This study evaluated the long term trends of biologic use outside the realm of clinical trials. The following Bio's were used.
Enbrel (etanercept)
Humira (adalimumab)
Remicade (infliximab)
Stelara (ustekinumab)

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Background/Objectives:
Data on biologic drug survival in real-world psoriasis treatment are limited. There is a need to evaluate long-term trends of biologic use outside the realm of clinical trials.

Methods:
A multicentre chart review was conducted with patients' data from September 2005 to September 2014. Kaplan–Meier plot analysis was used to determine 5-year drug survival rates. A log–rank test was used to compare the rates of drug survival between the studied biologics.

Results:
For the 398 patients and 545 treatment series analysed, 1, 2, 3, 4 and 5-year survival rates were 0.826, 0.687, 0.563, 0.475 and 0.420 with etanercept; 0.804, 0.648, 0.553, 0.508 and 0.508 with adalimumab; 0.838, 0.664, 0.554, 0.485 and 0.382 with infliximab; and 0.914, 0.856, 0.800, 0.755 and 0.755 with ustekinumab, respectively. A statistically significant difference was seen between ustekinumab and the other three biologics.

Conclusion:
A progressive decrease in treatment adherence was seen with all four biologics, as expected, but the survival rate of ustekinumab was highest.

This small study of 90 patients with psoriasis was conducted to assess the presence of entheseal abnormalities as detected by ultrasound, and to determine any correlation with nail involvement.

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Background:
Although subclinical enthesopathy is a well-established diagnostic criterion for psoriatic arthritis (PsA), it is frequently overlooked, as many patients are asymptomatic. The possibility of finding a clinical clue predicting enthesopathy would help clinicians establish an early diagnosis of PsA.

Material and methods:
A prospective single-center study of a total of 90 patients with psoriasis was conducted to assess the presence of entheseal abnormalities as detected by ultrasound, and to determine any correlation with nail involvement.

Results:
Entheseal abnormalities were found in 23 patients (25.5 %), 19 (82.6 %) of whom showed nail involvement, whereas four (17.4 %) individuals did not. Enthesopathy was present in 31.1 % (19/61) of patients with onychopathy compared to 13.8 % (4/29) of those without nail involvement (p = 0.07). There was a significant correlation between target NAPSI score and evidence of enthesopathy. In addition, the number of nails affected also showed a significant correlation with the presence of enthesopathy (p  = 0.035).

Conclusions:
Clinical evidence of onychopathy may be the clue to an early diagnosis of enthesopathy in psoriasis patients.

Hi I am Jen. I've had psoriasis since I was 10 years old (now 40). I've got guttate, plaque, inverse, scalp,PsA, and I had bout of Von Zumbusch.

Since it's been 30 years, I've been on a million different creams, ointments, etc. I'm currently only using topicals but I'm planning to return to biologics. I'm in the midst of a horrible flare.

Beyond psoriasis, I am a mom to two kids, a wife, a school paraprofessional to a girl with CP, and an avid reader.

Hey Everyone! 

Just made an account, was recently diagnosed with Palmoplantar Pustulosis Psoriasis. I've had this now for about 3 months, it only affects my hands and feet. 

My finger nails on one hand have the typical excess skin under the nail forcing the nail off etc and my hands are peeling, red, itchy but not really sore. 

My feet however are where the real problem is, I have several lacerations and new ones opening on a regular basis making it extremely difficult to walk and i'm in quite some pain no matter what i'm doing with my feet.

I'm only 23 and this just kind of came out of nowhere, i don't mind the aesthetics, I guess i'm lucky in that not many people see your feet but even the finger nails and hands it's not a big deal for me, the issue is with the effect it is having on my quality of life, I train MMA 5 days a week, I cycle a lot I walk places etc and I haven't been able to train for nearly 3 months now, it's getting me down not to mention the pain of just walking around in every day life.

Any advise or tips for dealing with this would be much appreciated, thanks!!

Hi, my name is Emir. I am 17 years old and bave been living with psoriasis since i was just 2, back in  2001. I got diagnosed cause od stress , a dog attack. I have  been able to cut my psoriasis down to just my elbows, knees and feet  However... For 3 Years i faintly belive my doctor that i have  foot fungus which is extremely painful. I was able to Pierce the skin and get all of the green pus run out. After it appears,it lasts a few days , turns brown and i Peel off all of my skin. It grows back and after about a month or less comes back. I am attatching photos so you Guys can  see ,comment and share your experiences, perhaps even diagnose or Help me. Thanks in  advance

I am a woman 58, just was diagnose of psoriasis... not 100%   , but very close, going to see dermatologist next week..
I am covered by terrible red spots (a lot!) - hands look ugly, legs too, but other parts of the body start to show these red spots... Feel very frustrated..How can i go to south vacation - i look scary for people.

Hello everyone

I find there is not much information about Acitretin when it comes to treating disorders other than psoriasis.
I have been suffering from seborrheic dermatitis and folliculitis on the scalp and chest for about 10 years, I am a 25 year old male.

My folliculitis is whats bothering me the most. I have been on Tetralysal before which did not help me and I just got prescribed Acitretin 10mg to take every day. 
I'm sorry if my question is not fit for this forum but does anyone here have any information or experience when it comes to treating these disorders with Acitretin?

Anyone taking Consentyx every experience at Hairloss, about to take the drug and wondering if this is one of the side effects.

I am about to start consentyx and I am a 37 year old male.  We are planning to have our second child and wondering if this affects a man in conceiving or the baby

I have very minor psoriasis (it is never thick, doesn't flake and I've never had a patch much bigger than a coin) and less than 1% of my body is covered  but recently I have noticed I am getting small pimples appear on my legs, mainly on the calves. If I didn't have psoriasis I wouldn't be at all concerned about them but because I do and have heard about pustular psoriasis I'm wondering if that is what it is. 

The only treatment I've had for psoriasis is topical creams, namely Dovonex and Dovobet.  I use Dovobet once on Saturdays and Sundays and Dovonex twice a day on week days. I know a side effect of topical steroids is folliculitis and I'm wondering if it's that? I have noticed there has been a hair coming directly through the middle of the pimple a few times but it's not always the case as you can see in the pics. I have to admit I sometimes lightly prick these pimples with a sterilised needle and gently squeeze them after which they disappear after a few days. I've never had more than two at any one time but a new one will pop up every few days or so.. 

Here is a couple of pics of two different pimples on the back of each leg. 

Hi, I thought I would join this club as I am starting Cosentyx tomorrow (Nov 2/16).  I have heard and read lots of good things about this drug.  I have been a psoriasis suffer for most of my adult life (30 years +).  I have tried all kinds of topical ointments and have done lots of UV treatments,  nothing seems to work.  I use Olux-E Foam for the itch.  I have not been able to use biologics because I have kidney failure.  Cosentyx seems to be easier on the body so I have finally got the ok to use it.  I am looking forward to seeing what it can do for me.  Hoping everyone on here continues to get relief.

Hi everyone! Hope you are all well 

So I am a 25 year old from London, and for three years ago i came up with a really small patch of psoriasis. At the time I didn't think anything of it. It went away (lived quite a healthy lifestyle etc).


This year i have come up with psoriasis quite badly- at first it was only on my elbows (plaque) and a think patch on my leg and lower back. I started using dovabet, but I also started getting guttate spots all over. Now it has spread to my face, scalp, arms, legs, back and is even on my...well yeah sorry for too much info!!

Currently having photothreapy three times a week but its still coming up so probably going on Cyclosporine  in a couple of months after the photothreapy (which is scary so any experiences would be appreciated!!)

I guess the reason I am posting here is that I am finding it difficult to come to terms with - I know there are so many worse things out there and I should consider myself lucky, but I can't help feeling very UNlucky - i just look around at all my friends, colleague, people on the tube, and wonder how come everyone else is fine and I've got psoriasis - i cant even really cover the scars on my face that well! I haven't always treated myself well, and I have been a smoker for years, so I guess I feel like it is my fault and i deserve it - none of my family have it and i just can't understand how has happened. I feel really sad but I am embarrassed to talk to much about it because I feel like my friends do not understand and think i am just being a self indulgent, vain, narcissist - does anyone else feel like this??

Any tips on how to come to terms with the fact I will be living with this forever, or any treatment suggests/ experience would be really appreciated  

thanks!!

Good news for those in the UK waiting for Taltz The National Institute for Health and Care excellence (NICE) are about to approve it for use on psoriasis patients.

The key dates for this appraisal are:

Closing date for comments: 22 November 2016

Second appraisal committee meeting: 25 January 2017

Until final guidance is issued, NHS organizations should make decisions locally on the funding of specific treatments.

Source: nice.org.uk

Taltz (ixekizumab)

Hi all and thank you for having me. I have suffered from plaque psoriasis for over 10 years now. Glad to find a group to share experiences, hope and treatment options with! I took a year off from my Stelara treatments, and just resumed them. Got my first injection last month at the doctor's office, and my booster today. I can honestly say that NOTHING has worked for me the way the Stelara does. Thank God my insurance pays for it.

This study looked at the difference between early (before 40) and late (after 40) onset of psoriasis and suggests they are different.

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Background:
There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases.

Objectives:
We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP.

Methods:
We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study.

Results:
Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4+ : CD8+ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90–36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32–81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004–11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62–15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006).

Conclusions:
Our findings provide further evidence for the difference between EOP and LOP.

Another feather in the cap for Cosentyx

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Novartis has been awarded the prestigious 2016 Prix Galien USA Award for Best Biotechnology Product for Cosentyx® (secukinumab), as well as the Prix Galien Foundation "Discovery of the Decade" Award for Best Pharmaceutical Product for the drug Gleevec® (imatinib mesylate). The awards were presented at a ceremony in New York City on October 27.

"We are honored to receive these prestigious awards for Cosentyx and Gleevec, which not only have changed the practice of medicine for certain conditions, but also represent years of hard work by our scientists," said Joseph Jimenez, CEO of Novartis. "These wins underscore our commitment to addressing the unmet medical needs of patients through science-based innovation."

Cosentyx was the first fully human interleukin-17A (IL-17A) antagonist approved by the US Food and Drug Administration (FDA) in 2015 for the treatment of adults with moderate to severe plaque psoriasis1. Psoriasis affects an estimated 7.5 million people in the US2. It is a chronic immune-mediated disease characterized by thick and extensive skin lesions (plaques), which can cause itching, scaling, and pain2. Cosentyx was also approved for the treatment of active ankylosing spondylitis and psoriatic arthritis in 20161.

The discovery of Gleevec marked the first time in the history of cancer treatment that scientists were able to identify a chromosomal abnormality and then develop a drug that would target that specific protein. Gleevec, a molecularly targeted treatment, rapidly became a therapy of choice for Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) and KIT (CD117)-positive gastrointestinal stromal tumors (KIT+ GIST)3. By showing that certain diseases can share a drug-sensitive target with seemingly unrelated ailments, and that molecular targeting can be medically and commercially successful, Gleevec helped establish a new paradigm for drug development.

###

About the Prix Galien Awards

Considered "the pharmaceutical industry's Nobel Prize," the Prix Galien rewards excellence in scientific innovation that improves the state of human health. The award was first established in 1970 by French pharmacist Roland Mehl and was inaugurated in the United States in 2007 to recognize the technical, scientific and clinical research skills necessary to develop innovative medicines. Since 1970, Novartis has received more than 40 national Prix Galien awards in fifteen countries for innovative therapies such as Gleevec® (imatinib mesylate), Rimactane® (rifampin), Parlodel® (bromocriptine mesylate), Sandimmune® (cyclosporine), Sandostatin® (octreotide acetate), Simulect® (basiliximab) and Visudyne® (verteporfin)4.

The "Discovery of the Decade" is a special once-in-10-years recognition for distinguished industry achievement in medical innovation. The awards honor extraordinary human health impact in three categories - Best Pharmaceutical Product, Best Biotechnology Product, and Best Medical Technology. In addition to Gleevec® (imatinib mesylate), two other Novartis products were nominated for "Discovery of the Decade," including Coartem® (artemether/lumefantrine) for Best Pharmaceutical Product and Promacta® (eltrombopag olamine) for Best Biotechnology Product. Gleevec won the Prix Galien International Prize in 2002, and was recognized again in 2009 by the Prix Galien USA committee for "Best Pharmaceutical Product"5.

About Cosentyx and interleukin-17A (IL-17A)

Cosentyx is a fully human monoclonal antibody (mAB) that selectively binds to the interleukin-17A (IL-17A) cytokine and inhibits its interaction with the IL-17 receptor1.

Cosentyx is approved in more than 65 countries for the treatment of moderate to severe plaque psoriasis which includes the European Union countries, Japan, Switzerland, Australia, the U.S. and Canada6. In the U.S., Cosentyx is approved for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy (light therapy). Cosentyx is also approved in the US for adult patients with active ankylosing spondylitis and active psoriatic arthritis1.

More than 10,000 patients have been treated with Cosentyx in clinical trial settings across multiple indications, and over 50,000 patients have been treated in the post-marketing setting worldwide7.

My eyes have been very dry and itchy for a few weeks now, I have an appointment with my GP on Wednesday about it, but just wondered if it was connected to stelara as a side effect. Anyone ever experienced this?

Hi there sorry but i am new to forums any all thse types of things.

O was just wondering if anybody has used clobaderm and dovobet as i have been prescribed them by the doctor and old to use them together. I have been prescribed many steroid creams to no avail and  he will not refer me to 
A dermotologist

 many thanks in advance

 danny

One for the DMF Gang to have a chinwag about.

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Background:
Fumaric acid esters (FAE) have been used for over 30 years in the management of psoriasis. There have been a number of case reports linking the use of FAE with nephrotoxicity, including acute renal injury and Fanconi syndrome. However, one large multicentre retrospective trial showed no evidence of renal dysfunction with FAE.

Objectives/Aims:
The aim of this study was to determine the number of patients in our institution being treated with FAE who developed significant proteinuria or renal dysfunction.

Methods:
This was a single-centre retrospective study assessing all patients on FAE who attended for follow-up during an 18-week period between February and June 2015. Demographics, co-morbidities, duration and dose of treatment with FAE, proteinuria, renal function and other biochemical serum abnormalities were recorded.

Results:
One hundred and twenty seven patients were included in the study. Eighty-two patients had proteinuria detected at some stage during treatment with FAE, and 18 of these had persistent proteinuria (positive in at least 3 consecutive specimens, 12 weeks apart). Six patients (5 female) developed proximal tubular dysfunction (PTD). The risk factors for the development of PTD appear to be lower body weight (p=0.03), higher dose per weight (p=0.03) and longer duration of treatment (p=0.03). Renal dysfunction improved on discontinuation or dose reduction of FAE.

Conclusion:
Fumaric acid esters are frequently associated with transient or persistent proteinuria. Significant renal dysfunction is rare and usually reversible on dose reduction or discontinuation of FAE. This study highlights the importance of screening for proteinuria. Higher doses per weight of treatment and longer duration of FAE therapy are likely risk factors for PTD.

Hi all, new to the forums, and hoping that you may be able to answer some of my questions to help with my anxiety re Acitretin.

I am a 30 yo male who has been suffering with Psoriasis since I was 19. This was mainly plaque psoriasis on my elbows and knees but when I was 25 i developed a major case of guttate following tonsillitus. I went for UVB treatment for this and it cleared all the Psoriasis up. Unfortunately within 6 months the plaque had returned and another strep infection 2 years later caused another bout of guttate. I went for more UVB treatment and the same cycle repeated itself to where I am today.

I went through major depression following my first bout of guttate as it covered me from head to toe. I was much better the 2nd time round as I understood the condition, and it wasn't as severe as the first time. I treat my plague with Dovabet but this this little to the guttate scales. I wouldn't consider my Psoriasis to be having a detrimental effect to my life; it's annoying it's there but I can live with it!

I went to see the Derm today regarding my Psoriasis as the patch on my knee is growing and I have developed two patches in my groin area that I have never had before (ironically one looks like the male 'bits' - Psoriasis is mocking me now?!  ) - I am going on holiday in March and would prefer to have a clear body rather than it be there. Rather than refer for UVB he has asked me to take Acetritin 20mg per day. I was initially game for this but I've since read horror stories about Acetritin and one thing is particularly worrying me - hair loss! Call me vain but I really like having hair and it's something I will try hold onto if I can!

Am I thinking too much into it or is this something I should be worried about? I was thinking about taking Biotin to try and counteract the effects but it's unclear if this will help or if it will have an effect on the Acitretin. 

Any peoples experiences with this would be appreciated. From reading 20mg is a low dose compared to what others have been taking anyway?

Thanks in advance.