This Dutch study looked at the cost effectiveness of bio psoriasis treatments.

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Background:
Treatment with biologics may be indicated for patients with moderate to severe plaque psoriasis, but comparative evidence on cost-effectiveness is limited. Switching of biologics is common, but it is unclear what the effect is of differences in sequences of biologics.

Objective:
Evaluate the cost-effectiveness of different biologic treatment sequences for psoriasis based on real-world evidence.

Methods:
A sequence model was developed to evaluate the costs and health effects of three consecutive lines of biologic treatments (for example adalimumab-etanercept-ustekinumab versus etanercept-ustekinumab-adalimumab) over a 10-year time horizon in the Netherlands. The model was populated with data from the Dutch BioCAPTURE registry and scientific literature. Analyses were conducted of cost per quality-adjusted life year (QALY) and uncertainty was addressed by probabilistic as well as scenario analyses.

Results:
Treatment of psoriasis with biologics for a 10-year period was estimated to be associated with a cost of € 141,962 to € 148,442 per patient depending on the treatment sequence used. Cumulative health effects ranged from 7.79 to 8.03 QALYs. Starting with adalimumab or ustekinumab seems favourable concerning cost and utilities compared to strategies starting with etanercept, though credible intervals were partly overlapping.

Conclusions:
The order in which biologics are used influences treatment cost-effectiveness, both in terms of costs and health effects. Initiation of a biologic treatment sequence for psoriasis may best be done with adalimumab or ustekinumab; etanercept seems less optimal from a health-economic perspective.

Pfizer announced it has received approval by the FDA for the use of Xeljanz (tofacitinib) in psoriatic arthritis.

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Pfizer announced today that the United States Food and Drug Administration (FDA) has approved XELJANZ® 5 mg twice daily (BID) and XELJANZ® XR (tofacitinib) extended release 11 mg once daily (QD) for the treatment of adult patients with active psoriatic arthritis (PsA) who have had an inadequate response or intolerance to methotrexate or other disease-modifying antirheumatic drugs (DMARDs). XELJANZ/XELJANZ XR is the first and only Janus kinase (JAK) inhibitor approved by the FDA for both moderate to severe rheumatoid arthritis (RA) and active PsA.

The recommended dose of XELJANZ/XELJANZ XR is in combination with nonbiologic DMARDs, and use in combination with biologic DMARDs or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.

The FDA approval of XELJANZ for the treatment of adult patients with active PsA was based on data from the Phase 3 Oral Psoriatic Arthritis Trial (OPAL) clinical development program, which consisted of two pivotal studies, OPAL Broaden and OPAL Beyond, as well as available data from an ongoing long-term extension trial, OPAL Balance.

Both pivotal studies met their two primary efficacy endpoints, demonstrating statistically significant improvements in American College of Rheumatology 20 (ACR20) response and change from baseline in the Health Assessment Questionnaire–Disability Index (HAQ-DI) score at three months in patients receiving XELJANZ 5 mg BID treatment in combination with a nonbiologic DMARD, compared to those treated with placebo. In OPAL Broaden, 50% of patients taking XELJANZ 5 mg BID achieved an ACR20 response, compared to 33% of patients taking placebo (p≤0.05), at three months. In OPAL Beyond, 50% of patients achieved an ACR20 response with XELJANZ 5 mg BID, compared to 24% of patients taking placebo (p≤0.05), at three months. In both studies, statistically significant improvements in ACR20 response was also seen with XELJANZ 5 mg BID compared to placebo at week 2, a secondary endpoint and the first post-baseline assessment (OPAL Broaden: 22% and 6% [p=0.0003], respectively; OPAL Beyond: 27% and 13% [p=0.0046], respectively).

The safety profile observed in patients with active psoriatic arthritis treated with XELJANZ was consistent with the safety profile observed in rheumatoid arthritis patients. The most common adverse events observed occurring in greater than 3% of patients on XELJANZ 5 mg BID were nasopharyngitis, upper respiratory tract infection, headache and diarrhea.

Following on from Taltz getting FDA approval for psoriatic arthritis, the Committee for Medicinal Products for Human Use (CHMP) has recommended it for use in Europe too.

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On 14 December 2017, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorisation for the medicinal product Taltz.

Taltz, alone or in combination with methotrexate, is indicated for the treatment of active psoriatic arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drug (DMARD) therapies.”

Detailed recommendations for the use of this product will be described in the updated summary of product characteristics (SmPC), which will be published in the revised European public assessment report (EPAR), and will be available in all official European Union languages after a decision on this change to the marketing authorisation has been granted by the European Commission.

The Scottish Medicines Consortium has said no for Kyntheum (aka Brodalumab / Silq ) in the treatment of psoriasis.

A short statement read:

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The committee was unable to accept brodalumab (Kyntheum) for the treatment of moderate to severe plaque psoriasis, a condition which causes red scaly patches on the skin, because of uncertainties in the case made by the submitting company

So I have been on Humira for about 18 months now, and I am starting to notice that its slowly starting to stop working. I take it once every 2 weeks, and during the first week, most symptoms of my psoriatic arthritis disappear, but after like 5-6 days they start coming back. Anyone else having this issue?

Hi everyone, I have been suffering P for the past 15 years, initially patches on my legs and then eventually spreading across the body. I have been on UVB for the past 5 years or so, but find that the effectiveness is wearing down, longer time to clear and whenever I stop , the P comes back faster and with a vengeance. I feel that my skin is drying up and I feel burnt all the time with UVB, hence I am trying out Dovobet gel.

Looking to get some tips on using the gel, it seems fairly effective to me, but it is sticky and leaves a stain on my clothes. So I apply it before I go to work, my office wear is stained, if I apply it before I go to bed, my sheets and clothes are stained as well. My kids like rolling around on the bed and I am not sure whether the dovobet stains have any impact in them.

Can anyone using dovobet gel share how you use dovobet gel and any tips on getting around the staining on clothes. Thank you very much and everyone have a great day.

Hi All

I’ve recently stopped acitretin due to side effects, and not being effective, so methotrexate is next on the list.
I’m starting on 15mg weekly, bit worried about the side effects of this. I know people get mixed results.
How long before seeing a benefit?

Thanks

Liz

This study set out to provide practical recommendations for the management of patients with Psoriatic arthritis (PsA) in the dermatology setting including early diagnosis and treatment.

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Background:
Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable.

Objective:
To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Methods:
A consensus document was written by an expert panel composed by dermatologists (n=12) and rheumatologists (n=6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) by using the Delphi method.

Results:
A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biological disease modifying anti rheumatic drugs to be considered for the treatment of PsA have been reported.

Conclusions:
The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

I've been lurking around on this forum for about 2 years and thought it'd now be a good time to come out of the closet. I thought about starting posting last Oktober when I went over from yearly UV-B light therapy to Metotrexat (due to the fact that I've hit the lifetime limit of UV exposure apparently) but I held off. I've had severe Gutate Psoriasis since 2002 when I was 19 until now (34). Light therapy was a life saver for me until the spring of 2016 when it was determined that I had to give it up. Got really depressed that summer and with a big flare up to boot. Got on Methotrexate in September and it worked (decently) until my liver values shot up over 3.2. What values they measure exactly I don't really know. But I had to give it up. Just as well cuz ever since I started I've been feeling weaker week by week. (20mg a week) with a 5mg folic acid tablet the day after. This spring I also started taking the biosimilar Benepali, but I feel it's done nothing for me.  
I've been checking in on this forum often and have been keeping tabs on what you guys have been talking about, and from what I've gathered (fumaric acid esters) seems to be really good for a lot of you. I really wanted to start with Fumaderm (I've heard good things about it), but my dermatologist said that since Skilarence is on the Swedish market and it's the same activ substance ie. The same thing It's not possible to get it imported anymore.
I've only seen discussions about Skilarence on here, and no accounts to my knowledge of any one here being on it, so I thought I'd share my upcoming experience with it with all of you. So if everything goes according to plan I'll start taking it next week. Cheers! 

A recent presentation by Erlangen University Germany at Psoriasis gene to clinic suggest a link to taste and smell with psoriasis patients.

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The various aspects of nutrition are a major issue in patient care for psoriasis. Metabolic disorders and increased body mass index are frequently encountered in this patients group and may result from systemic inflammation characteristic for the disease and/or unbalanced intake of food calories by the patients.

Interestingly, in chronic inflammatory bowel diseases relevant gustatory and olfactory changes have been detected. These result in a disturbed food intake and are normalized again upon successful treatment of the disease. Here, patients with psoriasis were tested before any systemic treatment for the gustatory qualities sweet, sour, salty, bitter and umami. They were tested with appropriate solutions sprayed onto the back of the tongue in a standardized procedure, as well as by using sniffing sticks for olfaction.

Thirty-three patients were tested: 18 women and 15 men with a mean age of 54.3 years (range 21–85), a mean Psoriasis Area and Severity Index (PASI) of 8 (range 0.7–24) and mean C-reactive protein (CRP) of 5.4 ng mL (range 0.6–24.1). The results were compared with those in a group of healthy volunteers. Whereas sweet taste was detected by all patients, bitter could not be tasted by 21 patients and umami by 11 patients. Two and 23 patients showed hyposmia with results off the 10% and 50% percentiles of normal volunteers, respectively. Altogether, a distinct impairment of gustatory and olfactory senses was found in patients with psoriasis.

Considering the low number of patients, the correlation to PASI and CRP was barely significant. In addition, a normalization of sensory capacity in relation to therapeutic responses and improvement of psoriasis has to be monitored.

In the last year my ps has developed much thicker dead skin over the plaques. Or maybe the dead skin is the plaque... Either way, I am looking for a good way to remove the dead skin. I have a home UVB unit, and the light is useless as it won't penetrate through the dead skin. I have been using lanolin in a tube for nursing mothers. It helps but really doesn't do the job. I also use argon oil to moisturize my face and my hands. Real genuine argon oil is expensive so I cannot use it all over, plus it really won't remove the dead skin.

Is there anything that dissolves the dead skin?

What do you use?

Thanks

Hello everyone
I have been reading many posts to help my try to understand this horrible disease better and get an idea as to what medications/diet or other treatments are working best for others. Have had pustular psoarisis since 2014.  Getting worse all the time. Have landed in the hospital with cellulitous. Hands and feet are terrible., I am typically a very active person but this is starting to really affect me emotionally and physically. Have tried creams, methotrexate, humira, now taltz. Any advice or what worked for others I woukd appreciate.  Thanks in advance

Following on from this thread Taltz shows good results for psoriatic arthritis Lilly have announced it has now got approval for psoriatic arthritis.

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Eli Lilly announced today that the U.S. Food and Drug Administration (FDA) has approved Taltz® (ixekizumab) injection 80 mg/mL for the treatment of adults with active psoriatic arthritis (PsA). Taltz was first approved by the FDA in March 2016 for the treatment of adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Taltz may be administered alone or in combination with a conventional disease-modifying antirheumatic drug, such as methotrexate. Taltz should not be used in patients with a previous serious hypersensitivity reaction, such as anaphylaxis, to ixekizumab or to any of the excipients. Taltz may increase the risk of infection. Other warnings and precautions for Taltz include pre-treatment evaluation for tuberculosis, hypersensitivity reactions, inflammatory bowel disease and immunizations.

The efficacy and safety of Taltz was determined from findings from two randomized, double-blind, placebo-controlled Phase 3 studies - SPIRIT-P1 and SPIRIT-P2 - which included more than 670 adult patients with active PsA. SPIRIT-P1 evaluated the safety and efficacy of Taltz compared to placebo in patients with active PsA who had never been treated with a biologic disease-modifying antirheumatic drug. SPIRIT-P2 evaluated the safety and efficacy of Taltz compared to placebo in tumor necrosis factor inhibitor (TNFi)-experienced patients with active PsA who failed one or two TNF inhibitors. Across both studies, patients were required to have a diagnosis of active PsA for at least six months and at least three tender and three swollen joints. Non-responder imputation (NRI) methods were used. Inadequate responders (defined by blinded tender and swollen joint count criteria) at Week 16 received rescue therapy and were analyzed as non-responders.

In studies of biologic-naïve and TNFi-experienced patients, the primary efficacy endpoint was the proportion of patients at 24 weeks achieving ACR20 response, which represents a 20 percent reduction in a composite measure of disease activity as defined by the American College of Rheumatology (ACR).1 Results from both studies demonstrated that patients treated with Taltz achieved significant improvement in joint symptoms, as measured by ACR20, compared with placebo. At 24 weeks, patients achieved ACR20 at the following response rates:

   SPIRIT-P1: 58 percent of patients treated with Taltz vs. 30 percent for placebo1
   SPIRIT-P2: 53 percent of patients treated with Taltz vs. 20 percent for placebo1

"For patients with PsA, treatment goals often include improvement in joint symptoms," said Philip Mease, M.D., Swedish Medical Center and University of Washington. "Based on the study results, Taltz can provide significant improvement in joint symptoms for patients who had never been treated with a biologic disease-modifying antirheumatic drug as well as patients who had inadequate response to one or two TNF inhibitors or were intolerant of TNF inhibitors."

Lilly will work with insurers, health systems and providers to ensure patients are able to access this treatment.

my daughter has severe plaque psoriasis which she has had for 11 years and has undergone all available treatment, except for stelera injections. she went for an assessment recently and was told her score was 8.5/10, which was not quite enough to qualify for treatment in Bournemouth. She is becoming suicidile. Does anyone know if there are any areas of the country where this treatment might be more readily available, because I suspect that the Bournemouth area would prefer not to spend money on this type of treatment if at all possible.

This study looked at the effectiveness of Bio treatments on  health-related quality of life (HRQoL) in psoriasis patients.

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Background:
Evidence of the comparative effectiveness of biological therapies for psoriasis on health-related quality of life (HRQoL) in routine clinical practice is limited.

Objectives:
To examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQoL in patients with psoriasis, and to identify potential predictors for improved HRQoL.

Methods:
This was a prospective cohort study in which changes in HRQoL were assessed using the Dermatology Life Quality Index (DLQI) and EuroQoL-5D (EQ-5D) at 6 and 12 months. Multivariable regression models were developed to identify factors associated with achieving a DLQI of 0/1 and improvements in the EQ-5D utility score.

Results:
In total, 2152 patients with psoriasis were included, with 1239 patients on adalimumab, 517 on etanercept and 396 on ustekinumab; 81% were biologic naïve. For the entire cohort, the median (interquartile range) DLQI and EQ-5D improved from 18 (13–24) and 0·73 (0·69–0·80) at baseline to 2 (0–7) and 0·85 (0·69–1·00) at 6 months, respectively (P < 0·001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female sex, multiple comorbidities, smoking and a higher DLQI or a lower EQ-5D utility score at baseline predicted a lower likelihood of achieving a DLQI of 0/1 or improvement in the EQ-5D. Compared with adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biological therapies in EQ-5D improvement.

Conclusions:
In routine clinical practice biological therapies produce marked improvement in HRQoL, which is influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biological therapy for patients related to improvements in HRQoL.

Novartis have announced that Cosentyx is the first Bio to demonstrated long term efficacy and safety in nail and palmoplantar psoriasis.

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Novartis today announced first-of-its-kind long-term data showing that Cosentyx® (secukinumab) provided sustained improvements in nail and palmoplantar psoriasis out to 2.5 years. These data are unique as it is the first time any biologic has demonstrated long-term efficacy and safety in nail and palmoplantar psoriasis.

Up to 90% of psoriasis patients may develop nail psoriasis or palmoplantar psoriasis, which affects the palms of the hands and soles of the feet. Both nail and palmoplantar psoriasis heavily impact patients' quality of life leading to reduced mobility, functional impairment and physical discomfort.
Cosentyx addresses the cornerstone cytokine interleukin-17A (IL-17A) involved in the development and progression of psoriasis, and is the first and only fully human IL-17A inhibitor to show sustained skin clearance rates at 5 years in psoriasis. By working to specifically target and inhibit IL-17A, Cosentyx can more effectively address the underlying cause of the disease. To date, psoriasis treatments targeting other, less direct, pathways have not shown long-term efficacy out to 2.5 years in these hard-to-treat forms.

"Patients with nail and palmoplantar psoriasis need effective treatment options to address the significant impact these conditions can have on their day-to-day lives," said Eric Hughes, Global Development Unit Head, Immunology & Dermatology. "As an IL-17A inhibitor, Cosentyx provides a highly targeted treatment option that can not only effectively treat the plaques caused by psoriasis, as evident by recently presented 5-year data, but also hard-to-treat forms and associated arthritic conditions."

In GESTURE, 59% and 53% palmoplantar psoriasis patients who received Cosentyx 300 mg and 150 mg respectively achieved clear or almost clear palms and soles at 2.5 years (as measured by Palmoplantar Investigator's Global Assessment (ppIGA) 0/1). In the TRANSFIGURE study, patients with nail psoriasis who were treated with Cosentyx 300 mg and 150 mg showed a substantial NAPSI (Nail Psoriasis Severity Index) improvement from baseline of -73% and -63% respectively. GESTURE, the largest and longest randomized controlled trial to date in palmoplantar psoriasis patients, and TRANSFIGURE, the first large, controlled trial to report long-term results in nail psoriasis, both demonstrated strong sustainability out to 2.5 years, with a favorable and consistent safety profile, including close to zero injection site reactions or associated pain.

I would like to introduce myself, I'm Jerry and I have had psoriasis for over 20 years also. I have tried about everything and then 6-8 years ago I was put on the Humira injection and I went from 60% of my entire body covered in thick scale to less than 5%. It has also been a blessing with my arthritis.

Has anyone else using Cosentyx tried moving from 4 to 3 weeks between shots ?

It's something I'm trying and you can read more here: RE: Cosentyx for psoriatic arthritis Fred's journey

But I thought I would start another thread to ask if anyone has tried it.

When on Stelara I had to play around with the dosing regime and did find moving to a shorter period between shots helped, so I'm giving it a try with Cosentyx and would be interested to know if anyone eles has tried  a shorter than 4 weeks between shots.

Hi All, I hope your are all well and having a fantastic day.

I was googling my plaques off looking for info about acitretin when I came across this place and thought I should dip my toes in the water, so I guess I should do a brief bio;
 
I live in Tasmania, that tiny triangular island at the bottom of the Australian mainland and I have had plaque psoriasis for about 20 years.  In that time I have ended up trying most treatments "snake oil" and otherwise. After a massive flare up while on methotrexate over the past 10-12 months, I returned to my dermatologist who listened to my plea and suggested we try acitretin along with returning to UVB treatment and continuing with topicals.  So far so good apart from spending days 2 and 3 shedding skin like a demented snake,  I have now reached day 6 and I'm seeing some positive results.

Anyway enough about me..... what treatments have everyone else seen rapid results from?

Hi, this is my first experience using this forum, I have yet to read the user posts but I thought I should introduce myself first.


To get started, I haven't seen a doctor for psoriasis for almost 7 years now. I was prescribed Tenovate-M back then as a cream to apply to the affected area which did help me early on. I have been using this cream for about 7 years now(Yes, since it helped me get rid of the flaking, although temporarily). I was in India back then, have moved to the US now for about 4 years but haven't seen a physician yet. That one spot of flaking has now turned into 50 all over the body. This happened recently during a very stressful phase of life, the psoriasis and stress mode each other worse over time. Now that I am stress-free I feel I should fight psoriasis as well. Till now my flaking was random, mostly flaring up once every year, gradually spreading over the body. The cream I mentioned above helped me through these years(atleast I like to think it that way).

Currently, I am not able to get the same cream here in the US so I am trying things like MG217 and its products(doesn't seem to work) which I got from Amazon. 
I am finally going to see a doctor soon but I am happy I can also discuss this with you all here.

I do have a lot of questions to ask but I think I should be reading stuff here which is a lot of content.