Hi all, it's been a while since I last posted. I thought I'd give an update on things.

After over a year on skillerence with no real results but plenty of stomach cramps, and with my immune system dropping to 0.6 my derm has decided that I should move onto Humira.

Now, for full disclosure I thought I'd inform you that I suffer from terrible health anxiety and this isn't helped by reading the possible side effects which sound terrifying, with everything from TB to lymphoma.

This has been enough to make me think that maybe psoriasis may not be that bad after all.

If I do start Humira, what are the odds of any of the effects actually happening? I need to process this in order to move forward with treatment otherwise I think I'll not try anything again.

Thanks in advance.

This study looked at the mortality trends of Psoriasis (PsO) and Psoriatic arthritis (PsA) between 2010 and 2021, focusing on the effects of the COVID-19 pandemic.

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Background:
Little is known about mortality trends among patients with psoriasis (PsO) and psoriatic arthritis (PsA) in the United States.

Objectives:
To ascertain mortality trends of PsO and PsA between 2010 and 2021, focusing on the effects of the COVID-19 pandemic.

Methods:
We collected data from the National Vital Statistic System and calculated age-standardized mortality rates (ASMR) and cause-specific mortality for PsO/PsA. We evaluated observed versus predicted mortality for 2020–2021 based on trends from 2010 to 2019 with joinpoint and prediction modelling analysis.

Results:
Among 5810 and 2150 PsO- and PsA-related deaths between 2010 and 2021, ASMR for PsO dramatically increased between 2010–2019 and 2020–2021 (annual percentage change [APC] 2.07% vs. 15.26%; p < 0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (0.27 vs. 0.22) and 2021 (0.31 vs. 0.23). The excess mortality of PsO was 22.7% and 34.8% higher than that in the general population in 2020 (16.4%, 95% CI: 14.9%–17.9%) and 2021 (19.8%, 95% CI: 18.0%–21.6%) respectively. Notably, the ASMR rise for PsO was most pronounced in the female (APC: 26.86% vs. 12.19% in males) and the middle-aged group (APC: 17.67% vs. 12.47% in the old-age group). ASMR, APC and excess mortality for PsA were similar to PsO. SARS-CoV-2 infection contributed to more than 60% of the excess mortality for PsO and PsA.

Conclusions:
Individuals living with PsO and PsA were disproportionately affected during the COVID-19 pandemic. Both ASMRs increased at an alarming rate, with the most pronounced disparities among the female and middle-aged groups.

This study evaluated the reliability, validity, and responder definitions of the generalized pustular psoriasis physician global assessment (GPPGA) and generalized pustular psoriasis area and severity index (GPPASI)

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Background:
Generalized pustular psoriasis (GPP) is a rare and life-threatening skin disease often accompanied by systemic inflammation. There are currently no standardized or validated GPP-specific measures for assessing severity.

Objective:
To evaluate the reliability, validity, and responder definitions of the generalized pustular psoriasis physician global assessment (GPPGA) and generalized pustular psoriasis area and severity index (GPPASI).

Methods:
The GPPGA and GPPASI were validated using outcome data from Week 1 of the Effisayil™ 1 study. The psychometric analyses performed included confirmatory factor analysis, item-to-item/item-to-total correlations, internal consistency reliability, test-retest reliability, convergent validity, known-groups validity, responsiveness analysis, and responder definition analysis.

Results:
Using data from this patient cohort (N=53), confirmatory factor analysis demonstrated unidimensionality of the GPPGA total score (root mean square error of approximation <0.08), and GPPGA item-to-item and item-to-total correlations ranged from 0.58–0.90. The GPPGA total score, pustulation subscore, and GPPASI total score all demonstrated good test-retest reliability (intraclass correlation coefficient: 0.70, 0.91, and 0.95, respectively), and good evidence of convergent validity. In anchor-based analyses, all three scores were able to detect changes in symptom and disease severity over time; reductions of -1.4, -2.2, and -12.0 were suggested as clinically meaningful improvement thresholds for the GPPGA total score, GPPGA pustulation subscore, and GPPASI total score, respectively. Anchor-based analyses also supported the GPPASI 50 as a clinically meaningful threshold for improvement.

Conclusions:
Overall, our findings indicate that the GPPGA and GPPASI are valid, reliable, and responsive measures for the assessment of GPP disease severity, and support their use in informing clinical endpoints in trials in GPP.

Good morning, I’m wondering if anyone else on here has psoriasis as well as under active thyroid (Hashimoto's). I’m trying to compare the suggested diet do’s and don’ts. I am already gluten free, dairy free, sugar free and nightshade free and don’t eat seafood ?. I would love to know people’s ideas for meals, snacks etc.

I have looked at the food pyramid and have a question about cacao powder. Thoughts on it? Good, bad etc. I like to put 1 tablespoon in my morning smoothie. It’s the only chocolate I have had in over two weeks. As I have read conflicting research on eating chocolate or not with psoriasis. I’m on a very limited diet already and like just that little touch of ?

I am new to all of this. I have a possible diagnosis of psoriasis with a follow up appointment in a couple of weeks with a dermatologist. I do know that if I eat gluten, dairy, nightshade vegetables or sugar I get more spots, flaking and itching. I have eliminated all from my diet but still have mild spots, but no itching. Just trying to figure this all out.

Just wondering if anyone else on Taltz has ever experienced a reaction after using a Hot Tub that you never previously experienced before Taltz?

I had been in Hot Tubs years ago with no reactions, since using Taltz I get extremely itchy rashy areas to my lower legs, arms, pits, and upper torso.

I spoke to my Taltz Nurse and she found no info on anyone complaining of this reaction so she did not think Taltz would be the cause.

We are pleased to join the Psoriasis Club.  It is mainly Tanya who does the computer stuff but it is Mike who has suffered from Psoriasis for years.  Tanya encouraged him to go to a Dermatologist and he got started on some treatments.  The treatments led to trials in Canada for approximately 20 years.  But in the end it was Taltz that I live with now!  Tanya was by my side through all the creams, lotions, IV's, lights, and injections and knows everything from my journey better than I do (can you tell she is typing......LOL).

good morning, i am new here just started otezla and hoping to get some insight on if it actually is helping anyone?

Im on my third dose, soon to be 4th of bimzelx and have noticed spots some almost as big as boils under my arms and on my flanks but i can get them everywhere even on my fingers. i normally have 5 or 6 under each arm/flank and two on each arm.
with cosentyx i started getting a red rash under my armpits. inverted p?  and that hasnt gone away in fact its spread slightly and the spots have come to play as well. they struggle to get a head and im trying to get some fucidin to help. i did get a few spots with cosentyx but nothing like this.

also my face flares up all the time under my beard, and on my forehead.
and ive got p inbetween my toes.

anyone else?

i am alan and live in the uk
i have been on bimzelx for 3 months and prob 90% clear but having some side effects
before that cosentyx successfully for a few ears and before that stelara for many years good for p but not so good for pa
i am 61 years old  barely married, still working and after suffering with p for 42 years i have finally got used to the shame of looking diseased and ugly. i have suffered mental illness anxiety and depression on and off for the same time ive had p.  linked maybe?
ive joined up on here hoping there are people here who can answer a few questions i have about my medication and other aspects of lifestyle changes diet etc to manage my symptoms better.
i am happy and have hobbies including motorbikes (riding and tinkering),  guitar playing, watching football, romance, and boring people to death with long intros on forums.

alan

Comparing Tremfya to Stelara 104-week multicentre retrospective study in Italy.

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Background:
Guselkumab is a humanized monoclonal antibody that binds selectively to the p19 subunit of interleukin-23, which has shown efficacy in patients with previous incomplete response to ustekinumab in the NAVIGATE clinical trial.

Objectives:
We conducted a 104-week multicenter retrospective study to assess the effectiveness and safety of guselkumab in patients affected by plaque psoriasis with an inadequate response to ustekinumab in a real-life setting.

Methods:
Our retrospective study included 233 adults affected by moderate-to-severe plaque psoriasis, enrolled in 14 different Italian centers, and treated with guselkumab after failing therapy with ustekinumab. Patient characteristics and PASI (Psoriasis Area and Severity Index) score at each visit (baseline, weeks 16, 52 and 104) were recorded. The percentages of patients achieving 75%, 90% and 100% (PASI 75, PASI 90 and PASI 100) improvement in PASI, compared with baseline, were registered.

Results:
At week 52, PASI 75 was reached by 89.88% of patients, PASI 90 by 71.43%, PASI 100 by 58.83% and absolute PASI ≤ 2 by 90.48%. At week 104, similar effectiveness results were observed. Compared to the NAVIGATE trial, we observed higher rates of PASI 75/90/100. Patients with the involvement of difficult-to-treat areas were significantly less likely to achieve PASI90 and PASI100 at week 16. Obese patients had significantly lower rates of PASI75 and PASI≤2 at week 52. At week 104, comparable responses were observed among all patients’ subgroups, regardless of BMI status, involvement of difficult-to-treat areas, presence of cardiometabolic comorbidities and concomitant psoriatic arthritis. No significant safety findings were reported throughout the study.

Conclusion:
Our data suggest that the efficacy of guselkumab in patients with inadequate response to ustekinumab for plaque psoriasis in “real-life” clinical practice is comparable with NAVIGATE study with higher percentages of patients achieving PASI90 and PASI100 at weeks 16, 52 and 104.

Does anyone have experience using Ambetter insurance for their Tremphya prescription? I know I need pre-approval but want to see want an Ambetter user might have to say.

Hi all again 

I am off course searching a lot of stuff about psa, and listened to some podcasts where also food was mentioned. I was wondering did some of you had concrete results with certain foods to avoid? That would trigger flares?

Would eating vegetarian help avoiding symptoms of inflammation. 

Like I heard about dairy, sugar, soda and all that. And I understand that smoking and drinking etc would not help off course with this kind of disease.

I was wondering about your experiences and what maybe worked for you (or not). About certain foods, etc lifestyle changes.

Greetings!

Looking at pruritis in different clinical variants of psoriasis.

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Background:
Pruritus, which is the most frequent subjective symptom of psoriasis, may cause significant discomfort, embarrassment, and even interfere with patients normal daily activities. However, the perception of itch in various psoriasis subtypes remains unknown.

Objectives:
The aim of this study was to investigate and to characterize pruritus in different clinical variants of psoriasis.

Methods:
This cross-sectional, binational, multicentre study included 295 subjects suffering from 9 different clinical subtypes of psoriasis: large-plaque psoriasis (n=45), nummular psoriasis (n=32), guttate psoriasis (n=31), scalp psoriasis (n=32), inverse psoriasis (n=23), erythrodermic psoriasis (n=33), palmoplantar psoriasis vulgaris (n=33), palmoplantar pustular psoriasis (n=42) and generalized pustular psoriasis (n=23). Measures included sociodemographic and anthropometric data, detailed pruritus characteristics including but not limited to pruritus intensity, frequency, and extend, as well as psoriasis severity.

Results:
The lifetime prevalence of pruritus in each clinical variant of psoriasis was similar and quite high, reaching up to 100% in some disease subtypes (i.e. nummular psoriasis, scalp psoriasis and generalized pustular psoriasis). Psoriasis severity correlated with pruritus intensity in scalp psoriasis, palmoplantar pustular psoriasis and generalized pustular psoriasis. The age, duration of psoriasis and BMI did not interfere with the intensity of itch.

Conclusions:
Pruritus is highly prevalent in each clinical variant of psoriasis. However, the sensation of itch is very individual, difficult to universally describe even in the same subtype.

A Delphi panel study to identify current evidence and gain advanced insights into generalized pustular psoriasis (GPP)

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Background:
Generalized pustular psoriasis (GPP) is a rare and highly heterogenous skin disease, characterized by flares of neutrophilic pustules and erythema. As a rare disease with few clinical studies and no standardized management approaches, there is a paucity of knowledge regarding GPP.

Objectives:
Conduct a Delphi panel study to identify current evidence and gain advanced insights into GPP.

Methods:
A systematic literature review was used to identify published literature and develop statements categorized into four key domains: clinical course and flare definition; diagnosis; treatment goals; and holistic management. Statements were rated on a Likert scale by a panel of dermatologists in two rounds of online questionnaires; the threshold for consensus was agreement by ≥80%.

Results:
Twenty-one panelists reached consensus on 70.9%, 61.8%, 100.0%, and 81.8% of statements in the “clinical course and flare definition”, “diagnosis”, “treatment goals”, and “holistic management of GPP” domains, respectively. There was clear consensus on GPP being phenotypically, genetically, and immunologically distinct from plaque psoriasis. Clinical course is highly variable, with an extensive range of complications. Clinical and histologic features supporting GPP diagnosis reached high levels of agreement, and although laboratory evaluations were considered helpful for diagnosis and monitoring disease severity, there was uncertainty around the value of individual tests. All acute and long-term treatment goals reached consensus, including rapid and sustained clearance of pustules, erythema, scaling and crust, clearance of skin lesions, and prevention of new flares. Potential triggers, associated comorbidities, and differential diagnoses achieved lower rates of consensus, indicating that further evidence is needed.

Conclusions:
Global consensus between dermatologists was reached on clinically meaningful goals for GPP treatment, on key features of GPP flares, and on approaches for assessing disease severity and multidisciplinary management of patients. On this basis, we present a management algorithm for patients with GPP for use in clinical practice.

This study compared Cosentyx (secukinumab) with narrow band ultraviolet B (nb-UVB) phototherapy in new onset moderate to severe plaque psoriasis patients.

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Background:
Biologic treatments have been studied mainly in patients with a long-term history of psoriasis and previous treatment failures.

Objectives:
The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new-onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb-UVB) phototherapy.

Methods:
The STEPIn study is a randomised, open-label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously vs. standard treatment with nb-UVB phototherapy in patients with new-onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively.

Results:
In the secukinumab and nb-UVB study arms, 77/80 and 76/80 randomised patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm vs. 42.3% (32/76) in the nb-UVB arm (P<0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm vs. 36.8% in the nb-UVB arm (P<0.0001). The safety data were consistent with the safety profiles of secukinumab and nb-UVB with no new or unexpected safety signals.

Conclusions:
Secukinumab was superior to nb-UVB in treating patients with new-onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course.

This study evaluated reported outcomes of patients with generalized pustular psoriasis (GPP) who were treated with Spevigo (spesolimab)

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Background:
Generalized pustular psoriasis (GPP) is a rare inflammatory skin disease with a considerable clinical burden. In the EffisayilTM 1 study, spesolimab, an anti-interleukin-36 receptor monoclonal antibody, demonstrated efficacy in treating GPP flares.

Objectives:
To evaluate patient-reported outcomes (PROs) of patients with GPP who were treated with intravenous (IV) spesolimab 900 mg in the EffisayilTM 1 study.

Methods:
53 patients presenting with a GPP flare were randomized (2:1) to receive a single dose of IV spesolimab 900 mg or placebo and were followed for 12 weeks. Four PROs [pain visual analog scale (pain VAS); Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT–Fatigue); Dermatology Life Quality Index (DLQI); and Psoriasis Symptom Scale (PSS)] were assessed throughout the 12-week study. Minimal clinically important differences (MCIDs) were defined. All data are reported descriptively.
Results

In patients who received spesolimab, improvements from baseline (median [Q1, Q3]) were observed in pain VAS (–21.3 [–55.3, –3.1]), FACIT–Fatigue (7.0 [1.0, 20.0]), DLQI (–2.5 [–8.0, 1.0]), and PSS (−4.0 [−7.0, 0.0]) within 1 week of treatment. These improvements were sustained over 12 weeks and corresponded to the achievement of MCIDs at Week 1, which were also sustained over 12 weeks. Patients in the placebo arm experienced improvements in PROs and achievement of MCIDs after receipt of open-label spesolimab at Week 1.

Conclusions:
Patients with a GPP flare treated with spesolimab achieved improvements in PROs by Week 1, which were sustained for 12 weeks, and achieved MCIDs as early as Week 1.

A real-world experience from a cohort of interleukin-17 inhibitors for psoriasis.

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Background:
Real-world studies on the use of biologics in psoriasis (Pso) are increasing, but still scarce. Trough concentrations (Cts) of interleukin-17 inhibitors (IL-17i) seem promising for clinical decision making, but their value in daily practice has yet to be proven.

Objectives:
To report on IL-17i effectiveness, treatment modifications, and Ct use in our clinic.

Methods:
Data was collected from IL-17i treated Pso patients followed up in the PsoPlus clinic at the Dermatology department, Ghent University Hospital, Belgium. Descriptive statistics and Kaplan-Meier analysis were performed.

Results:
A total of 111 patients were included, counting for 134 IL-17i courses (secukinumab, ixekizumab, and brodalumab). Fifty-five percent of the patients were bio-naive prior to IL-17i initiation. During maintenance, merely 97.0% and 77% achieved near-complete and complete skin clearance, respectively. Major reasons for treatment modification were: suboptimal response (63.0%) and safety issues (9.3%). Reported modifications were: switch (25.4%), dose escalation (11.9%), dose de-escalation (6.7%), treatment association (6.0%), and IL-17i stop (3.0%). Overall drug survival was 69.0 months, without difference between the different IL-17i (p=0.078). Ixekizumab tended to have the highest survival. Drug survival was higher in bio-naive subjects compared to bio-experienced subjects (p=0.011). Ct was measured in 20 patients, and interpreted post hoc. In 85% the clinical decision was in accordance with the Ct (e.g. substantiated need for dose escalation). For the other cases, the Ct would have led to another clinical decision if known at that time.

Conclusions:
This real-world study showed that IL-17i are very effective drugs for Pso, with ixekizumab as leading biologic. Prior bio-experience seemed to impact IL-17i drug survival. Treatment modifications were mainly performed in case of insufficient response, primarily via switch and dose escalation, and least frequently in ixekizumab patients. Ct might rationalize clinical decision making, however there is need for standardized algorithms to corroborate its use.

This study evaluated the effectiveness and safety profile of Siliq / Kyntheum (brodalumab) over a period of 104 weeks in the everyday practice.

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BACKGROUND:
Brodalumab, a fully human IgG2k antibody blocking the receptor of IL17, is characterized by a rapid onset of action with high skin clearance rates in clinical trials. Since setting PASI90/100 or absolute PASI≤3 as treatment goals has become attainable, evaluating effectiveness and safety profile of biologic agents, such as brodalumab, in a real-world setting is essential.

OBJECTIVE:
The aim of this study was to evaluate the effectiveness and safety profile of brodalumab over a period of 104 weeks in the everyday practice. Clinical predictive factors of initial (week 12/16) response to treatment and long-term drug survival were also investigated.

METHODS:
In this monocentric, retrospective study, PASI90/100 and absolute PASI≤1/3 were assessed in 91 patients with moderate-to-severe skin psoriasis under brodalumab at weeks 12/16, 24, 52, and 104 of treatment. At week 12/16, patients with an absolute PASI≤3 were defined as „initial-responders” and ≤1 as “super-responders”. Clinical parameters, such as age, gender, BMI, comorbidities, and previous systemic treatment were assessed in order to predict “super-responders”. Drug survival and its prognostic factors were also evaluated.

RESULTS:
PASI90/100 was reached in 81.1/66.0% at week 12/16. This response rate increased at week 104, where 87.1/80.7% had PASI90/100 and 84.9% had absolute PASI≤1. The presence of > 3 comorbidities, prior treatment with > 2 systemic agents, and obesity tended to be negative predictive factors of “super-response”. Previous exposure to IL17 inhibitors had no impact on both PASI<1 and PASI<3 initial response. One- and two-year drug survival probability was 87.6% and 77.32%, respectively. “Initial responders” and anti-IL17 drug naïve patients had better drug survival. Drug discontinuation occurred in 24.2%, mostly due to secondary failure and arthralgia was the most common adverse event that led to discontinuation.

CONCLUSIONS:
Our study confirms the high effectiveness and good safety profile of brodalumab in the real-world setting.