The future of psoriasis treatment is changing, and it's moving along very fast. This past few years have seen a huge increase in the number of Bio treatments and I was wondering how others see the future of psoriasis treatments.

Will it be an oral treatment, a cream, a spray, an injection, a natural treatment or maybe something we have not seen yet ?

As some of you know I have my contacts that pass me the latest information as it happens and I publish it as soon as I know, but I have noticed that most of the stuff I publish recently is concerned with the Bio treatments.

You may also know I'm a big fan of the Bio treatments as they gave me back my life, however I try not to be biased in the news reports so I'm curious to what others think the psoriasis treatment of the future will be.  

Over to you.

Hi 

Im jay & new to this forum. 
I havd has psorasis for nearly 20 years. I don't know the type think gluttate

This study looked at the psychometric properties of the Itch Numeric Rating Scale (Itch NRS) in patients with psoriasis.

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Background:
Itching is a profoundly distressing symptom for many patients with psoriasis, but it has not been rigorously studied using validated tools for this condition.

Objectives:
This study investigated the psychometric properties of the Itch Numeric Rating Scale (Itch NRS), a single-item patient-reported outcome (PRO) measuring the worst itching severity due to psoriasis in the past 24 h.

Methods:
Using disease-specific clinician-rated and PRO data from one phase II and three phase III randomized clinical studies of subjects with moderate-to-severe plaque psoriasis, the Itch NRS was evaluated for test–retest reliability, construct validity and responsiveness. A responder definition was explored using anchor- and distribution-based methods.

Results:
Test–retest reliability analyses supported the reproducibility of the measure (intraclass correlation coefficient range 0·71–0·74). To support the construct validity of the Itch NRS, large cross-sectional correlations with the Dermatology Life Quality Index (DLQI) Symptoms and Feelings domain (r ≥ 0·60 at baseline and r ≥ 0·80 at week 12) supported a priori hypotheses, while large correlations (r ≥ 0·71) between changes in Itch NRS scores and changes in DLQI Symptoms and Feelings domain scores from baseline to week 12 established responsiveness. A 4-point change was optimal for demonstrating a level of clinically meaningful improvement in itch severity after 12 weeks of treatment, which corresponds with marked clinical improvements in plaque psoriasis.

Conclusions:
The Itch NRS demonstrated sufficient reliability, validity and responsiveness, and appropriate interpretation standards for evaluating change over time in itch severity among patients with moderate-to-severe plaque psoriasis when validated using clinical trial data for this condition.

Hi all...

Ï'm new here... I just stumbled about this forum a few weeks ago while I was looking for some info/experiences about a possible Etretinato/Acitritin treatment that my Doc proposed to me.

That was real good Info that I found here... Especially it was the Story of kh924 that gave me the motivation to start with this treatment.

I'm now two weeks with this... Not sure... but I beleve it somehow works... All those heavy plaque-spots slowly turn into light red spots only. But they itch like hell !!! Yes really!!! Like  Hell!!!! Can hardly sleep with this ;(


Well... Anyway... Still full of hope...  let's see...


Mike

Can I add photos to my threads/posts ?
If so, how. 

This study suggests that Cyclosporin could be safe when pregnancy occurs.

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Problem:
Cyclosporin A (CYS A) is an immunosuppressant agent administered in autoimmune diseases, and its use during pregnancy and lactation is a debated topic.

Method of study:
The demographic characteristics, the activity of the underlying disease, and the onset of fetal–maternal complications have been investigated in 21 consecutive patients (2 RA, 14 SLE, 2 PA, 1 SjS, 1 DM, 1 Churg–Strauss vasculitis), treated with CYS A throughout 29 gestations. A subanalysis of the SLE group was performed.

Results:
We recorded a live birth rate of 86.2%. The median gestational age at birth was 38.2 weeks. The prevalence of maternal–fetal complications showed no differences with general population. Disease flares appeared in 4% of patients during gestation and in 12% during puerperium.

Conclusion:
We found no evidence justifying the suspension of CYS A when a pregnancy occurs. The drug does not appear to promote maternal–fetal complications and should be continued in patients who benefit from therapy. Data regarding breast-feeding during therapy are still scarce, but no evidence of toxicity has emerged.

Hello all-


Thanks again for sharing with me your experiences and results of your treatments. I will try and do the same.

I started Cosentyx one week ago, yesterday I took my second dose. 

For those whom are a little Trypanophobic (Fear of Needles), well the injections are easy to administer and almost completely painless.
Very similar to the auto-injectors given to us on the Fire Department. You choose the location to administer wether be it your arm, oblique, or upper thighs.
I have chosen my stomach for the first few doses. I will probably try my legs next.

So far the only symptoms I have felt is some slight lethargy and a runny nose.

My wife claims that my back looks like it's clearing. What's interesting is that in only one week the redness seems to be dissipating. (Fingers Crossed)

Also, my legs remain a bit itchy, but only in specific locations. I have no itchiness in my upper body. Again, a positive.

Well, I'll check back again. 

I hope this works. Enbrel didn't take and Otezla was a hellish experience for me.

I wish you all relief and clear skin. 

Ric

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Fertiliser or manure cells transform into war cells when they are repeatedly exposed to inflammatory mechanisms. This was written by the LUMC, the Leiden University Hospital, in the journal of Allergy and a clinical immunology.
This discovery can lead to new treatments of chronical diseases like allergies.
The immune system uses inflammation to fight invaders like viruses. When the system is not able to remove the threat, the inflammation mechanism stays active. This happens with auto immune diseases and allergies. This leads to a lot of damage to the tissue.

The medics/researchers wanted to know if immune cells with that kind of chronic diseases change after a while. They researched fertiliser (manure) cells: cells that are in contact with the outside world and are involved with allergic reactions. The fertiliser cells indeed appeared to transform after repeated exposure to inflammatory mechanisms. After this change they started to activate inflammatory molecules much stronger.
The researchers think that medication that reverses this change, can also reverse the symptoms of chronical immune diseases.

Hello,

I have been looking around the site for a while now...and with jiml's help I have been able to add my replys, but I don't know how to ask a question without going on PM.

So if anyone is there here's the question:

How do you know the difference between psoriasis arthritis and osteoarthritis?

I don't do the doctors anymore...the first thing they say is "do you smoke?" I want to reply  "well I didn't smoke when I was four?"

So...any help with the arthritis thing?  would be very greatful

Fifty

Not sure I have done this right either?  sorry

There are so many psoriasis studies around that sometimes it gets confusing, and it's getting harder to get comparability and combinability of cohorts and data. This study suggests further harmonization of data collection is demanded.

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Background:
Safety and efficacy of new treatments are analyzed in clinical trials but their capacity to show potential effects of long-term treatment and more than short latency of onset is limited. To meet this challenge, patient registries (of treatments or diseases) collect prospective data of real-world patients in daily practice without tight selection of patients.

Objective:
The aim of this article was to identify existing psoriasis patient registries by published articles and evaluation of monitored treatment classes, patients, research questions addressed, and measurement instruments implemented.

Materials & Methods:
A systematic review of Medline (pub med) and Embase (Ovid) databases for publications on psoriasis patient registries, including cross-validation was conducted October 2015.

Results:
14 patient registries for long-term observation of psoriasis patients in real-world care were identified. Registries were established since 2005, the majority is located in Europe. The number of published studies from single registries ranged from 1 to 10. Most registries include patients treated by conventional systemics as well as biologics. The number of patients analyzed ranged from 35 to >12 000 patients. The publications mostly addressed safety issues or treatment outcomes, followed by baseline description, drug survival, predictor analyses, and treatment patterns.

Conclusion:
A variety of local, national, and international patient registries collect longitudinal data on (systemic) psoriasis treatment. The number of publications reflect the main registry objectives of safety and effectiveness, with additional therapy-related investigations being addressed as well. Based on the information from publications, the combination of data from these registries will involve many methodological challenges. To gain comparability and combinability of cohorts and data across registries, further harmonization of data collection is demanded.

I have read a lot of members going off topic discussing what their idea of being clear of psoriasis is

My idea of clear is what makes me happy. I having spent my life keeping covered up, but for the last 4 years I am what I regard as clear......I am happy to mix with people on the beach, go swimming at the pool, wear shorts and tee shirts without feeling self conscious ........and don't get strange looks from people

I have an odd small plaque on an elbow, and occasionally get a spot in my hair.....I can live with that...it keeps me on guard

So I regard clear as "virtually clear" I'm happy with that and I certainly won't strive or lose any sleep if it always stays that way

I would be interested in what others regard as clear or what level they are happy to live with the

This Danish study looked at Psoriasis and Type 2 Diabetes in 34 781 Twins aged 20 - 71.

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Importance:  
Psoriasis has been shown to be associated with overweight and type 2 diabetes mellitus. The genetic association is unclear.

Objective:  
To examine the association among psoriasis, type 2 diabetes mellitus, and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) in twins.

Design, Setting, and Participants:  
This cross-sectional, population-based twin study included 34 781 Danish twins, 20 to 71 years of age. Data from a questionnaire on psoriasis was validated against hospital discharge diagnoses of psoriasis and compared with hospital discharge diagnoses of type 2 diabetes mellitus and self-reported BMI. Data were collected in the spring of 2002. Data were analyzed from January 1 to October 31, 2014.

Main Outcomes and Measures:  
Crude and adjusted odds ratios (ORs) were calculated for psoriasis in relation to type 2 diabetes mellitus, increasing BMI, and obesity in the whole population of twins and in 449 psoriasis-discordant twins. Variance component analysis was used to measure genetic and nongenetic effects on the associations.

Results:  
Among the 34 781 questionnaire respondents, 33 588 with complete data were included in the study (15 443 men [46.0%]; 18 145 women [54.0%]; mean [SD] age, 44.5 [7.6] years). After multivariable adjustment, a significant association was found between psoriasis and type 2 diabetes mellitus (odds ratio [OR], 1.53; 95% CI, 1.03-2.27; P = .04) and between psoriasis and increasing BMI (OR, 1.81; 95% CI, 1.28-2.55; P  = .001 in individuals with a BMI>35.0). Among psoriasis-discordant twin pairs, the association between psoriasis and obesity was diluted in monozygotic twins (OR, 1.43; 95% CI, 0.50-4.07; P = .50) relative to dizygotic twins (OR, 2.13; 95% CI, 1.03-4.39; P  = .04). Variance decomposition showed that additive genetic factors accounted for 68% (95% CI, 60%-75%) of the variance in the susceptibility to psoriasis, for 73% (95% CI, 58%-83%) of the variance in susceptibility to type 2 diabetes mellitus, and for 74% (95% CI, 72%-76%) of the variance in BMI. The genetic correlation between psoriasis and type 2 diabetes mellitus was 0.13 (−0.06 to 0.31; P = .17); between psoriasis and BMI, 0.12 (0.08 to 0.19; P < .001). The environmental correlation between psoriasis and type 2 diabetes mellitus was 0.10 (−0.71 to 0.17; P = .63); between psoriasis and BMI, −0.05 (−0.14 to 0.04; P = .44).

Conclusions and Relevance:  
This study determines the contribution of genetic and environmental factors to the interaction between obesity, type 2 diabetes mellitus, and psoriasis. Psoriasis, type 2 diabetes mellitus, and obesity are also strongly associated in adults after taking key confounding factors, such as sex, age, and smoking, into account. Results indicate a common genetic etiology for psoriasis and obesity.

Hi,

Just been to see my dermatologist today and have finally managed to persuade him that light treatment/ointments and creams are not working, he said he didn't want me to go on methotrexate so has prescribed me cyclosporine.
First time I've tried anything like this so I'm a bit unsure about it... The leaflet with possible side effects is of similar thickness to the bible!

Anyway he says this is a short term fix to try and get me clear then we can have a look at trying some biologic treatments.

Anybody had much experience with cyclosporine? i have quite a physical job down a mine and am just a bit worried it might knock me for six.

Cheers

Jamie 

This albeit small study looked at distress in patients with psoriatic arthritis and suggests, patients reported their condition is being dismissed or belittled by others and they therefore hide their distress from people around them.  

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Objective:
PsA is associated with significant distress and can be life-ruining. Reducing distress can improve quality of life and disease outcomes. Quality of life measures broadly identify the extent to which PsA impacts on people’s lives but do not enable clinicians to address PsA-specific distress in the setting of the clinic. The aim of this study was to explore people's illness beliefs, emotions and behaviours that relate to living with PsA and account for the distress experienced by those living with this condition.

Methods:
Semi-structured individual interviews were conducted in the UK with adults with PsA. Interview questions were theoretically informed by the Common-Sense Self-Regulation Model (CS-SRM). Two stages of data analysis, in line with thematic and framework analysis principles, involved coding pre-determined CS-SRM components and identifying any additional emergent themes. Constant comparison techniques allowed for patterns across CS-SRM components to emerge inductively from the data.

Results:
Twenty-four people with PsA participated (54% male; aged 27–71; time since onset ranged between 4 months and 29 years). Four core themes comprising clusters of illness beliefs, emotions and related behaviours emerged accounting for patient distress: restrictions, role of others, resentment and resignation. Suicidal ideation in the sample was commonly expressed and patients feared exponential degeneration of their condition. Patients reported the condition being dismissed or belittled by others and therefore hiding their distress from people around them.

Conclusion:
People with PsA experience significant disease-related distress, including suicidal ideation. Misperceptions, ineffective coping styles (e.g. avoidance/blocking) and negative emotions should be actively identified and addressed with people with PsA.

My husband had a kidney function of 9 on Tuesday and is in hospital. They have taken him off the psoriasis treatment which was Accitretin as they thought the Fumaderm was causing the kidney problem, when function dropped from 90-50! Dermo did say Acitretin which had been used before, would not control  the psoriasis but wanted him to take them until they could sort out the injections. However the function dropped even more when he was no longer on Fumaderm!

So we now have Eric coming home today or tomorrow on NO medication for the psoriasis and I think they may have taken him off the allupurinol as well for his gout. He is also not to take painkillers. He has to go back on Wednesday to see the nephro.

He is seeing the Dermotologist on Tuesday but has been told not to take anything until passing it by the Nephro.
Are injections likely to cause kidney problems? I realise that there are several options so this is just a general question.

I do think we specialists taking 'snapshots' and not really seeing the whole patient although I do accept that the kidney function of 9 was the most dangerous and needed to be sorted. They still do not seem sure what caused the sudden drop.......

But psoriasis can cause infections and very low quality of life..He literally could not walk this time last year and his skin was peeling off.
I do not know if anyone has co -morbidities and has been through similar things? I know that the injections are the last resort in the UK.
Thanks for reading. I shall print out the discharge from the unit and get husband to take it with him when he sees the dermo on Tuesday. It is going to be a difficult bank holiday!

Following on from this report Taltz (ixekizumab) gets FDA approval for Psoriasis  Taltz (ixekizumab) has now also been given approval for psoriasis in the EU.

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Lilly is expecting to start rolling out Taltz in EU countries from this summer and through to the end of 2018, taking into account the typical cycle times for reimbursement assessment.

The approved dosing regimen for Taltz is a 160mg subcutaneous injection, followed by an 80mg injection every two weeks for 12 weeks and then a maintenance dose of 80mg each month. In trials, around 90% of patients treated with Lilly's drug had a 75% or more clearance in skin lesions after 12 weeks, with the majority (80%) showing clear or almost clear skin.

While second to market after Cosentyx, some clinicians say the phase III data for the two drugs suggest that Taltz may have some efficacy advantages over Novartis' product - though no head-to-head comparison is available - and could allow it to mount a strong challenge.

This study suggests there is no need for exploration of alitretinoin in palmoplantar pustulosis.

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Background:
Palmoplantar pustulosis (PPP) is an inflammatory, debilitating skin disease. Topical drugs and systemic immunosuppressive agents are often ineffective. Previous uncontrolled studies have suggested that alitretinoin could be a meaningful treatment option for PPP.

Objectives:
The primary objective was to determine response to alitretinoin for the treatment of PPP based on the Palmoplantar Pustulosis Area and Severity Index (PPPASI) after 24 weeks of treatment.

Methods:
A phase II, randomized, double-blind, placebo-controlled, multicentre study. Adult patients with PPP (with or without psoriasis) refractory to topical therapy and standard skin care were randomized 2:1 to alitretinoin 30 mg once daily or placebo for up to 24 weeks. The primary end point was PPPASI at week 24 (or the last visit in case of early withdrawal). Secondary end points included: percentage change from baseline in the modified Psoriasis Area and Severity Index (mPASI); percentage of patients with ≥ 50% or 75% improvement in PPPASI or mPASI scores from baseline; change in pustule count on the palms and soles; change in the Nail Psoriasis Severity Index and safety and tolerability assessments.

Results:
Thirty-three patients were randomized: 24 patients to alitretinoin 30 mg and nine to placebo. Overall, there were no significant differences between alitretinoin 30 mg and placebo for any end point. The safety profile was consistent with that seen in patients with chronic severe hand eczema refractory to potent topical corticosteroids.

Conclusions:
Although the results were unexpected based on previous studies of alitretinoin in the treatment of PPP, this study provided no evidence to support further exploration of alitretinoin in the treatment of severe PPP.

Following on from this thread MALT1 gene could be new target in psoriasis you may also find this interesting.

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Background:
The CARD14 gene encodes a protein that enhances nuclear factor (NF)-κB activation and the upregulation of proinflammatory pathway genes. CARD14 is upregulated in psoriatic vs. normal skin, and rare and common CARD14 variants have been associated with the risk of developing psoriasis. Our hypothesis was that CARD14 variants could also influence the response to antitumour necrosis factor (anti-TNF) therapies among patients with psoriasis.

Objectives:
To determine whether CARD14 gene variants were linked to a significant positive anti-TNF response in patients with psoriasis.

Methods:
DNA from 116 patients with psoriasis was subjected to next-generation sequencing of the CARD14 gene. All of the patients were nonresponders or had contraindications to conventional systemic treatments.

Results:
A reduction of at least 75% in Psoriasis Area and Severity Index (PASI 75) at week 24 was considered a positive response to treatment. In total 116 patients (79 responders and 37 nonresponders) were next-generation sequenced, and we identified five nucleotide variants that would result in missense amino acid changes. These variants were determined in all of the patients, and allele and genotype frequencies were compared between the two groups. We found a significantly higher frequency of rs11652075 CC (p.Arg820Trp) among the group with a positive response (P = 0.01, odds ratio 3.71, 95% confidence interval 1.30–10.51). Furthermore, among responders, six patients were heterozygous carriers of the rare p.Glu422Lys variant, and two patients were heterozygous for p.Arg682Trp (P = 0.04).

Conclusions:
The common CARD14 p.Arg820Trp variant might have a significant effect on the response to anti-TNF therapies among patients with psoriasis. In addition, rare CARD14 missense variants could also predispose to a better response.

This study suggests the MALT1 gene could be a possible new target to help those with psoriasis.

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Mutations in CARD14 have recently been linked to psoriasis susceptibility. CARD14 is an epidermal regulator of NF-κB activation. However, the ability of CARD14 to activate other signaling pathways as well as the biochemical mechanisms that mediate and regulate its function remain to be determined.

Here, we report that in addition to NF-κB signaling, CARD14 activates p38 and JNK MAP kinase pathways, all of which are dependent on the paracaspase MALT1. Mechanistically, we demonstrate that CARD14 physically interacts with paracaspase MALT1 and activates MALT1 proteolytic activity and inflammatory gene expression, which are enhanced by psoriasis-associated CARD14 mutations.

Moreover, we show that MALT1 deficiency or pharmacological inhibition of MALT1 catalytic activity inhibits pathogenic mutant CARD14-induced cytokine and chemokine expression in human primary keratinocytes.

Collectively, our findings demonstrate a novel role for MALT1 in CARD14-induced signaling and indicate MALT1 as a valuable therapeutic target in psoriasis.

This study shows that the paracaspase MALT1 is indispensable for CARD14-induced NF-κB and MAP kinase signaling. Pharmacological inhibition of MALT1 prevents pro-inflammatory gene expression in primary keratinocytes induced by psoriasis-associated mutation of CARD14.

Read this in the monthly paper of Sanquin.


Sanquin, Dutch blood institute, participates in a British consortium, PSORT, Psoriasis Stratification to Optimize Relevant Therapy. Dermatologists, researchers, pharmaceutical organisations but also patients are here in United to try to Optimize the therapy with biologicals. The consortium received 5 million pounds in 2013 from the English medical research council and another 2 million of the industrial partners.

People with serious forms of psoriasis benefit from the treatment with biologicals. This new class of medication is very expensive, estimated costs 15.000 per patient per year. Unfortunately part of the patients does not respond well. Possible reasons are genetic background, too low medication levels because of metabolic variations of the forming of antibodies against the medication. PSORT strives for personalised treatment, that holds this and other factors into account.
This results in optimal clinical results, but also in insight in other less common immune diseases as well as a cost reduction in health care.

With the division research, dr. Karien Bloem and dr. Theo Rispens are involved with PSORT. And From diagnostics dr. Annick de Vries with her biologicals lab. Direct corporation in Great Britain is going via doctor-researchers from the Kings College in London and from the university of Manchester. "We are very happy that we found a lab that is able to measure medication as well as anti-drug antibodies combined with the expertise of Sanquin Research on the area of immunogenicity. Together with other parameter that we study with the consortium these tests are an easy and cheap way to support personalised medication". Sanquin is busy developing a blood-spot technique for PSORT so patients can take their blood at home and inform their consultant for adjusting the personalised treatment.