Skyrizi vs Fumaderm for psoriasis

[Caroline]

So... the difference is the point where you act.
Biologicals suppress the cytokines áfter they have been produced by the body.
DMF prevents the cytokines to appear.

Okay so this part I understand. 

I guess there is still confusion and or disagreement within the medical community as to certain things with psoriasis.  The majority thinking that it is an auto immune disease if I understand correctly.  But  Dr. Schweckendieck has a different theory but as of right now it's a theory (based on his studies) right?  Not saying what is correct or incorrect, simply again getting it sorted in my non scientific brain.

But, unless I read it wrong doesn't this study show Skyrizi had better outcomes in their study over DMF?  With DMF you say the "cytokines are less produced and you can imagine that the overactiveness of the immune system slows down and the Psorasis disappears"  But if this study is to be believed, that wouldn't be true of everyone.  Or am I overthinking here?

I think from what I've read more on this forum (including a lot of your information!!) is that DMF works well for some and biologics works well for others.  I don't know if/when/how psoriasis forms but it seems that both are effective treatments just individually one may work better than the other (as in for each individual person).  That's my views on it, but I constantly remind you all that I don't know what I'm talking about 

Well I think you are absolutely right. Psoriasis is a very individual disease and everyone has an immune system of his own which are all different. Think of Covid, there are some that become very ill and others that hardly remark that they are ill. All the results of the difference in immune system.

So... there will be people for whom DMF will not work, as we are all different there are people for whom the mechanism of adding fumarates to the citric acid cycle, either has no result or does not succeed.
Identical this probably is so with Skirizi. The advantage of Skirizi is that you will reach the conclusion faster as it works much faster than the slow process of DMF.

And indeed there is a difference in thinking also. The majority thinks it is an auto-immune disease, but they cannot prove that, as the typical element of auto-immune diseases, anti-bodies, cannot be found.
Schweckendieck was working on psoriasis in the 1970-80 -ties, there were no biologicals then. He was also a chemist and must have been able to find out that there was pyruvic acid involved. By trying the antagonist, fumaric acid, he found out that this worked for Psoriasis. It is a logical way of thinking and perhaps half by accident he was able to solve his own psoriasis.
Of course I cannot exactly guess his thinking, but this is a reconstruction of the most logical line of thinking.
If you look into the fluid you can take out of the joints of someone with Psoriatic Arthritis, then you can find piruvic acid crystals. This immediately also explains the pain and reason for inflammation.