Hi

Had psoriasis since I was 24 I'm 39 now. I firmly believe in the theory (well for me anyway) it's a stress based illness, as when I am happy it slowly goes away on it's own. I have however tried a couple of creams.. Dovonex was excellent! one application lasted 6 months at one time another 8 months, while Dovobet is a hard slog for me.. it works..kinda, takes ages and many many applications, I can finish a tube in under a week if i'm not careful (my psoriasis is quite extreme, covering I'd guess 16th of my body). I asked the doctor for Dovonex again a few years ago..but he said the NHS don't prescribe it anymore because it's too expensive. He offered me Dovobet.. I tried to insist but no. Then in 2011 I got confused between them and asked for Dovobet.. I was so surprised when he agreed! Using it.. ahh it reduces my plaque but I need to keep using it but then I have to go back.. pay for a taxi..you get the idea. I have sleep apnoea also (which is stress related) so my memory is junk, and im not awake at the same time + remember to get to the doctors. They get quite annoyed if you miss appointments ..not so much with me, but i wouldn't like to let anyone down. 

I bought Dithrocream online to give it a go.. my fiancee is always telling me to look after myself and im starting to think she's right. I just wish I could get that Dovonex again.. that was brilliant for me!

feel free to chat and share experience and info

Dava

Hi guys

New here, thought i'd say hi.

trying to find some info..but ill make a proper post.

thanks

Dava

An interesting one for the DMF gang, this study looked at the effectiveness of Dimethyl Fumarate (DMF) in modulating the Th17, Th1 and Th2 helper cells. We have a lot of members using DMF in it's various forms (Fumaderm, Psorinovo, and even Bill using it raw) so I thought you may find this interesting.

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Background:
Fumaric acid esters such as dimethyl fumarate (DMF) have proven to be effective in the treatment of psoriasis.

Objectives:
In view of the role of Th17 in the pathogenesis of psoriasis, the present study was conducted to investigate the effects of DMF on Th1, Th2, and Th17 responses in patients.

Methods:
Peripheral blood mononuclear cells (PBMCs) were isolated from psoriasis patients and healthy individuals and were cultured in the presence or absence of phytohemagglutinin and DMF. The cell supernatants were removed to measure cytokine secretion, and the lymphocytes were used for real-time polymerase chain reaction to establish gene expression.

Results:
An increase in gene expression of interferon-γ (IFN-γ), as a marker for Th1 activity, and interleukin-17 (IL-17), granulocyte macrophage colony-stimulating factor (GM-CSF) and IL-22 representing the Th17 subset in the PBMCs of patients in comparison with those of control subjects was observed. Culture of PBMCs from psoriasis patients and controls in the presence of DMF decreased IFN-γ and increased IL-4 gene expression in both groups. Treatment with DMF could significantly decrease IL-17, GM-CSF, and IL-22 mRNA levels in the PBMCs of patients. Decreased release of IFN-γ and GM-CSF cytokine secretion after DMF treatment was also observed in PBMC cultures of patients and controls.

Conclusions:
These data show the effectiveness of DMF in modulating Th17 cells in addition to Th1/Th2 cells and reflect one of the underlying mechanisms of action of DMF in psoriasis. These findings may also support the possible benefits of using fumarate in the treatment of other autoimmune diseases in the pathogeneses of which Th1 and Th17 cells play major roles.

This small Japanese study set out to evaluate the efficacy of Humira (adalimumab) in treating joint disease in patients with PsA, using the PsA magnetic resonance imaging scoring system (PsAMRIS)

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Psoriatic arthritis (PsA), a seronegative arthropathy, may often result in progressive joint damage without treatment, leading to disability and impaired quality of life. Early therapeutic intervention of PsA is therefore crucial before the development of irreversible joint damage.

Because psoriatic skin lesions generally precede the onset of PsA, dermatologists occupy an important position in treating patients with early PsA.

This study aimed to evaluate the efficacy of adalimumab in treating joint disease in patients with PsA, using the PsA magnetic resonance imaging scoring system (PsAMRIS). Five adult Japanese male patients with active PsA were treated with adalimumab. Magnetic resonance imaging was obtained at baseline and 8–32 weeks with 2–3 time points following adalimumab treatment and assessed using PsAMRIS. Adalimumab treatment markedly improved clinical symptoms and disease activities of joint disease, which was confirmed by the reduction of PsAMRIS scores in all patients. Bone marrow edema and periarticular inflammation, reflecting the presence of enthesitis, were dramatically improved at week 8, while improvement of synovitis and flexor tenosynovitis was observed later, at week 24 or 32. However, bone erosion was not improved by adalimumab treatment during the follow-up period.

These results indicate that adalimumab treatment is associated with dramatic improvement of enthesitis in patients with PsA, whereas bone erosion may be resistant to such treatment. PsAMRIS appears to be useful for the evaluation of treatment efficacy in PsA.

I'm just wondering what shampoos and treatments that all you guys use. I'm having a nightmare at the minute with mine it's the first place my psoriasis has flared after coming off cyclosporine :( the shampoo the dermo has given me had just caused it to irritate and flake way more than it previously has. Didn't know if you guys can recommend anything? I've booked an earlier appointment with the dermo to try and get something

Any help would be appreciated

Are we the psoriasis patient expecting to much from our treatments? how soon do we expect them to work, how long do we expect them to work, etc. This study evaluated psoriasis patients subjective future expectations regarding health-related quality of life (HRQOL) and life expectancy, and to explore clinical features associated with under- or overestimating behaviour.

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Background:
Unrealistic expectations regarding treatments and clinical outcomes may lead to disappointment about therapy and sub-optimal compliance; nonetheless, these expectations have not been studied in psoriasis patients yet.

Objective:
To evaluate psoriasis patients' subjective future expectations regarding health-related quality of life (HRQOL) and life expectancy, and to explore clinical features associated with under- or overestimating behaviour.

Methods:
A cross-sectional questionnaire survey of consecutive adult patients with moderate to severe psoriasis was conducted. HRQOL expectations were recorded by applying the EQ-5D descriptive system for 6 months ahead and for future ages of 60, 70, 80 and 90 respectively.

Results:
In total, 167 patients (71% males) were included in the analysis with mean age of 50.4 ± 12.4 years and mean EQ-5D score of 0.71 ± 0.30. Overall 65% had chronic plaque psoriasis, 35% nail psoriasis, 35% scalp involvement, 29% psoriatic arthritis, 9% inverse psoriasis and 5% palmoplantar psoriasis respectively (combinations occurred). Participants expected 0.1 ± 0.23 mean improvement in EQ-5D within 6 months (P < 0.001) that achieves the minimum clinically important difference. Overall 37% expected improvement and 13% decline; however, 49% expected no changes in any of the five dimensions of EQ-5D within 6 months. Female gender, inverse or palmoplantar involvement and more severe psoriasis were likely associated with higher expectations. Patients at the initiation of their first biological at the time of the survey expected 0.18 ± 0.24 increase that seems to be realistic compared to the EQ-5D utility gain achieved in randomized controlled trials. Males expected by 2.7 ± 11.1 more, while females expected by 5.2 ± 9.3 less life years compared to the average statistical gender- and age-matched life expectancy (P < 0.05). Patients who expected to be alive at ages of 60, 70, 80 and 90 scored their future EQ-5D at ages of 60 to 90: 0.59 ± 0.46, 0.48 ± 0.41, 0.42 ± 0.41 and 0.22 ± 0.47 respectively.

Conclusion:
Our findings highlight the importance of exploring expectations that might help to increase patients' compliance.

A new assessment called PSOCUBE has been proposed which may be employed by practising dermatologists to perform standardized assessment procedures on psoriatic patients raising the chances of early recognition of patients at risk for comorbidities.

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Background:
There is increasing awareness of the clinical relevance of psoriasis comorbidities and of the importance of timely and effective screening for such comorbidities in the management of psoriatic patients. Previous works have focused on assessing evidence for prevalence of comorbidities and on the best available evidence for sensitivity in diagnosing suspected comorbidities. No algorithms are available, which have been tested on large numbers of physicians concerning the acceptance of such algorithms both by practicing clinical dermatologists and by their consulting specialists from other fields.

Objective:
To propose a multidimensional assessment algorithm for psoriasis comorbidities which may prove at the same time enough sensitive and practically sustainable in daily clinical practice.

Methods:
After an exhaustive literature search, we performed a Delphi procedure involving 50 dedicated dermatological centres to obtain a standardized assessment algorithm, which would meet requirements of sustainability and acceptability both from the point of view of Evidence-Based Medicine as well as from the point of view of practical and clinical feasibility: to meet both requirements, results from the Delphi procedure were elaborated and modified by a restricted panel of experts.

Results:
The procedure has yielded PSOCUBE, a three-dimensional table comprising 14 clinical examination and history taking items, 32 screening laboratory and instrumental exams and 11 clinimetric scores.

Conclusion:
PSOCUBE, a simple algorithm, may be employed by practising dermatologists to perform standardized assessment procedures on psoriatic patients raising the chances of early recognition of patients at risk for comorbidities, thus fostering more effective prevention; PSOCUBE may therefore contribute to reduce the overall impact of this chronic, widespread disease.

This Egyptian cohort study set out to determine whether inter-ethnic differences exist in the genetic susceptibility to psoriasis, it genotyped single-nucleotide polymorphism variations in the vicinity of candidate genes in 132 Egyptian patients and 175 healthy controls.

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Background:
Psoriasis vulgaris is a common chronic inflammatory skin disease. Development of early onset psoriasis is, to some extent, genetically determined and a strong association with the major histocompatibility complex HLA-Cw6 has been demonstrated. The use of genome-wide association studies has highlighted novel genes associated with the development of psoriasis as IL12B, IL23R, TNFAIP3 and IL13 for instance. The majority of these studies were performed on cohorts of European descent.

Objective:
To determine whether inter-ethnic differences exist in the genetic susceptibility to psoriasis, we genotyped single-nucleotide polymorphism variations in the vicinity of candidate genes in 132 Egyptian patients and 175 healthy controls.

Methods:
Blood samples of patients and controls were screened for nucleotide polymorphisms in four candidate genes by TaqMan single-nucleotide polymorphisms Genotyping Assays.

Results:
We found a significant association between psoriasis and the single-nucleotide polymorphism rs610604, within the TNFAIP3 gene. The TNFAIP3 gene is involved in the TNF-α signalling cascade (P-value: 0.004952), a key step in the pathogenesis of psoriasis. Although there was no significant association found between rs610604 (IL12B) and rs11209026 (IL23R) in this population, the interaction of these two genes showed a significant association with psoriasis (P-value: 0.025). Moreover, when selecting the patients with early disease onset (less than 30 years), we also found that the association of IL12B and psoriasis was highly significant (P-value 1.14 × 10−12). No association between rs20541 (IL13) and psoriasis was observed in our Egyptian cohort.

Conclusion:
Replicating the association of single-nucleotide polymorphisms in the TNFAIP3, IL12B and IL23R genes with psoriasis vulgaris, in subjects from different ethnic backgrounds, underlines their importance in the pathogenesis of the disease. In contrast, the lack of any association between rs20541 (IL13) and psoriasis in our Egyptian cohort suggests the existence of important inter-ethnic genetic differences in psoriasis susceptibility.

Hi everyone, I am Ando Urukwe 37 years old from Nigeria Africa. I have psoriasis for 4 years running. Initially, I thought it was sort a spiritual attack not until the patches spread all over my body. My skin is dilapidated..Contacted a dermatologist, he said no cure that is a rare skin condition in the tropic...mostly common in the developed world. He recommended some cream for me..Nothing work. Went to another skin clinic in Zaria Nigeria, clinic was established in 1920 ...try no improvement. Try dieting...cut nightshade, sugar, alcohol, ..less improvement...now iam using coconut oil.the skin is getting darker but the flaring and small scaling is still there. Notice this days that I need to shower at least 3 times a day and rob coconut oil to have small relive . It's frustrating sometimes. I'm tired. Any assistance in the forum is heartily well..My question is has any one cure of Psoriasis?

If you have been following the development of ASP015K which we first reported here in 2012 Janssen & Astellas to develop ASP015K (JAK) inhibitor you may be interested in these phase 2a results that show ASP015K has demonstrated dose-dependent improvements in clinical and histological measures of severity over 6 weeks of treatment. And t all doses, ASP015K was well tolerated, with no reported serious adverse events (AEs).

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Background:
Many immune-mediated disorders, including psoriasis, involve cytokine signalling via Janus kinase (JAK) enzymes. ASP015K (also designated JNJ-54781532), a novel oral JAK inhibitor, has shown moderate selectivity for JAK3 over JAK1 and JAK2 in enzyme assays.

Objectives:
The objective of this study was to evaluate the efficacy and safety of escalating, sequentially grouped, doses of ASP015K vs. placebo in patients with moderate-to-severe psoriasis.

Methods:
This phase 2a multicentre, double-blind, randomized, placebo-controlled study (NCT01096862) enrolled 124 patients with moderate-to-severe plaque psoriasis. Five sequential ASP015K cohorts were enrolled, consisting of four twice-daily dosing groups (10, 25, 60, 100 mg) and one once-daily dosing group (50 mg) for 6 weeks.

Results:
The primary efficacy end point [mean change in Psoriasis Area and Severity Index score from baseline to end of treatment (EOT; day 42)] significantly favoured ASP015K (overall treatment effect; P < 0·001) vs. placebo, with greater improvements at higher doses. By EOT, the secondary end points [Physician Static Global Assessment (PSGA) score, percentage of patients achieving PSGA success, and change in percentage, body surface area (BSA)] also improved with ASP015K vs. placebo (P < 0·001 for PSGA score and BSA; P < 0·01 for PSGA success). Epidermal thickness and proliferation decreased from baseline with ASP015K vs. placebo. ASP015K was generally well tolerated, with no serious adverse events (AEs) reported.

Conclusions:
In patients with moderate-to-severe psoriasis, ASP015K demonstrated dose-dependent improvements in clinical and histological measures of severity over 6 weeks of treatment. At all doses, ASP015K was well tolerated, with no reported serious AEs.

This is another one of the those systematic review and meta-analysis articles that looked into prevalence of undiagnosed psoriatic arthritis (PsA) among psoriasis patients, it concluded that there is a high prevalence of undiagnosed PsA in patients with psoriasis and recommended that dermatologists need to screen all patients with psoriasis for PsA.

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Background:
Skin psoriasis precedes the onset of psoriatic arthritis (PsA) in 84% of patients with psoriasis. Dermatologists have an important role to screen psoriasis patients for PsA. The efficiency of PsA screening remains unknown.

Objective:
We sought to determine the point prevalence of undiagnosed PsA in patients with psoriasis using a systematic search of the literature and meta-analysis.

Methods:
pub med, Cochrane, and Embase database searches yielded 394 studies for review. No study aimed to determine the prevalence of undiagnosed PsA in patients with psoriasis. We assumed that the prevalence of newly diagnosed PsA in patients with psoriasis at the time they seek medical care could be a sound estimate of this value. Seven epidemiological studies and 5 studies on PsA screening questionnaires allowed us to clearly identify patients with newly diagnosed PsA and were selected for review.

Results:
The prevalence of undiagnosed PsA was 15.5% when all studies were considered and 10.1% when only epidemiological studies were considered.

Limitations:
Data were obtained from studies not designed to address the question at hand. Heterogeneity was high (I2 = 96.86%), and therefore a random effects model was used.

Conclusion:
The high prevalence of undiagnosed PsA in patients with psoriasis adds to the recommendation that dermatologists need to screen all patients with psoriasis for PsA.

This Friday, the 18th, i am going to see the dermatologist for the first time in 42 years. I wonder if you could tell me what types , of creams or ointments most of the members, use . As i have said in previous posts, i only have it mildly, even though it's on different parts of my body.
I would prefer, i think to have a go taking tablets instead of everyday applying different creams. I have had the most success with Dovobet, but it's supposed not to use it for long periods, even though i have used it for years, without the doctor ever telling me to come of it.

The last time i saw the docs and asked to try a different ointment he put me on Dovonex, well first of all i didn't think it was doing any good, but secondly it says not to be in contact with the sun, when using it.Well with me spending six months of the year in Tenerife it was impossible not to be in the sun. So i am trying to ask for your advise as to when i see the Dermatologist what ointment you think that most of the members have the greatest success with, or the tablets. As i would like to tell him, what i would like to use with the suggestions of the Moderators. Thank you.

Good Afternoon All,

I stumbled on the site this morning while searching comments on hemp oil.  Just spent the last 2 hours reading all the posts here.  Thank you for taking my mind off the current condition of my skin!  I have plaque psoriasis and use clobetasol ointment for treatment.  I decided to give it a break recently as it was not working effectively.  Bad idea.  Tired of being sticky all the time; tired of my bed looking like a snow globe blew up in it; sorry my wife wakes up every morning with dandruff (she doesn't have dandruff).  It was 100+ degrees outside the other day and this guy (me) was the only one at a pool party fully dressed and sweating my ass off.  Shorts and short sleeves are out of the question, exposing my skin in public is out of the question.  I keep my hands hidden and instead of a handshake, most people get a elbow bump upon introduction.   I know there is no cure, just trying to gain some control!  I appreciate all the posts, hopefully I will find something close to a remedy here. -Joe

This large retrospective cohort study included 205 820 health plan enrollees in Israel, and set out to assess the relationship between adherence to statins and the risk of psoriasis.

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Background:
Statins have been shown to downregulate immune mechanisms activated in psoriasis. However, previous studies on their potential role in preventing psoriasis have yielded conflicting results.

Objectives:
To assess the relationship between adherence to statins and the risk of psoriasis.

Methods:
This retrospective cohort study included 205 820 health plan enrollees in Israel (mean age 55 years; 54·1% women) who initiated statin treatment from January 1998 through to September 2009. Adherence to statins, measured by the proportion of days covered (PDC), throughout the entire follow-up period (mean 6·2 years) was recorded. Diagnosis codes of psoriasis were assigned by a dermatologist or rheumatologist, or at discharge from hospital.

Results:
During 1·28 million person-years (PY) of follow-up (median 5·74 years per person; interquartile range 3·78–8·36), 5615 cases of psoriasis (incidence density rate 4·4 per 1000 PY) were recorded. Compared with patients who did not adhere to statins (PDC < 20%), patients covered by statins for 40–59% of the time had a significantly lower risk of psoriasis (P < 0·05), with hazard ratios (HRs) of 0·84 and 0·74 among men and women, respectively. Among patients who adhered better to statins (PDC ≥ 80%), HRs were 0·88 (95% CI 0·79–0·98) and 1·00 (95% CI 0·90–1·11) among men and women, respectively.

Conclusions:
The results of the current study suggest that high and long-term adherence to statins is not associated with a meaningful reduction in the risk of developing psoriasis.

Good news for palmoplantar psoriasis patients as Novartis announce results of two trials that showed superior efficacy compared to placebo in patients with psoriasis of the palms, soles and nails.

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Novartis announced today that Cosentyx® (secukinumab) met the primary endpoints in two new clinical studies, showing superior efficacy compared to placebo in patients with psoriasis of the palms, soles and nails, all difficult-to-treat locations of plaque psoriasis. Detailed findings were presented for the first time at the 23rd World Congress of Dermatology (WCD) in Vancouver, Canada.

In the GESTURE study in patients with moderate-to-severe palmoplantar psoriasis, Cosentyx (300 mg) was superior to placebo at Week 16 in achieving clear or almost clear palms and soles as assessed using the Palmoplantar Investigator’s Global Assessment (33.3% vs. 1.5%; P<0.0001) Similarly, in the TRANSFIGURE study in patients with significant nail psoriasis, Cosentyx (300 mg) was superior to placebo at Week 16, as assessed by mean improvement (decrease) in the Nail Psoriasis Severity Index (NAPSI) compared to baseline (-45.3% vs -10.8%; P<0.0001) The safety profile of Cosentyx in both studies was comparable to previously reported Phase III clinical trials.

“These are the largest trials to prospectively compare an active therapy to placebo in patients with psoriasis affecting the palms, soles, and nails, an area where a high unmet need for an effective treatment still exists,” said Vasant Narasimhan, Global Head of Development, Novartis Pharmaceuticals. “These results add to the growing body of evidence that Cosentyx is setting a new standard of care for patients with even the most challenging types of psoriasis.”

Estimated to affect as many as 90% of all psoriasis patients at some point in their lifetime, psoriasis of the palms, soles and nails is extremely difficult to treat and often requires biologic treatment (a protein based medicine made from cells) to control. Patients with these locations of psoriasis endure significantly greater physical disabilities than those whose psoriasis is limited to other parts of the body. Patients may experience difficulty walking, more pronounced burning sensation and difficulty grasping and handling objects, skin soreness and difficulty participating in recreational activities, social and workplace interactions. Nail psoriasis is a significant predictor of psoriatic arthritis, an important comorbidity of psoriasis.

Cosentyx is the first and only interleukin-17A (IL-17A) inhibitor approved for the treatment of moderate-to-severe plaque psoriasis. It was approved in January 2015 in the United States and European Union, and is also approved in Australia, Canada, Chile, Japan, Singapore and Switzerland.

This matched cohort study looked into the risk of getting psoriatic arthritis (PsA) in psoriasis patients after physical trauma, it concluded that there is an increased risk of PsA among psoriasis patients exposed to physical trauma, particularly when trauma to bone and joints was recorded.

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Background:
Most incident cases of psoriatic arthritis (PsA) present among patients with pre-existing psoriasis, and because of the high absolute prevalence of PsA among psoriasis patients this group offers a unique opportunity for risk modification. Several environmental and genetic factors have been associated with PsA. Trauma has been found to be associated with PsA in case series and cross sectional studies. This observation has led to the idea of a “deep Koebner” phenomenon playing a role in PsA, mirroring the Koebner phenomenon in skin psoriasis. We have performed a population based cohort study to determine the risk of PsA following trauma in psoriasis patients.

Objectives:
To evaluate the risk of incident PsA among psoriasis patients exposed to physical trauma.

Methods:
We performed a matched cohort study within the Health Improvement Network (THIN) database among psoriasis patients with data available between 1995 and 2013. Patients exposed to trauma were randomly matched to up to five unexposed controls based on gender, age, and the date of entry into THIN. Trauma exposure was stratified into subgroups of joint, bone, nerve, and skin trauma. Cox proportional hazard models were used to calculate the hazard ratio of developing psoriatic arthritis among those exposed to physical trauma, and the full model included adjustment for age, gender, date of entry into THIN, duration of psoriasis, BMI, smoking, alcohol consumption and the number of visits to the general practitioner. Missing values for smoking, alcohol use, and BMI were imputed by a sequential regression method. For comparison an identical analysis was performed in the non-psoriasis THIN population to evaluate the risk of developing rheumatoid arthritis (RA) following physical trauma.

Results:
Psoriasis patients exposed to trauma (N=15,416) and unexposed controls (N=55,230) were identified and followed for a total of 425,120 person-years (py) during which 1,010 incident PsA cases were recorded. The incidence rate of PsA among unexposed psoriasis patients was 22 (95% CI 21 to 24) per 10,000 py and 30 (95% CI 26 to 34) per 10,000 py in the exposed group. The results of the fully adjusted cox model analysis showed that psoriasis patients exposed to trauma had an increased risk of PsA compared to controls, with a hazard ratio (HR) of 1.32 (95% CI 1.13 to 1.54). In our subset analysis, bone and joint traumas were associated with multivariate HRs of 1.46 (95% CI 1.04 to 2.04), and 1.50 (95% CI 1.19 to 1.90), respectively, while nerve trauma and skin trauma were not associated with a statistically significant difference in risk compared to controls. Patients without psoriasis exposed to trauma did not have an increased multivariate adjusted risk of developing RA: HR 1.04 (95% CI 0.99 to 1.10) based on an analysis of 551,723 exposed individuals and 2,672,836 unexposed individuals followed for 19,479,771 py.

Conclusions:
We found an increased risk of PsA among psoriasis patients exposed to physical trauma, particularly when trauma to bone and joints was recorded.

Following on from Lilly's Ixekizumab phase 3 report, Lilly have now published results from the UNCOVER-2 and UNCOVER-3 clinical studies of more than 2,500 psoriasis patients, and the trials look very encouraging.

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Eli Lilly and Company announced today that detailed results of two pivotal Phase III studies for ixekizumab were published by The Lancet. The UNCOVER-2 and UNCOVER-3 clinical studies of more than 2,500 patients found ixekizumab to be statistically superior to etanercept and placebo on all measures of skin clearance. Patients treated with ixekizumab also demonstrated significant and meaningful improvements in health-related quality-of-life measures. Ixekizumab is the company's investigational medicine for the treatment of moderate-to-severe plaque psoriasis.

"These studies show ixekizumab - at two different dosing regimens - performed significantly better than etanercept or placebo, inducing a rapid and high level of psoriasis plaque resolution for patients with moderate-to-severe disease," said Christopher Griffiths, M.D., FRCP, professor of dermatology at The University of Manchester, U.K. and primary study investigator. "Importantly, these clinical results were accompanied by significant improvements to patient quality of life, and were achieved with a safety profile comparable to etanercept in these studies."

In each study, co-primary efficacy objectives assessed whether ixekizumab administered once every two weeks or once every four weeks was superior to etanercept and placebo after twelve weeks, as measured by a Psoriasis Area and Severity Index reduction of at least 75 percent (PASI 75) and a Static Physician Global Assessment score of clear or minimal (sPGA 0/1).

PASI is a measure used by healthcare professionals to determine the severity of psoriasis, including redness, thickness, scaling and the extent of psoriasis coverage. A PASI 75 score signals at least a 75 percent reduction in a patient's psoriasis from their baseline assessment. The sPGA is the physician's assessment of severity of a patient's psoriasis lesions overall at a specific point in time.

"The results of UNCOVER-2 and UNCOVER-3 provide a strong reason to believe that, if approved,  ixekizumab may help patients treat their moderate-to-severe psoriasis quickly and effectively," said Brian J. Nickoloff, M.D., Ph.D., senior medical fellow, Lilly Bio-Medicines. "We saw clinically-meaningful improvements in skin clearance as early as week one of treatment with ixekizumab, and with approximately 40 percent of patients achieving complete skin clearance at 12 weeks, we're hopeful clear skin may be attainable for more people living with this hard-to-treat disease."

Rapid Onset of Efficacy; High Levels of Skin Clearance
In both studies and at both dosing regimens, ixekizumab achieved superiority to etanercept and placebo for PASI 75 at week 12, with statistically significant differences seen as early as the first week of the studies. Approximately 50 percent of all ixekizumab-treated patients achieved PASI 75 by week four.

Patients treated with ixekizumab also achieved higher rates of skin clearance as measured by PASI 90 and PASI 100 compared with etanercept and placebo. PASI 90 reflects at least a 90 percent reduction in psoriasis symptoms, while PASI 100 is the highest possible reduction, representing complete skin clearance. Patients treated with ixekizumab were five to seven times more likely to achieve a PASI 100 score than with etanercept. At the end of the 12-week study period, patients achieved PASI 90 and PASI 100 at the following rates:

Patients receiving ixekizumab every two weeks: 71 percent in UNCOVER-2 and 68 percent in UNCOVER-3 achieved PASI 90; 41 percent in UNCOVER-2 and 38 percent in UNCOVER-3 achieved PASI 100;
Patients receiving ixekizumab every four weeks: 60 percent in UNCOVER-2 and 65 percent in UNCOVER-3 achieved PASI 90; 31 percent in UNCOVER-2 and 35 percent in UNCOVER-3 achieved PASI 100;
Patients receiving etanercept: 19 percent in UNCOVER-2 and 26 percent in UNCOVER-3 achieved PASI 90; 5 percent in UNCOVER-2 and 7 percent in UNCOVER-3 achieved PASI 100.

Quality-of-Life Measures Significantly Improved
Clinical improvements in ixekizumab-treated patients were accompanied by rapid improvements in health-related quality-of-life measures. Nearly 60 percent of ixekizumab-treated patients reported that their psoriasis had no impact on their quality of life by week 12 as measured by the Dermatology Life Quality Index (DLQI). The DLQI is a standardized tool that evaluates how psoriasis affects various aspects of a person's quality of life, including itching, ability to conduct daily activities, and relationships and intimacy.

In a separate, pre-specified analysis evaluating patients that had achieved PASI 100, 78 percent in UNCOVER-2 and 85 percent in UNCOVER-3 reported the disease had no impact to their quality of life as measured by the DLQI.

"Psoriasis is more than just a condition that affects the skin; it affects a person's relationships with friends and families, their day-to-day activities and, in many cases, other aspects of their health," said Aarti Shah, Ph.D., global brand development leader, Lilly Bio-Medicines. "Based on these study results, we believe ixekizumab, if approved, could offer those with moderate-to-severe psoriasis a treatment choice that may improve both the physical and emotional challenges of psoriasis."

Adverse Events
The overall rates and severities of adverse events observed were comparable to those for etanercept in the two active comparator trials. Most Treatment-Emergent Adverse Events (AEs) were mild or moderate in severity. The most common (≥2 percent) Treatment-Emergent AEs in ixekizumab-treated patients were upper respiratory tract infections, injection site reactions, itching, headache and arthralgia. Serious Adverse Events (SAEs) were reported by < 2 percent of patients, and there were no deaths in either study. Rates of SAEs and discontinuations due to AEs were comparable across treatment groups.

About UNCOVER-2 and UNCOVER-3
UNCOVER-2 and UNCOVER-3 are double-blind, multicenter, Phase III studies evaluating more than 2,500 patients with moderate-to-severe psoriasis in 18 countries. In these comparator studies, patients were assigned to receive either placebo, etanercept (50 mg twice a week) or ixekizumab (80 mg every two or four weeks) for 12 weeks, following a 160 mg starting dose. Patients enrolled in the UNCOVER-2 and 3 studies had a confirmed diagnosis of chronic plaque psoriasis for at least six months prior to randomization. Additionally, at screening and at randomization, they demonstrated at least 10 percent Body Surface Area (BSA) of psoriasis, an sPGA score of at least 3 and PASI score of at least 12.

Following on from the bad news for Otezla (apremilast) Germany says Otezla gives no benefit to psoriasis patients today Celgene looks like taking another knock in the UK.

NICE (National Institute for Heath and Care Excellence) look set to say no to Otezla for England and Wales, (Scotland will be getting it however) it looks set to get rejected for use in England and Wales after not meeting cost effectiveness.

Don't ask me why Scotland gets preferential treatment, as far as I know it's a political thing.

*This report is made up from various pieces of information that have been passed on to me, I've not been able to find any official announcement as yet but it looks very likely this is going to happen.

Another new treatment goes into phase 1 for the treatment of psoriasis, this one is from Prothena a late stage clinical biotechnology company and the treatment is PRX003 a monoclonal antibody for the potential treatment of psoriasis and other inflammatory diseases.

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Prothena Corporation plc, a late-stage clinical biotechnology company focused on the discovery, development and commercialization of novel protein immunotherapy programs, today announced the successful first human dosing in a Phase 1 clinical trial of its proprietary protein immunotherapy, PRX003. PRX003 is a monoclonal antibody targeting melanoma cell adhesion molecule (MCAM) for the potential treatment of psoriasis and other inflammatory diseases.

"PRX003, our third program to advance into clinical development, further demonstrates our commitment to develop a robust pipeline of protein immunotherapies that have the potential to transform patients' lives," said Gene Kinney, PhD, Chief Scientific Officer and Head of Research and Development for Prothena. "MCAM allows disease-causing immune cells to migrate into the surrounding tissues to initiate and/or maintain a pathogenic process and we believe that blocking this process holds tremendous promise for the treatment of inflammatory diseases. We look forward to assessing the safety and tolerability of PRX003 in subjects through this Phase 1 single ascending dose study and also expect to initiate a multiple ascending dose study in patients with psoriasis in 2016."

The Phase 1 clinical trial is a randomized, double-blind, placebo-controlled, single ascending dose study designed to assess the safety, tolerability, pharmacokinetics and immunogenicity of PRX003. Prothena plans to enroll up to 40 subjects in the U.S.

About PRX003:
PRX003 is a monoclonal antibody for the potential treatment of psoriasis and other inflammatory diseases. Within the immune system, Th-17 white blood cells initiate the body's response to infections, and are known to be a key participant in both normal inflammatory reactions and autoimmune diseases. MCAM is expressed on the surface of Th-17 cells, and allows certain cells traveling in the blood stream to leave the circulation and enter tissues, primarily to initiate or continue a disease process. PRX003 is designed to block MCAM and not allow the migration of these pathogenic cells into tissues. PRX003 may be useful for treating a variety of inflammatory diseases such as psoriasis, psoriatic arthritis, rheumatoid arthritis, multiple sclerosis, sarcoidosis, uveitis, vasculitis, and Behcet's disease.

About Prothena:
Prothena Corporation plc is a late-stage clinical biotechnology company focused on the discovery, development and commercialization of novel protein immunotherapy programs for the potential treatment of diseases that involve amyloid or cell adhesion. The company is developing antibody-based product candidates that target a number of potential indications including AL amyloidosis (NEOD001), Parkinson's disease and other related synucleinopathies (PRX002), and psoriasis and other inflammatory diseases (PRX003).

Psoriasis trial drug halted due to suicide concerns



According to a statement released last week, one of the makers of brodalumab, a biologic drug currently being tested as a treatment for psoriasis and psoriatic arthritis, will no longer participate in developing the drug. Amgen, which, along with the company AstraZeneca, had been developing brodalumab, has stopped developing the drug based on reports of suicidal thoughts and behavior during clinical trials for the drug, the company stated in a press release.

AstraZeneca is still considering whether to continue with the drug development, according to a statement released by AstraZeneca last week.Brodalumab targets the receptor of a cytokine, or inflammatory protein, involved in psoriasis known as interleukin-17 (IL-17).

Brodalumab is still in the testing phase, and is not available to patients outside of clinical trials.

It differs from Cosentyx (secukinumab), a drug recently approved by the Food and Drug Administration (FDA). While brodalumab targets the receptor of IL-17, Cosentyx targets the inflammatory protein itself, IL-17A. Ixekizumab, which is being developed by Eli Lilly, also targets IL-17A and still is in clinical trials and not available to patients.

So far, there have been few reports of serious side effects from Cosentyx. The most commonly reported side effects are upper respiratory tract infections, the common cold and diarrhea.
“There does not appear to be any concern over suicidal behavior in patients receiving either secukinumab or ixekizumab, two other drugs that also block IL-17A function,” said Dr. Andrew Blauvelt,  a dermatologist and president and investigator at Oregon Medical Research Center, a clinical research center.
Regarding brodalumab, Blauvelt also said that he “did not see any documentation from the trials that the rate of suicidal behavior was higher than expected in the general population.” However, he said, the FDA had asked Amgen to monitor all patients on brodalumab for suicidal behavior.