This study investigated the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA)

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Objective:
To investigate the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA).

Methods:
Quantitative gene expression analysis of Th1, Th17, and Th9 cytokines was performed in intestinal biopsy samples obtained from patients with PsA, HLA−B27−positive patients with ankylosing spondylitis (AS), patients with Crohn's disease (CD), and healthy controls. Expression and tissue distribution of interleukin-23 (IL-23), IL-17, IL-22, IL-9, and IL-9 receptor (IL-9R) were evaluated by immunohistochemistry and confocal microscopy. Flow cytometry was used to study the frequency of Th9 cells among peripheral blood, lamina propria, and synovial fluid mononuclear cells. The functional relevance of IL-9R expression on epithelial cells was assessed in functional in vitro studies. Th9 cells in synovial tissue from patients with PsA were also studied.

Results:
Subclinical gut inflammation in PsA patients was characterized by a clear Th17 and Th22, but not Th1, polarized immune response. Unlike AS and CD, a strong and significant up-regulation of IL-9 was observed in PsA gut, especially among infiltrating mononuclear cells, high endothelial venules, and Paneth cells. IL-9−positive mononuclear cells were demonstrated to be in large part Th9 cells. IL-9 overexpression was accompanied by significant Paneth cell hyperplasia. Paneth cells strongly overexpressed IL-9R, and stimulation of epithelial cells, isolated from PsA patients, with IL-9 resulted in overexpression of α-defensin 5 and IL-23p19. Peripheral and synovial expansion of α4β7+ Th9 cells was also observed in patients with PsA. Increased expression of IL-9 and IL-9R was also found in synovial tissue.

Conclusion:
Strong IL-9/Th9 polarization seems to be the predominant immunologic signature in patients in PsA.

This study assessed if Cosentyx (secukinumab) is associated with sustained inhibition of radiographic progression inhibited radiographic progression in patients with psoriatic arthritis.

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Objective:
To assess whether secukinumab treatment in patients with active psoriatic arthritis (PsA) is associated with sustained inhibition of radiographic progression.

Methods:
In this phase III, double-blind, placebo-controlled study, 606 patients with PsA were randomized to receive intravenous (IV) secukinumab at a dose of 10 mg/kg (weeks 0, 2, 4) followed by subcutaneous secukinumab at a dose of 150 mg or 75 mg (the IV > 150 mg and IV > 75 mg groups, respectively) or placebo. Patients were stratified according to prior anti–tumor necrosis factor (anti-TNF) exposure (71% were anti-TNF naive). At week 16, placebo-treated patients who had at least a 20% reduction in the tender and swollen joint counts (responders) continued to receive placebo until week 24; nonresponders were re-randomized to receive secukinumab at a dose of 150 mg or 75 mg. The modified total Sharp/van der Heijde score (SHS) was determined at baseline, week 16 or 24, and week 52.

Results:
In the overall population, radiographic progression was inhibited through 52 weeks; efficacy was demonstrated for both erosion and joint space narrowing scores and in patients who switched from placebo to secukinumab at week 24. Subgroup analyses showed that secukinumab reduced radiographic progression at week 24, regardless of previous anti-TNF treatment. Among anti-TNF–naive patients, the mean changes from baseline to week 24 in the modified total SHS were 0.05 in the pooled secukinumab group and 0.57 in the placebo group; among patients with an inadequate response or intolerance to anti-TNF treatment, the mean changes were 0.16 and 0.58, respectively. Anti-TNF–naive patients showed negligible progression through week 52. Inhibition of structural damage was observed through week 52 irrespective of concomitant methotrexate use. A high proportion of patients receiving secukinumab showed no progression (change in SHS of ≤ 0.5) from baseline to week 24 (82.3% of the IV > 150 mg group and 92.3% of the IV > 75 mg group) and from week 24 to week 52 (85.7% of the IV > 150 mg group and 85.8% of the IV > 75 mg group).

Conclusion:
Secukinumab inhibited radiographic progression over 52 weeks of treatment in patients with active PsA.

Ive just started uvb treatment does anyone know if its safe to take certain medications, like antihistamines and ive been prescribed a period delay tablet im due to take today but just not sure i dont see the nurse till fri, any advise would be great thanks

Today I have been to the hospital to see the rheumatologist we had a frank discussion and I informed her again that I was reluctant to come off my psoriasis drug ( Fumaderm ) as it works so well . I'm on 4x 120mg tablets a day

But have noticed joint pain recently and have been diagnosed with psoriatic arthritis, the hospital are passing me between dermatology and rheumatology

The rheumatologist wanted me back on methotrexate but I have refused that.

I asked about Cosentyx and Otezla and was told to suggest something she could prescribe ....I mentioned Humira but I haven't got three swollen joints and haven't failed enough oral treatments to get them

Now I'll get to the point I have also been offered leflunomide or Sulfasalazine ....now as I've never been on a DMARD I have no experience of what to expect, and I'm hoping for some guidance here

Ok, so I am not sure if I am posting in the correct place or not.... My name is Deborah and I am 50 years old.  I was diagnosed with PA back in 1997 and for the most part have been on Enbril or a long time.  Unfortunately for me the side effects outweighed the benefits and last November I stopped taking all meds.. ON a plus, I have not been  sick with an upper respitory infection since January and I use to get them 3-5 times a year, down side, my psoriasis and arthritis is at an all time high and I feel horrible.  I am welcome to any advice or suggestions that you all have and I am glad to have finally found a group of people who all have what I do.... Nice to meet you

RHi - my name is Margot. I've had Psoriasis since I was six (I'm now 49) and have never really looked for other people to talk to about it before despite the massive effect it has had on my life. I have been through ups and downs with it and I am lucky that although at times it has been bad, there are people around who have had it much worse than me. I think this is a fantastic idea as peer support and being able to connect with people who really get what you are talking about is so important. I don't know why I haven't looked into something like this before. I'm off to a holiday in the sunshine tomorrow, which really helps, but am looking forward to being part of the forum and hearing from others who 'get it'. Thanks

Hi all this is my first post.  Just found this site today and am really enjoying reading the comments posted.  My question to all of you is this:  (sorry ahead of time for the length).
My daughter 22, Sam has recently (since March 2016) developed gutate psoriasis. She has coverage over 80% of her body and is MISERABLE.  My first question is what are the stages this condition goes through?  She was on a topical cream that was  doing very little, but she was going through the large jar of cream very quickly.  She has not had the cream for several weeks and it has come back with a vengence.  She is moisturizing, but nothing else medically and her skin has very little scaling (except her scalp), but the patches are raw and red and hot and painful.  I am at a loss as how to help her and was wondering if this "stage" is a bad sign of worse things to come or just a stage before the scaling starts.  Is there anything naturally we can use right now to shrink some of the sores or is this it for her?  I am worried about her being able to afford medication, biologics etc. when she is too old to be on my insurance, so I was trying to treat this naturally for her pocketbook's sake.  Any suggestions would be welcome.  Thanks again for this site; it is very comforting to know there are other sufferers out there although I wouldn't wish this on my worst enemy.

Mary - Mom of Sam

This is a small study looking at the efficacy and safety of Acitretin in childhood and adolescent psoriasis patients.

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Background:
Acitretin is licensed for and is most commonly used to treat psoriasis. Little information exists about its efficacy and safety in childhood and adolescent psoriasis.

Methods:
Retrospective analysis of a group of children and adolescents (<17 years of age) with moderate to severe plaque psoriasis treated with acitretin between 2010 and 2014 at Italian dermatology clinics. Patients were identified through databases or registries.

Results:
The study population consisted of 18 patients with a median age of 9.5 years at the start of therapy. The median maintenance dosage per day was 0.41 mg/kg. Eight patients (44.4%) achieved complete clearance or good improvement of their psoriasis, defined as improvement from baseline of 75% or more on the Psoriasis Area and Severity Index at week 16. Three had three or more courses of treatment with short disease-free intervals. In three patients, acitretin treatment was ongoing at the time of data collection. The mean total duration of treatment in responders was 22.7 months. One patient discontinued treatment because of arthralgia. The remaining nine patients (50%) discontinued treatment because it was ineffective. Mucocutaneous adverse effects occurred in all patients, but did not affect therapy maintenance.

Conclusions:
In this retrospective case series, acitretin was a moderately effective, well-tolerated treatment in children with moderate to severe plaque psoriasis. Given the small number of patients, statements about long-term safety are not possible.

Hello, and I hope today was better than the last. I am waiting to hear about patient assistance, but I'm wondering, is Novartis generous, is your insurance amazing, or are you paying out of pocket? Because I am literally falling apart head to toe and don't see how I can afford this until 2020. 

This Danish study suggests there is an increased risk of periodontitis in psoriasis patients.

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Background:
Psoriasis and periodontitis are chronic inflammatory disorders with overlapping inflammatory pathways, but data on risk of periodontitis in psoriasis are scarce and a possible pathogenic link is poorly understood.

Objective:
We investigated the association between psoriasis and periodontitis in a nationwide cohort study.

Methods:
All Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2011 (n = 5,470,428), including 54 210 and 6988 patients with mild and severe psoriasis, and 6428 with psoriatic arthritis, were linked through administrative registers. Incidence rate ratios (IRRs) were estimated by Poisson regression.

Results:
Incidence rates of periodontitis per 10 000 person-years were 3.07 (3.03–3.12), 5.89 (1.07–6.84), 8.27 (5.50–12.45) and 11.12 (7.87–15.73) for the reference population, mild psoriasis, severe psoriasis and psoriatic arthritis respectively. Adjusted IRRs were (1.66; 1.43–1.94) for mild psoriasis, (2.24; 1.46–3.44) for severe psoriasis and (3.48; 2.46–4.92) for psoriatic arthritis. Similar results were found when a case–control design was applied.

Conclusions:
We found a significant psoriasis-associated increased risk of periodontitis, which was highest in patients with severe psoriasis and psoriatic arthritis.

This German study suggests psoriasis patients do better on Bio treatments.

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Background:
Psoriasis is associated with significant patient burden. Few studies have specifically measured patient preferences and benefits.

Objectives:
Outcomes assessment using the Patient Benefit Index (PBI) in nationwide psoriasis surveys comparing health care in 2007 and 2014.

Methods:
This was a non-interventional, cross-sectional survey conducted in 2007 and 2014 in randomly selected dermatological practices and clinics recording by a) physicians: comorbidity, clinical severity (PASI, GCA), and b) patients: quality of life (DLQI, EQ-5D), patient-relevant therapeutic benefits (PBI) and previous and curent treatments.

Results:
In 2014, a total of n = 1265 patients (43.4% female, mean age 51.9 ± 14.3 years.; mean disease duration 21.6 ± 15.4 years.) were included. Overall PBI was 2.8 ± 1.1. A total of 91.6% of patients showed a more than minimum clinically relevant benefit (PBI>1). Patients treated with biologics and biologics combined with conventional systemics showed the highest benefit compared to patients with conventional systemic treatment and patients treated with topical steroids. In comparison with the 2007 survey (n = 2009), there was an increase in PBI from 2.5 ± 1.1 to 2.8 ± 1.1 and a gain of patients with high benefits (PBI ≥3) by 30% (38.5% vs. 49.4%).

Conclusion:
In German routine care, psoriasis patients have shown increased therapeutic benefits over time with highest benefits deriving from biologics combined with systemics.

After reading a lot about LDN, I decided to try it.
I was earlier recommended MTX but the first dose zombified me for around 3 days and I have been looking at alternatives since.

BTW, I am 36 years old.

So, I started liquid LDN on July 10 (2 mg).
Took 2 mg daily for 7 days.

I was experiencing pain in my ribs, fingers and toes (symptoms of PsA) and LDN gave me almost instant relief.
The pain is gone now and hasn't come back though it's too early to say how long this remission will last.

However, my whole body developed these red bumpy spots after I started LDN and therefore, I had to stop taking it.

These spots are going down in number and intensity three days after I have stopped LDN.

Additionally, my nail psoriasis has become worse as one of the fingernails had small amount of blood coming from the sides (though it seems to have subsided now on its own)

I never had such bad psoriasis on my ears. My ears are covered in plaque so much that I can't go out.

I think the red spots are due to the filler used in the tablets that i used to prepare liquid LDN.

But I am not sure about the psoriasis on ears.

Just wanted to share this experience.

I didn't find anything on the forum so I wanted to see if anyone had any experience with the Dead Sea or the Blue Lagoon. I am interested in going, but the Dead Sea is on the other side of the world and obviously expensive to the point of almost being prohibitive.

This is a summary of a  systemic review for the use of fumaric acid esters in the treatment of psoriasis.

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Summary:
Fumaric acid esters (FAEs) are increasingly used as a systemic treatment for psoriasis, but there are still uncertainties regarding their suitability. The objective of this systematic review was to assess the evidence for the efficacy and safety of FAEs in psoriasis treatment.

A systematic literature search was performed in seven databases up to 17 August 2015. Inclusion criteria were studies that reported clinical effects of FAEs in patients with psoriasis without restrictions in study design, language or publication date. Methodological quality of randomized controlled trials (RCTs) and overall level of quality were assessed using the Cochrane risk of bias tool and the Grading of Recommendation, Assessment, Development and Evaluation approach, respectively.

A total of 68 articles were included. There were seven RCTs (total 449 patients) that had an unclear risk of bias and were too clinically heterogeneous to allow a meta-analysis. Overall, mean Psoriasis Area and Severity Index decreased by 42–65% following 12–16 weeks of treatment. There were 37 observational studies (a total of 3457 patients) that supported the RCT findings, but most were uncontrolled with a high risk of bias.

Commonly reported adverse events included gastrointestinal complaints and flushing, leading to treatment withdrawal in 6–40% of patients. Several case-reports described rare adverse events, such as renal Fanconi syndrome and progressive multifocal leukoencephalopathy. There was a lack of studies focusing on long-term use and comparisons with other treatments.

This review concluded that there is low-quality evidence to recommend the use of oral FAEs to treat plaque psoriasis in adult patients. Studies focusing on long-term safety and comparison with systemic psoriasis treatments could lead to a better understanding of the role of FAEs as a treatment for psoriasis.

Following on from this report Brodalumab still in the running for psoriasis treatment Brodalumab has been given FDA Advisory Committees recommendation with conditions related to product labelling and post-marketing risk management obligations.

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Valeant Pharmaceuticals International, Inc. (NYSE: VRX and TSX: VRX) today announced that the Dermatologic and Ophthalmic Drugs Advisory Committee appointed by the U.S. Food and Drug Administration (FDA) has voted by a margin of 18 to 0 for the approval of brodalumab injection, 210 mg, for adult patients with moderate-to-severe plaque psoriasis with conditions related to product labeling and post-marketing/risk management obligations.

The committee's recommendation will be considered by the FDA in its review of the Biologics License Applications (BLA) for brodalumab, a monoclonal antibody that targets the IL-17 receptor.  As previously announced, the FDA assigned a Prescription Drug User Fee Act (PDUFA) action date of November 16, 2016.

"The positive recommendation by the FDA's advisory committee represents an important milestone toward our goal of delivering brodalumab to patients who suffer from moderate-to-severe plaque psoriasis," said Joseph C. Papa, chairman and chief executive officer.  "Brodalumab has the potential to improve the lives of many patients suffering from this chronic, debilitating disease, and we greatly appreciated the opportunity to present our body of evidence to the panel.  We look forward to working collaboratively with the FDA as it continues its review process."

"Brodalumab is an extraordinary drug that has meaningfully improved the quality of life of some of my most difficult-to-treat psoriasis patients, many of whom achieved complete skin clearance with this treatment," said Dr. Mark Lebwohl, Chairman, Department of Dermatology, Mount Sinai School of Medicine. "I am very pleased that the Advisory Committee has recommended that this life-changing treatment should be available to psoriasis patients who require a treatment with brodalumab's unique mechanism of action, and I look forward to prescribing this therapy to patients who are suffering from the devastating effects of moderate to severe plaque psoriasis."

As previously announced, the Marketing Authorisation Application (MAA) for brodalumab in psoriasis was accepted by the European Medicines Agency (EMA) in Q42015. In August 2015, Valeant entered into a collaboration agreement with AstraZeneca (AZN.LN, NYSE:AZN ) granting Valeant an exclusive license to develop and commercialize brodalumab globally, except in Japan and certain other Asian countries where rights are held by Kyowa Hakko Kirin Co., Ltd.  In July 2016, AstraZeneca and Valeant amended Valeant's license for brodalumab to terminate Valeant's right to develop and commercialize brodalumab in Europe.  LEO Pharma currently holds exclusive rights to develop and commercialize brodalumab in Europe, and Valeant holds the license to develop and commercialize brodalumab in the U.S and other territories, other than Japan and certain other Asian countries. In July 2016, brodalumab was granted approval from the Ministry of Health, Labour and Welfare Japan.  

Hi all.  From browsing seems the liver plays a roll in Psoriasis.  And also obesity (me) + more.   My annual blood test at my local doctor always comes back with a highlight that it is in poor shape.

So what is needed to get my liver reading back to 'healthy'?

Had scalp psoriasis for about five years.  Its since spread to one lower leg and now starting to take up residence on my lower belly.  My usual treatment / control I've found to be most enjoyable is a good scratch. Since have been advised that far better is a pair of mittens (thick ones).

Tried dif. stuff but once i get on top of the psoriasis I tend to forget about it and treatment laps.   My wife has researched for me more intensely than I and so far we have dropped the cortisone stuff and are trying to go natural.  Best so far is licorice herb + fenegreek.  Both simmer-boiled for 10-15 mins. then water stored in fridge & painted on with a shaving brush when needed. 

I haven't tried diet yet.  But just ate choc. 2 days straight.  My tummy + leg psoriasis are itchy-itchy and flaring.  So I've come seeking 'internal' advice.  What do I need to avoid etc.  Reg. blood tests indicate poor liver + too low Vit. D

So far, I'm way to chubby and are about to start walking daily.  Hopefully you guys are gonna suggest other ways to combat this through changing diet etc.

best
AaLF

Sandoz a Novartis company has announced it has been given FDA approval for a biosimilar of Enbrel (etanercept) to treat multiple inflammatory diseases including psoriasis.

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Sandoz, a Novartis division and leader in biosimilars, announced today that the US Food and Drug Administration (FDA) Arthritis Advisory Committee recommended approval of its proposed biosimilar etanercept. The committee voted unanimously (20-0), in support of biosimilar etanercept for all five indications of the reference product, including rheumatoid arthritis (RA), plaque psoriasis (PsO), psoriatic psoriasis (PsA), ankylosing spondylitis (AS) and polyarticular juvenile idiopathic arthritis (JIA).

“We are encouraged by today’s favorable advisory committee recommendation for our proposed biosimilar etanercept,” said Mark McCamish, M.D., Ph.D., Head of Global Biopharmaceutical Development, Sandoz. “As a global market leader in biosimilars, we are pleased to move one step closer toward our goal of expanding patient access with our proposed biosimilar etanercept, and look forward to continuing to work with the FDA as they complete their review of our application.”

The recommendation was provided after the presentation of data from a global development program including analytical, pre-clinical and clinical studies of the Sandoz biosimilar etanercept, which demonstrated biosimilarity to the reference product. Clinical studies included four comparative pharmacokinetic (PK) studies in 216 healthy volunteers† and a confirmatory efficacy and safety similarity study in 531 patients with chronic plaque psoriasis.

The FDA frequently seeks the advice of its advisory committees as it reviews and decides whether to approve applications, although the agency does not always follow their recommendations.

In December 2015, the European Medicines Agency (EMA) accepted Sandoz Marketing Authorization Application (MAA) for its biosimilar to Amgen’s EU-licensed Enbrel®, which seeks approval for the same indications as the reference product.

Sandoz is committed to providing patient access to high-quality, life-enhancing biosimilars. It is the pioneer and global market leader and currently markets three biosimilars worldwide. Sandoz has a leading pipeline with several biosimilars in late stage development, including assets in immunology and oncology. As part of the Novartis Group, Sandoz is well-positioned to lead the biosimilars industry based on its experience and capabilities in development, manufacturing and commercialization.

About GP2015
GP2015, the Sandoz proposed biosimilar of Enbrel®, has been studied in a global development program, which included a comprehensive comparison of GP2015 and Enbrel® at the analytical, non-clinical, and clinical levels, including data from four pharmacokinetic (PK) studies (GP15-101, GP15-102, GP15-103 and GP15-104†) involving a total of 216 healthy volunteers, as well as data from a confirmatory efficacy and safety study of 531 patients with moderate-to-severe chronic plaque psoriasis (PsO) (GP15-302). The development program also included five non-clinical studies. The proposed indications for GP2015 are identical to the indications for Enbrel® in rheumatoid arthritis (RA), PsO, psoriatic psoriasis (PsA), ankylosing spondylitis (AS) and polyarticular juvenile idiopathic arthritis (JIA).

Hi all,

Another new member here, I'm Abz (Abdul) from just outside of Birmingham (UK).  Now I myself am not a sufferer of Psoriasis but my wife is.

I've joined basically to get a better understanding of this condition and maybe some advice when it comes to treatments, etc.

About my wife, she's 26 years old and has suffered with psoriasis for around 10 years it initially started as scalp psoriasis but within the last 1-2 years she now has arthritis and plantar fasciitis due to the psoriasis, and now the psoriasis has spread to legs arms and torso. It really is getting her down and I will do absolutely anything to help.

We've been to the Dr's many times and tried all their lotions and potions.  A while back she was on Methotrexate but this caused her hair to start falling out, bruising easily and generally feeling run down so she's stopped taking it.  They have offered her Humeira injections but, she believes the Methotrexate was poison enough she doesn't want to inject anything.

The arthritis is really getting her down as she says she feels much older than she is and might not be able to go through another pregnancy with the pains she's experiencing.

Ideally she would like to go down a natural treatment route, but which one??? I've done so much reading and research on the internet my eyes have turned square and I no longer know the difference between which is genuine and which is a scam.

I did come across one cream that seemed to be a wonder cream every review I read was positive, results within days, all natural (and legal) ingrediants, very very reasonably priced (some moisturizers are dearer), some people saying you only need to apply the cream two or 3 times a year!!!! This sounded like most of my wifes' answers in a tub, but and it's a big but, the EU bufoons banned this cream from being produced and sold in Europe.  I even contacted the manufacturers thinking they may sell the product outside of the EU, but no they've stopped making it altogether.  

Some of you may know it or have tried it Potters Psorasolv, if anyone has tried it please can you tell me the results you got, if they're as good as I've read I will buy the ingredients or travel the earth to get them and mix it myself that's how much I want to help my wife.

Anyway, apologies for the long first post, I hope you guys don't mind that I'm not a psoriasis sufferer myself, but I look forward to speaking and getting on with you all.

Kindest regards

Abz

Hi all
Am following Fred's advice and starting a thread here.

Long story short. Dermotologist has taken me off acitretin as of yesterday and wants to put me on Ciclosporin. I am a bit wary as the side effects with this seem even worse and it looks like I am susceptible.

So any thoughts or advice would be appreciated.

Thanks

S