This study looked at 10 years of real-world data on the effectiveness of biological treatments for psoriasis.

Quote:

---

Background:
Few studies have analysed the long-term effects of biological treatment in psoriasis. PsoReg, the Swedish national register for systemic psoriasis treatment, started in 2006 and now includes 10 years of real-world data on the effectiveness of biological treatment.

Objectives:
To analyse the long-term real-world outcome data of patients who are biologically naïve with moderate-to-severe psoriasis after switching to biological treatment.

Methods:
An observational study of patients who are biologically naïve with at least one registration of outcome before switching to biological treatment while included in PsoReg and at least one follow-up visit. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and EuroQol-5D (EQ-5D) values were analysed at 3–5 months, 6–11 months and at least once after ≥ 1 year, up to 9 years after the switch to biological treatment.

Results:
In total, 583 patients fulfilled the inclusion criteria. Of these, 399, 395 and 373 patients had observed outcome data beyond 1 year on the PASI, DLQI and EQ-5D, respectively, and 164, 168 and 152, respectively, were observed in at least three time periods after the switch. Significant (P < 0·01) improvement in PASI, DLQI and EQ-5D scores was observed 3–5 months after the switch and sustained under the whole observation period. The mean PASI, DLQI and EQ-5D changed from 13·5 ± 9·1, 9·0 ± 8·1 and 0·74 ± 0·22, respectively, before the switch, to 4·0 ± 3·5, 3·7 ± 4·7 and 0·79 ± 0·21, respectively, 1–5 years after the switch.

Conclusions:
Biological treatment, as used in clinical practice, shows a stable long-term effectiveness in all the measured dimensions, PASI, DLQI and EQ-5D.

This study tried to evaluate the safety of psoriasis biological treatments in conception and/or pregnancy.

Quote:

---

Background:
Biological therapies are effective treatments for psoriasis and are often prescribed to women of child-bearing age.

Objectives:
To evaluate the safety of biological therapy in conception and/or pregnancy.

Methods:
We performed a systematic review of pub med, Medline, Embase and Cochrane databases for multivariate-adjusted studies of women exposed to biologics relevant to the treatment of psoriasis during conception and/or pregnancy.

Results:
We identified four population-based cohort studies involving 1300 women exposed to tumour necrosis factor (TNF)-α inhibitors (TNFi) 3 months prior to or during the first 3 months of pregnancy. These studies showed a trend towards drug-specific harm with TNFi exposure in women with different inflammatory diseases, with an increased risk of congenital malformations [three studies; odds ratio (OR) range 1·32–1·64] and preterm birth (one study; OR 1·69, 95% confidence interval 1·10–2·60). This trend did not reach statistical significance in all studies; study heterogeneity, variation across comparator cohorts, inadequate adjustment for important confounding variables such as co-therapy, and an absence of a common constellation of malformations means there is uncertainty about the causal role of TNFi. No studies specifically addressed the effect of TNFi exposure in psoriasis during conception and/or pregnancy, or of interleukin (IL)-17 and IL-12/23 antagonists in any indication.

Conclusions:
When counselling women these findings must be balanced against the potential impact of untreated severe psoriasis on conception and/or pregnancy and maternal wellbeing; ongoing pharmacovigilance via registries remains essential to address this evidence gap.

This study investigated the risk of cancer in patients with psoriasis treated with biological therapy.

Quote:

---

Background:
Biological therapies are highly effective in psoriasis, but have profound effects on innate and adaptive immune pathways that may negatively impact on cancer immunosurveillance mechanisms.

Objectives:
To investigate the risk of cancer in patients with psoriasis treated with biological therapy.

Methods:
We searched Medline, Embase, and the Cochrane Library (up to August 2016) for randomized controlled trials, prospective cohort studies and systematic reviews that reported cancer incidence in people exposed to biological therapy for psoriasis compared with a control population.

Results:
Eight prospective cohort studies met our inclusion criteria. All the evidence reviewed related to tumour necrosis factor inhibitors (TNFi) with the exception of one study on ustekinumab. An increased risk of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma, was reported with TNFi compared with both a general United States population and a rheumatoid arthritis population treated with TNFi. No evidence for increased risk of cancers (reported as all cancers, lymphoma, melanoma, prostate, colorectal and breast cancer) other than NMSC was identified.

Conclusions:
There were important limitations to the studies identified including choice of comparator arms, inadequate adjustment for confounding factors and failure to account for latency periods of cancer. There remains a need for ongoing pharmacovigilance in relation to cancer risk and biological therapy; the NMSC signal requires further investigation to determine the risk specifically attributable to biological therapy using prospectively collected data with adjustment for known NMSC risk factors.

Hello
I am new to The forum. 
A week and a half ago I started Fumaderm. Early days i know.
I moved to 2, 30mg tablets on Tuesday. I took them at night and woke up the next day bright red. It didn't last long and I was my normal colour by 1. 
I let the doc know and they called me in for a look but I was back to nirmal. 
They could not explain this. They said maybe it was flushing and told me to take the tabs at separate times.
Nothing happened Thursday
Today I took a tablet at 630. I had my dinner at 830. At 945 my skin went insane. I felt hot and sore and mad itchy. When I looked i had once again turned pink from head to toe
I was just wondering if anyone else has experienced flushing like this. It is still going at the moment and i am on fire.
The doctor seemed to think flushing was only face and chest... Anyone else has whole body redness??
Thanks in advance
Cheers ☺

I thought it would be interesting to have a poll asking what people thought is the worst part of the body to have psoriasis. I don't think it's worth making the poll multi choice as we will probably tick all the boxes, so I have made it single answer.

Obviously anywhere to have psoriasis is a bad thing, but if you had to pick one what is the worst part of the body for you to have psoriasis ?

The poll is open to members and guests with no closing date.

Members are also welcome to post in this thread if they wish.

This study looked at the economic burden of psoriasis in German patients.

Quote:

---

Background:
Though psoriasis poses a substantial chronic socio-economic burden, few studies have addressed the economic impact in Germany.

Objectives:
The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective.

Methods:
A cross-sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardized questionnaires of illness-related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non-parametric tests.

Results:
Complete data were obtained from 1158 patients in 132 centres. Annual average costs for patients with psoriasis: total costs € 5543 ± € 8044, systemic treatment costs (paid by the statutory health insurances [SHI]) € 3733 ± € 7322, out-of-pocket costs € 224 ± € 406, total SHI costs € 4940 ± € 7533, direct costs € 5164 ± € 7581 and indirect costs € 379 ± € 2087. Significant higher costs in male and significant lower costs in 65+-year-old patients were found.

Conclusions:
Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out-of-pocket and indirect costs towards systemic drug costs.

This study suggest that smartphone overuse could speed up the possible development of psoriatic arthritis.

Quote:

---

Background:
Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems.

Objectives:
As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients.

Methods:
An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints.

Results:
The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P < 0.05) as well as in SA psoriasis patients compared to non-SA psoriatic subjects (15.2 vs. 6.7; P < 0.01). Higher mean of ultrasound score was found for left hand in controls (both SA or not) and for right hand in psoriatic subjects (both SA or not), however without reaching statistical significance.

Conclusions:
Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis.

This study looked at the impact of Taltz (ixekizumab) on facial psoriasis and related quality of life measures in moderate-to-severe psoriasis patients.

Quote:

---

Background:
Facial psoriasis was reported in 17–68% of patients with psoriasis and shown to have a negative impact on patients’ personal and health-related quality of life (HRQoL).

Objectives:
To explore the association of facial psoriasis with patients’ HRQoL and to assess the relationship between ixekizumab (IXE) and improvement in facial psoriasis and changes in HRQoL.

Methods:
This work reports the combined results of two phase III multicentre, randomized, double-blind, placebo-controlled, active-comparator trials in patients with moderate-to-severe psoriasis. Patients received placebo, etanercept (ETN; 50 mg twice weekly) or IXE [80 mg every 4 weeks (Q4W) or every 2 weeks (Q2W)] for up to 12 weeks following an initial 160-mg dose. HRQoL parameters were analysed based on facial psoriasis status at baseline using analysis of covariance models. Improvement was assessed as percentage of patients with no facial psoriasis.

Results:
The combined database included 1133 patients with facial psoriasis and 1437 without. Patients treated with IXE whose facial psoriasis cleared had improved Dermatology Life Quality Index 0.1 responses (P < 0.01) compared with patients with facial psoriasis at Week 12. At Week 12, clearance of facial psoriasis compared with the presence of facial psoriasis was independently associated with significantly better improvement in Psoriasis Skin Appearance Bothersomeness scores in the IXE Q2W treatment group (P < 0.01). At Week 12, facial clearance and overall Psoriasis Area Severity Index (PASI) improvement were observed in significant numbers of patients treated with IXE compared with ETN and placebo. Facial psoriasis clearance at Week 12 in patients treated with IXE or ETN was positively associated with PASI75 and PASI90 achievement.

Conclusion:
Facial psoriasis had a larger negative impact on HRQoL than no facial psoriasis. Facial psoriasis clearance was associated with improved HRQoL. Significantly more IXE-treated patients had rapid facial clearance vs. ETN and PBO, which led to better clinical outcomes.

I got the call today that I will able to get Stelara. I'll get a call soon to set up the appointment. For some reason they will not let me self inject and said it would be done in the doctor's office, however, due to insurance (more on that later in another thread so as not to take this one off topic) it will be done at the hospital. The dermatologist will still do the follow ups and be the one primarily taking care of things.

I'm excited and a teeny bit nervous ( but not of the injection.) So, I'll be joining the Stelara Bandwagon soon and I'll post injection dates with reactions to them and progress made (or not) in this thread.

hi 
i just want to share my exp with  Exemptia Adalimumab mad in india

i am on first month now with exemptia since humira is cost 1900 usd  7000 aed
tell i got exemptia
i am now in exemptia with almost 50% recovery and its only 1 month and half 
if u cannot go for humira ask your doc about the exemptia  cost 245 usd 900 aed  i think u can find it in dubai  not sure
but for me its workeing  like a charm
ask your doc about it and i hope its worked for you

Hi

I'm not quite sure how I go about deleting an account on this forum?  Anybody know how it can be done?

Cheers

Kit

This multinational dermatologist and psoriasis patient study looked at the burden of psoriasis.

Quote:

---

Background:
Psoriasis is a chronic, immune-mediated disease, characterised by symptoms that include itching and skin pain and is often associated with comorbidities. Patients have a substantial detriment to quality of life (QoL) and work productivity with associated cost burden.

Objective:
To investigate the incremental burden of comorbidities, itch, and affected body areas among systemic eligible patients with psoriasis, using a multinational survey of dermatologists and their psoriasis patients.

Methods:
Multinational data from the Growth from Knowledge (GfK) Disease Atlas global real-world evidence programme were used. Eligible patients were identified as those who were currently having or had ever had moderate-to-severe psoriasis, and must have been receiving prescription treatments at the time of the survey. Multivariable regression analyses were conducted to assess the incremental burden among psoriasis patients with physical and psychological comorbidities, itch, and affected visible and sensitive body areas versus psoriasis patients without these conditions, respectively.

Results:
The study enrolled 3,821 psoriasis patients, from 9 countries, with an average Psoriasis Area and Severity Index score of 6.4. The presence of comorbidities was associated with a significant increase in the likelihood of skin pain, lower QoL, greater work impairment and increased usage of medical resources (except in psoriasis patients with obesity and type II diabetes). Psoriasis patients suffering from itch and those with visible and sensitive affected body areas also had impaired QoL versus those without these conditions.

Conclusion:
Psoriasis patients with physical and psychological comorbidities, itch and, affected visible and sensitive body areas had lower QoL, and greater work impairment compared to those without these conditions.

Hi, I have been reading the forum as a guest for a few years now and decided it was time to try and add something to the debate. I am a 59 year old man and have have plaque and nail psoriasis for around 20 years.
I noticed there is not much history of Apremilast (Otezla) use and I have recently started on it so might be able to add something. 
For what it's worth a short history of my treatments is as follows; 
Various creams - not very effective.
PUVA - worked quite well and I got a home lamp made from an old sunbed which was effective but eventually the Dermatologist decided I had had enough sunlight for one lifetime.
Accitretin - made the psoriasis worse and made my lips peel! Awful stuff (for me anyway).
Ciclosporin - very effective after about 3 months use but had to come off it due to raised blood pressure.
Methotrexate - seemed to work but I only stuck it for a month as I felt run down and slightly ill all the time.
Fumaderm - I have been on and off this for around 2 years, it was very effective clearing nearly everything but my nails, but eventually had to come off due to very low blood count which wasn't recovering. I never quite got over the stomach problems with Fumaderm, never straying too far from the loo until after 11.00 am, but I felt it was worth the discomfort.
Otezla - started 3 weeks ago, no real side effects so far, felt a bit nauseous in the mornings but that's gone now. Hard to tell if it's working yet but it hasn't made it any worse!
I'll try and update on the Otezla in a few weeks time.

As far as I understand it the Bio is absorbed under the skin slowly and spread around the body over a period of time, but could it help psoriasis better or quicker if it was injected nearer to the psoriasis ?

I always inject in the belly, but today I have injected in my legs as that is where Cosentyx seems to be struggling. I doubt it will make any difference but thought it may be worth a try.

I know you should never inject directly into the psoriasis but does anyone have any thoughts on if there are indeed any benefits of injecting nearer the site of the problem  ?

Just started Orencia.  I chose the weekly injection over the infusion.  I just prefer the shorter half life in my body.  Injection was no biggie.  So far I feel absolutely nothing which is kind of good since most of the stuff makes me feel worse.  I'll chime in with more input on how this plays out.  But has anyone else done Orencia.  I know its more for PA, but just curious your thoughts.
Thanks

Hi Folks,
Just wondered if anyone has been on or is using Apremilast (Otezla tablets).
How are you doing on this medication and any 'nasty' side effects.
Thanks. 

Im suffering from psoriasis since 2014..im worried cpz my hair became thinner and my skin is not good anymore as before ive flawless skin..i visited 4 dermatologist anymore they are all giving me almost same treatment but my last dr.gave me dermovate scalp anf skin ointment..but it always comes back..what im gonna do im thinking about the injection cosentyx is that good???

Hey guys.

After 30+ sessions of light therapy not making a bit of difference to my skin and after not being eligible for methotrexate (didn't really fancy taking it anyway) and really not being keen on acitretin (due to reading about the side effects and how much it actually iimprovemprovrs psoriasis) my dermatologist has offered my Fumaderm. Currently waiting for it to arrive at the hospital.

Just got a couple questions for those that have been on it.

I've researched the side effects and I reckon I'll be able to stick them but I just have a question about the flushing...  does the flushing occur at about the same time after taking your dosage and if so how long after is this? I work a 9 to 5 job and would rather avoid the flushing at work if possible. I imagine that's possible on the early doses but may be impossible to avoid once you're taking a few tablets a day?

So, read some experiences here, but could not finder the answer I wanted; Which bio cleared you the fastest?

I don't know which one i Will start or if I have to go through a certain protocol again, but I just would like to know 

As I am taking a break from systemic treatment, I thought I might try some topical, Here are the ingredients:



I dissolve a 7 gram block of camphor in tea tree oil, then add the petroleum jelly, chest rub, 12 crushed aspirin, 50 grams of tar, and a bit of eucalyptus oil. Mixed together it looks like this:



As well as using it on a few spots behind my ears, I will apply it to a spot on my knee:



before applying a waterproof bandage.



I will change this every few days and record my progress. But what about my DMF? I do have a nice ardenium:



but another one has been badly afflicted with root rot:



So I have mixed in a bit of DMF with the soil as well as applying a bit to the infected part of the plant. DMF is a good inhibitor of mold, so fingers crossed.