  I have had psoriasis for about 15 years.  Was manageable at the beginning but worsened with age.  Once my joints/tendons etc starting hurting daily I knew something was going on.  Took awhile to get correct diagnosis.  I am on Tremfya now and has worked great since January.  Psoriasis is almost completely gone and arthritis is much better and manageable.   I also was on Humira, Enbrel Otezla, and Cosentyx in the past.

The National Institute for Health and Care Excellence (NICE) have issued final appraisal for Tremfya (guselkumab) to be used  for treating plaque psoriasis in adults.

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Guselkumab 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 therapies, including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet A radiation), or these options are contraindicated or not tolerated and the company provides the drug with the discount agreed in the patient access scheme.

Stop guselkumab 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.

For the cost comparison, it is appropriate to compare guselkumab with ixekizumab and secukinumab. Taking into account how many people continue treatment (which affects the costto the NHS), guselkumab provides similar health benefits to ixekizumab and secukinumab at a similar or lower cost. It is therefore recommended as an option for treating plaque psoriasis in the NHS.