This study looked at the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) on patients taking Bio treatments for psoriasis for up to 6.5 years.

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Background/Objectives:
Patients with psoriasis experience higher rates of depression, anxiety and suicidal ideation than the general population. With effective treatment, there is evidence that with the initial decrease in the psoriasis area and severity index (PASI) score, patients' quality of life (QoL), measured by the dermatology life quality index (DLQI) improves. However, to date, there have been no studies demonstrating that patients' QoL remains improved. We investigated the association between the DLQI and PASI of patients with psoriasis on biologic agents for an extended period of time of up to 6.5 years.

Methods:
The data for this longitudinal, retrospective study was collected from a large tertiary teaching hospital in South Australia. Data was collected from all patients with psoriasis who had been on biologic agents for 2 or more years (n = 54).

Results:
PASI and DLQI were highly correlated over all time points (ρ = 0.50), P < 0.001. DLQI scores significantly decreased by 0.8 (95% CI: 0.30, 1.26) units per year from 12 months to 6.5 years, P = 0.002. After 12 months, PASI scores declined by 0.19 (95% CI: 0.13, 0.52) units per year, P = 0.24.

Conclusion:
This study demonstrates that DLQI and PASI remain low after 12 months, and, in fact, both gradually decline further with time. Patients on biologic agents for prolonged periods maintained their improvement in QoL for up to 6.5 years.

This small study looked at the possible role of Proenkephalin (PENK) in the pathogenesis of psoriasis and to assess if it is related to the severity of psoriatic lesions, and concludes anti-PENK drugs in addition to current psoriasis treatments might be of value in its treatment.

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Background:
Psoriasis is a common chronic skin disease that can also affect the mucous membranes and joints. It is multifactorial in origin, occurring in genetically predisposed individuals, and triggered by various endogenous and exogenous factors. Proenkephalin (PENK) is an endogenous opioid polypeptide hormone that acts on specific opiate receptors found on nerve and mucosal cells, and on various cells in the immune system. PENK receptors are expressed on skin cells, and their activation can regulate keratinocyte and melanocyte activities. PENK expression has been found to be increased in keratinocytes in psoriatic skin, and together with its inflammatory basis, this suggests that PENK may be regulated by inflammatory stimuli.

Aim:
To assess the possible role of PENK in the pathogenesis of psoriasis and to assess if it is related to the severity of psoriatic lesions.

Methods:
Serum and tissue PENK levels were estimated in 20 patients with psoriasis vulgaris, and compared with those of 20 healthy controls (HCs).

Results:
PENK levels were found to be significantly increased both in serum and in psoriatic lesions in patients compared with HCs. No significant correlation was found between PENK levels and patient age, disease duration or disease severity (Psoriasis Area and Severity Index).

Conclusion:
Our results support the role of PENK in the aetiopathogenesis of psoriasis, and indicate that giving anti-PENK drugs in addition to current antipsoriatic therapies might be of value in treating this common chronic skin disease.

This study looked at the Minimal disease activity (MDA) in patients with psoriatic arthritis that are being treated with TNFα blockers, MDA is a concept that has been defined by the Outcome Measures in Rheumatology (OMERACT) as a state of disease activity deemed a useful target of treatment by both the patient and physician.

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Objective:
A state of minimal disease activity (MDA) was defined and validated as target for treatment in psoriatic arthritis (PsA). We aimed to identify disease characteristics, outcome, and predictors of MDA in patients treated with tumor necrosis factor α (TNFα) blockers.

Methods:
Patients fulfilling the Classification of Psoriatic Arthritis criteria treated with TNFα blockers were followed every 3–6 months. Patients were considered in MDA when they meet at least 5 of the 7 criteria. Sustained MDA was defined as an MDA state lasting ≥12 months. Patients achieving MDA were compared to non-MDA patients. A proportional odds discrete time survival analysis model was applied, adjusting for sex, age, PsA duration, abnormal erythrocyte sedimentation rate (ESR) and clinically damaged joint count at each visit to identify predictors for MDA.

Results:
Of the 306 patients treated with TNFα blockers identified from our database, 23 patients were in an MDA state when treatment was commenced; 57 were taking TNFα blockers prior to enrollment. Therefore, 226 subjects were in a non-MDA state and constituted the study population. One hundred forty-five patients of 226 patients (64%) achieved MDA within a mean ± SD duration of 1.30 ± 1.68 years. The mean ± SD duration of MDA was 3.46 ± 2.25 years. At total of 17 patients withdrew from therapy and remained in an MDA state. Male sex (odds ratio [OR] 1.65, 95% confidence interval [95% CI] 1.08–2.53; P = 0.02) and normal ESR (OR 2.27, 95% CI 1.22–4.17; P = 0.009) increased the odds for achieving MDA.

Conclusion:
MDA is achieved in 64% of patients treated with TNFα blockers in a clinical setting. Male sex and normal ESR are predictors for MDA. On withdrawal or reduction in treatment, 11.6% of patients maintained MDA state.

Hi everyone,

Its been a while since I posted here,the last time I posted was in 2014 when I was first diagnosed with plaque and scalp psoriasis and I was covered from my scalp to my lower legs. I just wanted to post a quick update.

My second flare up happened in winter (not surprised, I was actually expecting it) December 2014. But this time it was not too bad. It was however more concentrated on my face and inner arms. The derm prescribed Protopic for the face and it stung horribly after 20 min of application. It worked, but for a short time(approx 1 week) and it comes back, although I still have a tube just in case. My mom made a facepack made from cucumbers, oats, yogurt. Miraculously, it cleared all the scales and red bumps on the face after 2 applications per week for a month, the face has been cleared ever since.
Since my first flare up in January 2014, my lower legs and scalp have never been clear.
But recently, a hair stylist suffering from eczema recommended Denorex, a tar based shampoo available at drug stores. This is an amazing shampoo and it has been able to control the flakiness of my scalp.I would recommend this to anyone suffering from scalp psoriasis.

For my legs, I've strictly used Dovobet gel. Which actually clears up my legs within 3-4 applications, but but but but but but....the itch....
I absolutely cannot control the itch. Even after taking prescribed anti histamines, I'm not able to stop scratching. Which ultimately cancels the effect of the Dovobet gel. Does anyone have any suggestions on what to do about this? because to be honest, I really don't want to try anymore sprays, steroids, light therapy which might just worsen the condition.

If anyone has any questions regarding the above described treatments, then please let me know, I will be happy to help. Or even any suggestions that might help me, please let me know.

I do have one question, I'm sure this has been asked a few times, but....will a cure ever be available in the near future? and by cure I don't mean treatments.

Thanks
Karl

Just seen a link on the npf Twitter page showing that obesity and severity of psoriasis are connected and it recommended weight loss. I've never heard this before, and to be honest seems a load of rubbish to me, but would be interested to hear your thoughts on it.

Chugai Pharmaceutical Co has submitted a new drug application for M8010 a topical combination of maxacalcitol (an active vitamin D3 derivative) and corticosteroid betamethasone butyrate propionate for the treatment of psoriasis.

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Chugai Pharmaceutical Co., Ltd. [Head Office: Chuo-ku, Tokyo; Chairman & CEO: Osamu Nagayama] (hereafter “Chugai”) announced today that it has submitted a New Drug Application (NDA) to the Ministry of Health, Labour and Welfare for a combination topical drug preparation of maxacalcitol and betamethasone butyrate propionate (Development Code: M8010). M8010 has been co-developed with Maruho Co., Ltd. [Head Office: Kita-ku, Osaka; President and CEO: Koichi Takagi] (hereafter “Maruho”) for the indication of psoriasis vulgaris.

M8010 is a topical preparation combining maxacalcitol, an active vitamin D3 derivative created by Chugai, and the corticosteroid betamethasone butyrate propionate. Both drugs are indicated for psoriasis vulgaris and are used together to treat the disease in medical practice.

A Japanese phase III clinical study was conducted to evaluate a once-daily topical application of M8010 against maxacalcitol ointment monotherapy (twice daily inunction) and betamethasone butyrate propionate ointment monotherapy (once daily application). The result showed superiority over both monotherapies in terms of primary endpoint (total score of PSI at four weeks), and secondary endpoint (rate of reduction of mPASI at four weeks). As for safety, rhinopharyngitis and reduction of blood cortisol were observed as major adverse events during the study. However, these were mild and no major difference was observed in the rate of occurrence compared with both monotherapies, so safety of M8010 was similar to that of both drugs.

The collaboration between Chugai and Maruho started with the launch of Oxarol® Ointment, a product of maxacalcitol in 2001. Both companies will make efforts to obtain early approval and make sure that M8010 can be delivered to patients and healthcare professionals as soon as possible. Maruho will be responsible for providing information and marketing activities after an approval is obtained, the same responsibilities Maruho has for Oxarol® Ointment and Lotion, which are already on the market.

Brodalumab an investigational IL-17 inhibitor in development for patients with psoriasis and psoriatic arthritis has been dumped by Amgen,  they have commenced termination of its participation in the co-development and commercialization of brodalumab with AstraZeneca.

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Amgen announced the Company has commenced termination of its participation in the co-development and commercialization of brodalumab with AstraZeneca.  Brodalumab, an investigational IL-17 inhibitor, is in development for patients with moderate-to-severe plaque psoriasis, psoriatic arthritis, and axial spondyloarthritis.  The decision was based on events of suicidal ideation and behavior in the brodalumab program, which Amgen believes likely would necessitate restrictive labeling.

"During our preparation process for regulatory submissions, we came to believe that labeling requirements likely would limit the appropriate patient population for brodalumab," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen.  

After Amgen transitions the program to AstraZeneca, future decisions on the clinical development and submission of marketing applications for brodalumab will be at the sole discretion of AstraZeneca for all territories, except for certain Asian territories, including Japan, where Kyowa Hakko Kirin has rights to brodalumab.

Amgen has decided to focus its efforts and resources on other key molecules that address unmet medical needs and deliver value to patients and shareholders.  The Company continues to make progress against its strategic and financial commitments and does not expect any meaningful impact from this decision on its ability to meet them.

This is an older bb board so guess i have to host images to post but ive had peeling hands for years.I dont get sores or scabs,etc but during the winter my hands get so dry i get bad cracks and does effect my job.Anyway ive made non committed stabs at solving thehow d  problem but never was motivated to really solve it.Last night i saw an old book my father had on NAET and seemed like something interesting.
My real question was to diagnose what i have and then try a NAET practitioner in my area.They are abundant and am a believer in chinese medicine already.Acupuncture cut my healing time in half after ankle surgery and was a believer after that.
So guess ill post pics of my hands later but how do i do that?

Stelara is soon to be made available for adolescent psoriasis patients after the committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorisation for the medicinal product Stelara.

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The Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorisation for the medicinal product Stelara. The marketing authorisation holder for this medicinal product is Janssen-Cilag International N.V.

The CHMP adopted a new indication as follows

Paediatric plaque psoriasis:
Stelara is indicated for the treatment of moderate to severe plaque psoriasis in adolescent patients from the age of 12 years and older, who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies.

This isn't good news for new psoriasis treatment Otezla (apremilast), The German Institute for Quality and Efficiency in Health Care (IQWiG) has said after checking two dossier evaluations that there is no relevant data to say Otezla gives any benefit to psoriasis and psoriatic patients.

I have had to Google translate this so I'm not sure if the wording or spelling is correct, I will show both versions and if anyone can translate better please let me know. But you will get the gist of what has been said.

Quote:

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Google Translation:

Apremilast (trade name: Otezla) is since January 2015 available adults who either participated in a moderate to severe plaque suffering -Psoriasis or active psoriatic arthritis and where certain preliminary activities not sufficiently effective or are not suitable. The Institute for Quality and Efficiency in Health Care (IQWiG) has checked in two dossier evaluations, whether this drug compared to the respective appropriate comparator therapies provides an additional benefit. Such added value is, however, none of the dossiers derivable because they do not contain relevant information.

Producers themselves claimed no added value
The manufacturer must present for any of the two indications prior studies in which Apremilast has been tested against the respective appropriate comparator therapy. He only describes data from placebo-controlled trials, but uses these non for indirect comparisons.

Also, a systematic search for studies with the appropriate comparator therapy is missing that would be possibly suitable for an indirect comparison with apremilast. Therefore, it remains unclear whether an indirect comparison would have been possible and if Apremilast in this comparison an additional benefit or lesser benefit would have shown as the preparations already available. Consequently, claims the manufacturer itself for any of the two indications of additional benefit for the new active substance.

G-BA decides on the extent of the value added
This dossier evaluation is part of the early benefit assessment pursuant Pharmaceutical Market Restructuring Act (AMNOG), which is responsible for the G-BA. After publication of the dossier evaluation of the G-BA performs a commenting procedure and shall take a final decision on the extent of added benefit.

An overview of the results of the benefit assessment IQWiG following summary. In addition to the published by IQWiG website find generally understandable information.

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Original German statement:

Apremilast (Handelsname: Otezla) steht seit Januar 2015 Erwachsenen zur Verfügung, die entweder an einer mittelschweren bis schweren Plaque-Psoriasis oder an einer aktiven Psoriasis-Arthritis erkrankt sind und bei denen bestimmte Vorbehandlungen nicht ausreichend wirken oder nicht geeignet sind. Das Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) hat in zwei Dossierbewertungen überprüft, ob dieser Wirkstoff gegenüber den jeweiligen zweckmäßigen Vergleichstherapien einen Zusatznutzen bietet. Ein solcher Zusatznutzen ist jedoch aus keinem der Dossiers ableitbar, da sie keine relevanten Daten enthalten.

Hersteller selbst beansprucht keinen Zusatznutzen
Der Hersteller legt für keine der beiden Indikationen Studien vor, in denen Apremilast gegen die jeweilige zweckmäßige Vergleichstherapie getestet wurde. Er beschreibt lediglich Daten aus placebokontrollierten Studien, nutzt diese aber nicht für indirekte Vergleiche.

Auch eine systematische Recherche nach Studien mit der zweckmäßigen Vergleichstherapie fehlt, die sich gegebenenfalls für einen indirekten Vergleich mit Apremilast eignen würden. Deshalb bleibt offen, ob ein indirekter Vergleich möglich gewesen wäre und ob Apremilast in diesem Vergleich einen Zusatznutzen oder einen geringeren Nutzen als die bereits verfügbaren Präparate gezeigt hätte. Konsequenterweise beansprucht der Hersteller selbst für keine der beiden Indikationen einen Zusatznutzen für den neuen Wirkstoff.
G-BA beschließt über Ausmaß des Zusatznutzens

Diese Dossierbewertung ist Teil der frühen Nutzenbewertung gemäß Arzneimittelmarktneuordnungsgesetz (AMNOG), die der G-BA verantwortet. Nach Publikation der Dossierbewertung führt der G-BA ein Stellungnahmeverfahren durch und fasst einen abschließenden Beschluss über das Ausmaß des Zusatznutzens.

Einen Überblick über die Ergebnisse der Nutzenbewertung des IQWiG gibt folgende Kurzfassung. Auf der vom IQWiG herausgegebenen Website finden Sie zudem allgemein verständliche Informationen.

Going to ask a really stupid question:

Noticed in several posts while rummaging through the topics that blood tests are mentioned. Now, what kind of blood tests are we talking about?
I have never had a blood test taken from me since P was diagnosed on me - 20 odd years ago.

I have an appointment with a dermatologists coming up in the next few weeks and want to get my facts together before I get to see him/her.

I was talking to another member the other day about avoiding Live Vaccines whilst using Stelara for the treatment of psoriasis.

The reason being that all the Bio treatments recommend you avoid Live Vaccines because the Bio's weaken your immune system, but it got me thinking that maybe all people with psoriasis should avoid Live Vaccines. Ok the Bio's do weaken your immune system, but psoriasis is in itself an autoimmune disorder.

So we are all at a higher risk of infection, and taking a Live Vaccine could be to much for our systems to handle. A Live Vaccine is just that, it still has a tiny bit of life in it and the idea is to inject a person with it to make the body's immune system fight it. This is great for those with a strong immune system and it will stop us getting something like Polio, Measles, Etc. But what if we take a Live Vaccine whilst on a Bio treatment or those of us with bad psoriasis? could it cause our bodies to not be able to act and we could end up with the very thing that the vaccination was trying to protect us from!

Live Vaccines include but are not limited to:
Measles vaccine, Mumps vaccine, Rubella vaccine, Live attenuated influenza vaccine (the seasonal flu nasal spray and the 2009 H1N1 flu nasal spray), Chicken pox vaccine, Polio vaccine (Sabin), Rotavirus vaccine, Yellow fever vaccine, Rabies vaccine, Bacillus Calmette-Guerin vaccine, Typhoid vaccine, and Epidemic typhus vaccine.

*Note some of the above especially Flu and Rabies are available in Live and Killed Vaccines.

What do you think, should we avoid Live Vaccines?  

Hi everyone, I have just joined up to the forum and would like to introduce myself and ask for some advice on various treatments. My name is Murdo, 36 and have been suffering from P since the age of 17. I got a small tattoo aged 17 on my sholder and that was what triggered it off for me. At first the entire tattoo was covered with whte scales and it was no where else on my body. Eventually it started to appear on my body bit by bit and I saw a dermatologist for the first time and he told me it was Plaque Psoriasis. I didn't recieve any treatment for it at the time and it eventually went away and stayed away until I was around 24.

It started to appear on my lower legs, shins, knees and then spread to my arms, elbows and came and went over the next couple of years. The last 10 years has been the worst time for me where my P has been severe and at it's worst, legs, elbows, arms, back and body. I find that a sore throat triggers it off now. I have been prescribed all the creams and ointments available, Dovobet, Dovonex etc... and none of them worked. I have had 2 treatments of UVB light and 1 PUVA, and I have to say they all cleared it but only for a very short time. I have now been prescribed "Fumaderm" but I am a bit cautious about taking it. I live in Ireland and prescription drugs cost the earth, so the price is putting me off for a start, then there is the side effects, I am gong to get back onto my dermotologist and see if he can prescribe me Acitretin, which I believe is cheaper and has the same effect as Fumaderm.  I have also been told about "Dermylex Tablets" which are a natural product.

I am looking for some advice on the various tablets available on prescription and would like to hear from anyone who has used or been prescribed tablets or natural products for Psoriasis. Thanks and I look forward to any feedback.  

My Legs and feet seem to have a really strange habit of creating circle shapes with the droplets of Psoriasis.  Anyone else have this problem?

This thread was edited by jiml on 8 Jan 2017 to add new information from the new leaflet

This study looked at Serum IL-33 levels in people with psoriasis before and after anti-tumour necrosis factor (TNF)-α therapy.

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Background:
Interleukin (IL)-33 is a recently identified cytokine, which is a member of the IL-1 family and binds to a heterodimeric receptor comprising ST2 (suppression of tumorigenicity 2) and IL-1 receptor accessory protein. Serum levels of IL-33 have been reported to be upregulated in various T helper (Th)1/Th17-mediated diseases, such as rheumatoid arthritis and inflammatory bowel disease. IL-33 expression is increased in lesional skin in patients with psoriasis, but serum levels in patients with psoriasis have not yet been studied.

Aim:
To study serum IL-33 levels in patients with psoriasis, a Th1/Th17-mediated skin disease, before and after anti-tumour necrosis factor (TNF)-α therapy.

Methods:
Serum IL-33 levels were measured in patients with psoriasis vulgaris (PV), psoriatic arthritis (PsA) or pustular psoriasis (PP), and compared with those of healthy controls. Associations between serum IL-33 levels and serum TNF-α, IL-6, vascular endothelial growth factor and C-reactive protein levels were also studied. In addition, the effect of IL-33 stimulation on IL-6, IL-8, TNF-α and VEGF secretion by human keratinocyte was analysed.

Results:
Serum IL-33 levels in patients with PV, PsA and PP were significantly higher than those in healthy controls. Serum IL-33 levels correlated with serum TNF-α levels in patients with psoriasis, and decreased after anti-TNF-α therapy. IL-33 stimulated IL-6 and IL-8 secretion by human keratinocytes.

Conclusions:
These results suggest that serum IL-33 levels generally reflect increased inflammation in patients with psoriasis.

Another day and I have to wash my bed linen again! Blood stains all over again from scratching while I slept.
Anyone got some miracle advice as to what I can try and do?

Applying Elocon cream at night before I go to sleep. Tried some other creams but found that some will make me sweat like a pig and have to wash the linen anyways

Apart from sleeping on towels (which I hate to do). I do not like any other material around me other than bed linen. Yes I have tried pyjamas but end up feeling like a burrito roll at some point in the night and just rip them off.

I have a question regarding Psoriatic arthritis.

I have had this really annoying pain in my left elbow and shoulder for quite some time now. Up to such a point where I can not lift my elbow above my shoulder and even just picking up a laptop is very difficult. Seems like I have lost all power in my left arm. My GP said it was Tennis Elbow and just gave me a few anti-inflammatory painkillers for it. He has prescribed this now three times over the past year and a half. I did not think tennis-elbow can last that long??? Could it be that I have got Psoriatic arthritis as well?

This study suggests there is a significant association of PTPN22 (rs2476601) to psoriatic arthritis susceptibility, but no evidence for association with psoriasis, don't ask me to explain I'm not awake properly yet.

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Objectives:
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis; it has a higher estimated genetic component than psoriasis alone, however most genetic susceptibility loci identified for PsA to date are also shared with psoriasis. Here we attempt to validate novel single nucleotide polymorphisms selected from our recent PsA Immunochip study and determine specificity to PsA.

Methods:
A total of 15 single nucleotide polymorphisms were selected (PImmunochip <1×10−4) for validation genotyping in 1177 cases and 2155 controls using TaqMan. Meta-analysis of Immunochip and validation data sets consisted of 3139 PsA cases and 11 078 controls. Novel PsA susceptibility loci were compared with data from two large psoriasis studies (WTCCC2 and Immunochip) to determine PsA specificity.

Results:
We found genome-wide significant association to rs2476601, mapping to PTPN22 (p=1.49×10−9, OR=1.32), but no evidence for association in the psoriasis cohort (p=0.34) and the effect estimates were significantly different between PsA and psoriasis (p=3.2×10−4). Additionally, we found genome-wide significant association to the previously reported psoriasis risk loci; NOS2 (rs4795067, p=5.27×10−9).

Conclusions:
For the first time, we report genome-wide significant association of PTPN22 (rs2476601) to PsA susceptibility, but no evidence for association to psoriasis.

Has anyone ever tried acupuncture as a relief?

Sorry for the 20 questions but if I do not ask them now, I'll forget and only remember when I on top of a mountain in the middle of nowhere with no internet access for miles