This is an early view of a 10 patients study in the use of combination psoriasis treatments Cyclosporine and anti-TNF α.

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Combination therapy has become important in treating psoriasis, using synergism between different mechanisms to maximize efficacy and minimize toxicity. Little has been published on the combination of cyclosporine and anti-tumor necrosis factor (TNF) α agents.

In this study, a retrospective chart review was made of the effects of this combination therapy in 10 patients with recalcitrant psoriasis.

Treatment included a conditioning phase with cyclosporine, 3.14 ± 0.37 mg/kg for 4.6 ± 2 weeks, and a combination phase during which etanercept/adalimumab were initiated and cyclosporine was tapered over 10.2 ± 3.7 weeks.

Treatment success, evaluated after each phase, was classified as complete recovery (CR, more than 75% improvement), partial response (PR, 25–75% improvement), and no response (NR, less than 25% improvement). All patients reached CR at the end of the combination therapy. Two were still on combination therapy after 12 and 20 weeks. Adverse event occurred in three cases, all in the conditioning phase.

We conclude that combination therapy with cyclosporine and anti-TNF α appears to offer an effective and safe approach to treatment of psoriasis.

This study looked at the cost efficacy of systemic psoriasis treatments approved for use by the US Food and Drug Administration (FDA).

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Background:
Newer psoriasis treatments tout higher efficacy but are generally more expensive.

Objective:
We sought to estimate the cost efficacy of systemic psoriasis treatments that have been approved by the US Food and Drug Administration (FDA).

Methods:
A literature review of systemic psoriasis treatments that have been approved by the FDA was performed for the primary end point of a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75). Medication cost was referenced by wholesale acquisition cost (WAC), laboratory fees were obtained from the American Medical Association, and office visit fees are standard at our university. Total expenses were standardized by calculating cost per month of treatment considering the number needed to treat (NNT) to achieve PASI 75.

Results:
Methotrexate ($794.05-1502.51) and cyclosporine ($1410.14-1843.55) had the lowest monthly costs per NNT to achieve PASI 75. The most costly therapies were infliximab ($8704.68-15,235.52) and ustekinumab 90 mg ($12,505.26-14,256.75). Monthly costs per NNT to achieve PASI 75 for other therapies were as follows: narrowband ultraviolet B light phototherapy ($2924.73), adalimumab ($3974.61-7678.78), acitretin ($4137.71-14,148.53), ustekinumab 45 mg ($7177.89-7263.99), psoralen plus ultraviolet A light phototherapy ($7499.46-8834.98), and etanercept ($8284.71-10,674.89).

Limitations:
Drug rebates and incentives, potential adverse effects, comorbidity risk reduction, ambassador programs, and combination therapies were excluded.

Conclusion:
Our study provides meaningful cost efficacy data that may influence psoriasis treatment selection.

Hi everyone, newbie to the board. Im 31 had psoriasis since age 10 recently dx with ms...clearly this complicates things. My neurologist wants me to start tecfidera, im from US btw. I an hoping it will help my p. I have googled and googled and cant find anything. I called biogen and asked them if tecfidera has helped pts with p and they said no studies have shown that. In any event i am starting and hopeful the main ingredient dmf will help my p as well as ms. What is the clearing like. From what i understand it takes a while? Thoughts and comments woyld be appreciated thank you so much. Also, could you be on another drug like stelara and tecfidera? Jw with incidence of pml.

Lot's of Biosimilars coming through lately for well known psoriasis treatments, and today Samsung Bioepis announced that their Enbrel (etanercept) biosimilar candidate, SB4 has been validated and accepted for review by European Medicines Agency (EMA)

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Samsung Bioepis Co., Ltd., today announced that the Marketing Authorization Application (MAA) for its Enbrel (etanercept) biosimilar candidate, SB4 has been validated and accepted for review by European Medicines Agency (EMA). The acceptance of the MAA marks the first Enbrel biosimilar to advance into regulatory review in the European Union (EU). The MAA is based on results from a Phase III clinical trial in patients with moderate-to-severe rheumatoid arthritis (RA).

In Europe, Enbrel is indicated for the treatment of a number of rheumatic diseases, including moderate to severe RA, certain forms of juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis and plaque psoriasis. If authorized by the EMA, SB4 could be available for use in all of the same indications as Enbrel.

"This MAA validation represents a significant milestone for Samsung Bioepis in our work to develop and manufacture world-class biosimilars. More significantly, it offers an opportunity to provide high-quality and effective therapies for broadening access to patients in Europe" said Christopher Hansung Ko, chief executive officer of Samsung Bioepis.

If authorized by the EMA, SB4 will be commercialized in Europe by Biogen Idec. It will also be produced at the company’s manufacturing facility in Hillerød, Denmark which is one of the largest biologic manufacturing facilities in the world.

In addition to the European filings, Samsung Bioepis intends to move forward with additional applications for regulatory approvals in other territories worldwide.

About the SB4
Samsung Bioepis previously conducted SB4 Phase 1 and Phase 3 clinical studies. The MAA for the etanercept biosimilar was based on data from a Phase 3, controlled, randomized, multicenter study in Europe where SB4 demonstrated its comparability to Enbrel®. The primary and secondary endpoints of the study were assessed and met the qualification standard for the MAA submission. Full data from the study will be available later this year.

Hi all, just joined the forum! Have been reading some of the posts and just have a question I hope ye can help me with. Just started fumaderm this month. My dermatologist has only given me a one month prescription and has then requested for me to see him again one month in. Can anyone tell me if I need to see him every month for a check up and my prescription or will I eventually get to start seeing him less?? Thanks

Who's the better judge to know how a psoriatic patient is feeling? Is it the patient or the physician? This study set out to try and work it out. What do you think, do you know better than your physician? (I know I do I have the bloody psoriatic arthritis they don't.)

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Objective:
To assess the extent and determinants of discordance in scoring between patient global assessment (PtGA) and physician global assessment (PhGA) in patients with psoriatic arthritis (PsA).

Methods:
A cross-sectional and longitudinal analysis of data was conducted in patients attending a large PsA clinic. The difference between PtGA and PhGA (each measured on a scale of 0–10, with 0 indicating best status and 10 indicating worst status) reflected the discrepancy between the PtGA and PhGA of joint and skin activity and could take values from −10 (higher rating of disease activity by the patient) to 10 (higher rating of disease activity by the physician). Multivariate regression identified variables that contributed significantly to each of the outcomes. The proportion of variability of each outcome explained by each predictor was expressed by the partial R2.

Results:
A total of 565 patients were included in the analysis. Patients tended to score their disease worse than their physicians, with greater discordance for the joints than for the skin (mean ± SD 1.68 ± 2.41 PtGA–PhGA difference for joints, and 0.77 ± 2.66 for skin). Fatigue accounted for 21% of the variation in the difference between PtGA and PhGA for joints. Pain (inline image = 9%) and disability by Short Form 36 health survey (inline image = 1.2%) were also important factors, each of which led to higher patient rating; whereas increased tender joint count (inline image = 16%) and swollen joint count (inline image = 1.4%) resulted in a higher physician rating of arthritis.

Conclusion:
Fatigue, pain, disability, and tender and swollen joint counts were the most important factors contributing to discrepancy between patient and physician assessment of joint activity.

I'm always saying a positive attitude is a huge benefit to those of us with psoriasis (struggling myself at the moment, but that's another story) and I found this small study interesting in that it suggests *Type D personality is higher in patients with moderate to severe psoriasis as compared to healthy volunteers.

*Individuals with a Type D personality have the tendency to experience increased negative emotions across time and situations and tend not to share these emotions with others, because of fear of rejection or disapproval.

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Background:
Psoriasis may imply a remarkable psychological impairment, which can influence patient's personality. The Type D personality is defined by the combination of social inhibition and negative affectivity. Furthermore, Type D personality has been associated with impaired health-related quality of life (HRQOL) and increased cardiovascular risk, both facts being associated with moderate to severe psoriasis.

Objectives:
To explore the prevalence of Type D personality in moderate to severe psoriasis patients; To analyse the relationship between Type D personality and the most common physical and psychological comorbidities in moderate to severe psoriasis and To explore the impact of Type D personality on HRQOL.

Methods:
A prospective comparative study matched to age and sex. Eighty patients with moderate to severe psoriasis and 80 healthy volunteers were included in the study. The participants completed the DS14 test, the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, the SF-36 and the Psoriasis Disability Index.

Results:
The prevalence of Type D personality was higher in patients with moderate to severe psoriasis as compared to healthy volunteers: 38.7% vs. 23.7%, P < 0.001. Psoriasis patients with Type D personality had a 3.2-fold risk of anxiety when compared to patients without Type D personality; odds ratio 3.2 (1.3–8.83 P = 0.01). Type D personality was significantly associated with an impaired general, sexual and psoriasis-related HRQOL (P < 0.01).

Conclusion:
Because Type D personality could represent a frequent type of personality among individuals with moderate to severe psoriasis, it could serve as a ‘marker’ of more psychologically vulnerable patients, probably related to dysfunctional coping strategies. The Type D personality could represent a profile more frequently encountered among patients with psoriasis, and might therefore help identify subjects physiologically more vulnerable to disease, most likely due to inadequate adaptation mechanisms.

Hi my name is lisa.
I am 32 years old and have suffered from plaque and guttate psoriasis since I was 16.
It had recently gotten very bad following an allergic reaction I had to washing powder. I was literally burning on the outside with a good 50% of my body being covered in what felt like sunburn. I was immediately sent to my dermatologist who advised the use of methotrexate tablets 10mg with folic acid weekly. I was a little hesitant at first as the list of symptoms was both long and fairly in depth. I did however after 3 months of pure misery decide to give it a go. I literally couldn't get dressed it had gotten that bad. Everything that I put on burned, diet didn't help, even the topical treatments I had been using for years to control it had failed. I couldn't bathe or shower, I didn't go out, I even stopped going to work. My children couldn't even hug me without me wincing in pain. It was horrific! So the tablets arrived and I started a low dose over a 10 week period gradually built up to 10mg strength. I can tell you all that this treatment has been a huge success. Within just 3 weeks I had noticed the itchy red raw patches were less itchy and not as painful, my skin resisted cracking and flaking as much. It's steadily gotten better and better and 12 weeks in it is gone from my scalp, arms and if faiding on my torso and legs. I am amazed. I am over the moon. My life has come back to me. I can only hope the healing continues in the coming months. Very few side affects. Dry mouth and preety constant headache but that's a very very small price to pay.........

Hello all. I am Michelle vuong. I have been suffering plaque sporisasis for about 6 years. About 6 months ago, I was at my doctor office waiting to see the doctor and scratching my knee cap at the same time. A health educator saw me and told me to use duct tape. I was like " realy", why not?? And 6 month later the 24 hour itchiness is practically gone, the skin is back to normal except there is a white patch where the plaque is used to be. So far the duct tape works for me. May be someone on this site might want to try it. Good luck.

Thunder,

There are no sigs that psoriasis could be viral.
However there are signs, that is research, that indicate that bacteria may be in involved.
There are also thoughts that psoriasis has to do with mitochondrial cells.

Caroline

Hi fellow itchers! Has anyone here tried secukinamub or been in the trials? They just approved it in the US today so i thought i'd ask before I call my derm.

This study looked into the role of vitamin D in psoriasis, it is an early view before publication in The International Journal of Dermatology.

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Background and objective:
Psoriasis is a common, chronic autoimmune inflammatory skin disorder, which has potential systemic complications and is clinically defined by sharply demarcated, erythematous patches and plaques covered by a characteristic silvery white scale. Topical corticosteroids have widely been regarded as the mainstay first line of treatment. Recently, topical vitamin D analogs have been added to the first-line treatment repertoire as well, either as monotherapy or in combination with topical steroids due to synergistic, complementary effectiveness. In this paper, we review the role of vitamin D in the pathophysiology and treatment of psoriasis.

Methods:
A comprehensive search of the Cochrane Library, MEDLINE, and pub med databases were performed to identify relevant basic science and clinical trial literature investigating the role of vitamin D in psoriasis. Primary endpoints in clinical trials were largely based on clinical improvement as assessed by the psoriasis area severity index score or physician's global assessment.

Results and conclusion:
The role of vitamin D in psoriasis is complex and extensive. Oral and topical vitamin D therapies provide comparable efficacies to corticosteroids when used as monotherapy and may be superior when used in combination with a potent topical steroid. Additionally topical vitamin D analogs demonstrate a favorable safety profile with “steroid-sparing” effects. Thus, topical vitamin D derivatives should be considered an indispensable component of the current physician's arsenal in the treatment of psoriasis.

US Food and Drug Administration (FDA) follow Japan and Europe and gives the go ahead for Cosentyx (secukinumab) to be used as a psoriasis treatment.

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Novartis today announced the US Food and Drug Administration (FDA) has approved Cosentyx™ (secukinumab) for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy (a drug that is absorbed into the bloodstream and distributed to all parts of the body) or phototherapy (light therapy). Cosentyx is the first approved psoriasis medication to selectively bind to IL-17A and inhibit interaction with the IL-17 receptor. The approval is based on the efficacy and safety outcomes from 10 Phase II and Phase III studies, including over 3,990 adult patients with moderate-to-severe plaque psoriasis, which demonstrated that Cosentyx resulted in clear or almost clear skin in the majority of patients and had an acceptable safety profile.

"The FDA's approval of Cosentyx signifies a turning point for psoriasis patients, who can now benefit from the first and only approved treatment targeting the IL-17 pathway, which is proven to play a key role in the development of plaque psoriasis," said David Epstein, Division Head, Novartis Pharmaceuticals. "This important milestone will now allow patients to receive a treatment that has the proven ability to offer clear or almost clear skin."

The FDA approval follows the unanimous vote by the FDA Advisory Committee in October 2014. Additionally, in January 2015, the European Commission (EC) approved Cosentyx as a first-line systemic treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy.

Affecting 7.5 million Americans and more than 125 million people worldwide, psoriasis is a chronic immune-mediated disease characterized by thick and extensive skin lesions (plaques), which can cause itching, scaling, and pain and may negatively impact daily life. Nearly 35% of psoriasis patients suffer from moderate-to-severe plaque psoriasis. Research shows IL-17A plays an important role in driving the body's immune response in disorders such as moderate-to-severe plaque psoriasis. Cosentyx selectively binds to IL-17A, inhibiting its activity.

The Phase III clinical program included four placebo-controlled studies which examined Cosentyx 300 mg and 150 mg in patients with moderate-to-severe plaque psoriasis. In these studies, Cosentyx met all primary and key secondary endpoints, including Psoriasis Area and Severity Index (PASI) 75 and 90 and Investigator's Global Assessment modified 2011 (IGA) 0/1 responses, showing significant skin clearance at Week 12. PASI measures the redness, scaling and thickness of psoriatic plaques, and the extent of involvement in each region of the body. Treatment efficacy is assessed by the reduction of the score from baseline (i.e. a 75% reduction is known as PASI 75 and a 90% reduction is known as PASI 90). PASI 90 is a higher standard of skin clearance compared to PASI 75.

Has anyone with psoriasis ever been told cats can have a very bad effect on your skin? I have never heard of such a thing from any dermatologist or physician. I was raised with cats and dogs.

Not an exiting piece of news as this study was funded by Amgen the makers of Enbrel (Etanercept) but it may be helpful to those who have failed on Remicade or Humira.

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Background:
There is a paucity of data on the use of etanercept in patients who have previously failed a different tumour necrosis factor (TNF) alpha antagonist.

Objectives:
To study etanercept in patients who did not achieve a satisfactory response to adalimumab or who lost their response to adalimumab or infliximab and to explore the role of anti-adalimumab and anti-infliximab antibodies in etanercept response.

Methods:
Patients with psoriasis who did not achieve a satisfactory response to adalimumab or who lost their response to adalimumab or infliximab were included. All patients received etanercept 50 mg twice a week for 12 weeks followed by 50 mg once a week for 12 more weeks. Anti-infliximab and anti-adalimumab antibodies were measured at baseline. The primary objective was to study the efficacy of etanercept using the proportion of patients who achieved a physician global assessment (PGA) of 0 or 1.

Results:
A total of 81 patients were included. The proportion of patients who achieved a PGA of 0 or 1 after 24 weeks of etanercept was 20.0% (95% CI 4.8–35.2%) for patients who had an unsatisfactory response to adalimumab, 35.1% (95% CI 19.0–51.3%) and 35.7% (95% CI 7.0–64.4%) for patients who lost their response to adalimumab and infliximab respectively. The proportion of patients who achieved a PGA of 0 or 1 at week 24 was numerically higher for patients who had anti-adalimumab or anti-infliximab antibodies (36.5%) as compared to those without (17.2%; P = 0.08).

Conclusions:
Etanercept can be effective in patients with psoriasis who failed a previous TNF alpha antagonist.

Is Fumaderm any good for psoriatic arthritis ?

Caroline mentions in her thread Dimethylfumarates and Psoriasis that it can have a positive effect and I know she has psoriatic arthritis, I also know Fumaderm is a DMF but that's about all I've been able to find and she is using Psorinovo.

I've been reading through some threads about Fumaderm and I may be missing it, but does anyone have experience of using Fumaderm for psoriatic arthritis. ?

Howdy folks!  Glad I found this site. I have to ask;  What is the most ridiculous comment/question your dermatologist said while you there for a P visit?
Years ago, at the end of my visit which took all of three minutes, my then dermatologist said; "whatever you do, don't scratch".  It still makes me laugh today.  

Hi everybody! Im not really crazy! Ive had psoriasis for 44 years ago. Ran the gamut of treatment. Just wanted to see what y'all do.

Hi,
I've been recently been diagnosed with psoriatic arthritis in december at the age of 18 and i've had psorasis since 13. It has all hit me like a train and my life was ground to a halt. After my family saw how down in the dumps i've been they suggested this site. Where everyone seems lovely and informative since it's hard to find such an abundance of people all suffering with the same. So, after snooping around as a guest i finally became a member!

Following on from the announcement that Cosentyx (secukinumab) had been approved for use in Japan as a treatment for psoriasis, Novartis announced today that they have now been given approvel for Europe too.

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Novartis announced today that the European Commission (EC) has approved Cosentyx™ (secukinumab, formerly known as AIN457) as a first-line systemic treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy.

Cosentyx (at a dose of 300 mg) is the first and only interleukin-17A (IL-17A) inhibitor to be approved in Europe and this approval marks a significant milestone in the treatment of psoriasis, providing a new and important first-line biologic treatment option for patients. Currently, all biologic treatments for psoriasis, including anti-tumor necrosis factor therapies (anti-TNFs) and Stelara® (ustekinumab) are recommended for second-line systemic therapy in Europe[2-4].

"With this groundbreaking news from the European Commission, clear skin may now be a reality for patients living with psoriasis," said David Epstein, Division Head, Novartis Pharmaceuticals. "Nearly half of psoriasis patients are not content with current therapies, including biologic treatments, showing a significant unmet need for patients. Cosentyx, with a first-line systemic indication for treatment of psoriasis will provide patients a better chance of achieving clear or almost clear skin."

The key treatment goal for psoriasis patients is achieving clear skin. In clinical studies, 70% or more Cosentyx 300 mg patients achieved clear skin (PASI 100) or almost clear skin (PASI 90), during the first 16 weeks of treatment and importantly, this was maintained with continued treatment in the majority of patients up to Week 52. Data from the Cosentyx clinical trial program also showed a significant positive relationship between achieving clear to almost clear skin and psoriasis patients' health-related quality of life.

The EU approval follows the recent results of the Phase IIIb CLEAR study, which showed that Cosentyx was superior to Stelara® in clearing skin of patients living with moderate-to-severe plaque psoriasis. The CLEAR study was the second head-to-head study for Cosentyx. Cosentyx also showed superiority to Enbrel® (etanercept) in clearing skin in the FIXTURE study. In the Phase III clinical program the overall safety profile of Cosentyx was favorable, with minimal differences seen between etanercept and ustekinumab in head-to-head comparison.

In addition to the EU, Cosentyx has been approved in Australia for the treatment of moderate-to-severe plaque psoriasis and in Japan for the treatment of moderate-to-severe plaque psoriasis and active psoriatic arthritis (PsA).

The US Food and Drug Administration (FDA) decision in moderate-to-severe plaque psoriasis is anticipated early in 2015 following the unanimous recommendation of approval in October 2014 from the Dermatologic and Ophthalmic Drugs Advisory Committee (DODAC) to the US FDA.