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

Quote:

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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.

I put it on a little under the dark circles under my eye and I noticed the next morning it made my skin even lighter. Almost noticeably lighter in colour. I am a fairly white person, but it seemed to have changed the pigment colour in my skin. 
Umm, I'm so confused lol. Why has this happened and is it normal?
I can't find anything on Google regarding it.

To save confusion with old Introduction threads getting bumped back to the top I will be closing all threads over 3 months old.

We sometimes get people reposting in old threads after an absence, this causes confusion as others see the thread at the top and respond even though they may have already welcomed before.

It's also unfair on our new members if others bump up old threads in this section as it pushes theirs down and they could get missed. I'm sure you will all agree that a new members post in Introductions should take priority.

All members are welcome to start new threads in any of the other boards, even a new Intro after a long absence if they wish but it doesn't help our new members get found when we get old threads bumped to the top.

So from now on at the beginning of each month I will close all threads in Introductions that are more than three months old, that should give others time to respond to new threads.

Feedback welcome.

Hi my name is Georgie. I'm 25 yrs old. I have been living with this for 5 years and it only seems to get worst at times. I used to be very confident since I work out and love the beach. But psoriasis destroyed it all. My psoriasis has really affected my mental health. I tried accepting it but I just cant sometimes. I have to learn and have hope. Thank you.

Hello everyone
I am newly diagnosed ....turned 50 in March and four days later experienced first ever psoriasis. I'm covered scalp to feet including my face which has caused me to feel anxious and depressed. So far had a short course of oral steroids that did nothing. Topical steroids hardly touched it. Currently using protopic on face and diprosalic on scalp and body. Any advice gratefully received.....

Hello.

Does UV sunbed treatment for psoriasis at hospital still exist for patients in 2018 ?

I had this UV treatment in the 1980's but have always wondered how much radiation my body was exposed to .......... 

I remember going to hospital every week and laying on a sunbed with dark protective glasses on , I was too young to remember for how long the sessions lasted.

Anyone else done this ?

This study looked at the long‐term safety and effectiveness of Fumaric acid esters (FAEs) as monotherapy and in combination with phototherapy or methotrexate in patients with psoriasis treated at a single centre in Germany.

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Background:
Fumaric acid esters (FAEs) are an established systemic treatment for moderate‐to‐severe psoriasis. However, the long‐term clinical safety and effectiveness of continuous FAE monotherapy and combination therapy have not been established.

Objective:
To examine the long‐term safety and effectiveness of FAEs as monotherapy and in combination with phototherapy or methotrexate in patients with psoriasis treated at a single centre in Germany.

Methods:
This monocentric, retrospective observational study, with a follow‐up period of up to 32.5 years, included 859 patients: 626 received FAE monotherapy, 123 received FAEs with concomitant phototherapy and 110 received FAEs with methotrexate.

Results:
Approximately half of patients (49.0%) reported adverse events (566 total events), most of which involved the gastrointestinal tract. Serious adverse events were reported in 2.3% of patients, but none were deemed to have a causal relationship with any of the treatment regimens. Adverse events leading to treatment discontinuation were observed in 12.9% of patients. A median duration of 1 year was observed in all three treatment sub‐cohorts (P = 0.70) from initiation of FAE treatment to a 50% response rate, where response was defined as achieving a cumulative static Physician's Global Assessment (PGA) score of ‘light’ and at least a 2‐point reduction in baseline PGA. A 50% response rate for the cumulative Psoriasis Area and Severity Index 75 was achieved in the FAE monotherapy sub‐cohort after a median of 3 years of treatment, in the FAEs + phototherapy sub‐cohort after 6.7 years and in the FAEs + methotrexate sub‐cohort after 8.1 years (P = 0.001).

Conclusion:
According to our data, FAEs as monotherapy or in combination with phototherapy or methotrexate are safe and beneficial for long‐term clinical use. However, multicentre, randomised controlled trials are required to establish the clinical value of monotherapy versus combination therapy and the optimal treatment duration.

This study suggests there is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations in psoriasis patients.

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Background:
Nail psoriasis disease is associated with an increased probability of psoriatic arthritis and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered.

Objective:
To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and assimptomatic PsA.

Methods:
Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data, and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand.

Results:
Forty‐eight patients were included in the study; thirty‐three of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (p=0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs 1.23 ± 0.27, p=0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs 1.74 ± 0.21, p=0.66, and 1.79 ± 0.28 vs 1.67 ±0.19, p=0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs 46.4%, p 0.368).

Conclusion:
Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

Hello to forum members , I have just joined today. 

Hi, 

I thought i would do a quick introduction before i jump in with questions :-) 

I am 35 and have been suffering with serious psoriasis for about 18 months. 
I havent really had any issues in the past with this, only sometimes on my face and scalp if i was run down or stressed.  After a period of high stress a while back, i got it really bad all over my body, and i mean ALL OVER! 

My legs got it the worst, it was like burns on my legs.  I ended up going A&E as my feet and ankles had swollen up so bad i couldnt put shoes on. 

I was first put on Ciclosporin and now i am on Methotrexate.  Ciclosporin worked pretty well. I would say about 90% clear up.  Now i am on Methotrexate and i am not doing so well. 

So thought i should join a forum like this one where i can find out tips and tricks to living with my skin condition.  

Thanks
Jimish

I am glad I found this group to learn from others who are dealing with the same things I'm dealing with. I have had Psoriasis for 42 years, but have been fortunate to have had times of remission. I was diagnosed with Psoriatic Arthritis when I was 31 - I remember sitting in the doctors office crying because I couldn't play with my 2 small children because the pain was blinding at times (oh man, if I bumped an inflammed joint - took my breath away for a minute - I remember even getting light-headed from the pain). Fast forward to 20 years later - kids moved out and are on their own, my husband and I are empty nesters - and we are loving it (don't tell our kids - we dearly love them, but it is nice to be in this chapter of our life).

I have taken Stelara for 2 1/2 years and had fantastic results, but it is no longer working on my skin - darn psoriasis is spreading on my scalp again - no where else though. But you know what? If this is my lot in life, I can deal with it - it could be something much, much worse! It could always be worse! 

I am at a fork in the road right now, my derm and rheum want me to start cosentyx, but I am having a lot of anxiety after reading possible side effects and justifying taking this new drug for a little scalp psoriasis. The arthritis is not bad right now - I can tell it's worsening some, but is it bad enough to take a new drug or should I just use the topical treatments on my scalp for now and pain relievers for the joint pain? I've got to make a decision. 

It's nice knowing there are kindred spirits here with a listening ear and an understanding of what I'm going through. Looking forward to getting to know you all. 

This study looked at neuropsychiatric comorbidity in adolescent psoriasis patients.

Quote:

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Background:
Psoriasis is a known risk factor for neuropsychiatric diseases among adults. Less is known about the impact on adolescents.

Objectives:
To investigate the association between psoriasis and neuropsychiatric comorbidity and social skills among adolescents.

Methods:
A population‐based cross‐sectional study between 1 January 1999 and 1 January 2014 was conducted. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate‐to‐severe psoriasis, respectively. The psoriasis patients were diagnosed by a dermatologist. Neuropsychiatric diseases were diagnosed by a neurologist and a psychiatrist, as appropriate. Social skills were evaluated using psychosocial assessment. Patients with psoriasis were compared with 884 653 healthy controls by a multivariate analysis adjusted for age, sex, country of origin, socioeconomic status, cognitive skills and body mass index. A subgroup evaluation was done for comorbidity that could only be evaluated for part of the recruitment years, using a univariate analysis.

Results:
Overall chronic headaches (8·1% vs. 3·4%), intermediate frequency migraine (4·8% vs. 1·6%), low‐frequency migraine and nonmigraine headaches (3·4% vs. 1·8%) were associated with moderate‐to‐severe psoriasis only compared with healthy controls [adjusted odds ratios (OR) 1·9, 95% confidence interval (CI) 1·6–2·4; 2·3, 95% CI 1·8–3·0 and 1·5, 95% CI 1·1–2·1, respectively]. Anxiety disorders (2·1% vs. 0·8%) and impaired social adjustment skills (7·5% vs. 4·2%) were also associated with moderate‐to‐severe psoriasis only compared with healthy controls [adjusted ORs 2·9, 95% CI 1·6–5·5 and 1·9, 95% CI 1·3–2·6 (of 466 vs. 265 023), respectively].

Conclusions:
Psoriasis among adolescents is associated with neuropsychiatric comorbidity and impaired adjustment skills, depending on disease severity.

Gundry claims that, of 800 people who followed his diet, after 6 months everybody was cured (forum rules won't let me post the link).
 
I have been following his protocol for 4 months now and still have psoriasis. The first 3 months, I may have unintentionally cheated when eating out, and ate rice, possibly too much fruit, and drank vodka. The past 3 weeks I have followed it down to a tee with no remarkable improvement and I am tempted to give it up.

When have others given up or been cleared?

On a standard elimination diet, usually 4 days is recommended to detect if this is causing issues.

With psoriasis, do we think 4 days without worsening psoriasis is sufficient to conclude this is not a problem food?

Hi all,

Update from my January 2018 review. Yes the low dosage of FUME was still holding it at bay. I had agreed with the nurse as such a low dosage. It was probably doing nothing so felt it was time to come off it and may be restart when P started to raise its ugly head again. 

That was in January . Its now Mid April and still 99.5 % free small patch on knee.  Topics coping with this.

Has anyone else experienced this as 

Wish you all well.

Baz