Netakimab in treatment of moderate to severe forms of psoriasis

The article presents an overview of published sources on etiology, pathogenesis and treatment of psoriasis, and described the treatment of moderate to severe psoriasis with new biologics netakimab.

IL-17 Pathway Members as Potential Biomarkers of Effective Systemic Treatment and Cardiovascular Disease in Patients with Moderate-to-Severe Psoriasis

Psoriasis is a chronic inflammatory condition associated with atherosclerotic cardiovascular disease (CVD). Systemic anti-psoriatic treatments mainly include methotrexate and biological therapies targeting TNF, IL-12/23 and IL-17A. We profiled plasma proteins from patients with moderate-to-severe psoriasis to explore potential biomarkers of effective systemic treatment and their relationship to CVD. We found that systemically well-treated patients (PASI < 3.0, n = 36) had lower circulating levels of IL-17 pathway proteins compared to untreated patients (PASI > 10, n = 23). Notably, IL-17C and PI3 were decreased with all four examined systemic treatment types. Furthermore, in patients without CVD, we observed strong correlations among IL-17C/PI3/PASI (r ≥ 0.82, p ≤ 1.5 × 10−12) pairs or between IL-17A/PASI (r = 0.72, p = 9.3 × 10−8). In patients with CVD, the IL-17A/PASI correlation was abolished (r = 0.2, p = 0.24) and the other correlations were decreased, e.g., IL-17C/PI3 (r = 0.61, p = 4.5 × 10−5). Patients with moderate-to-severe psoriasis and CVD had lower levels of IL-17A compared to those without CVD (normalized protein expression [NPX] 2.02 vs. 2.55, p = 0.013), and lower IL-17A levels (NPX < 2.3) were associated with higher incidence of CVD (OR = 24.5, p = 0.0028, 95% CI 2.1–1425.1). As a result, in patients with moderate-to-severe psoriasis, we propose circulating IL-17C and PI3 as potential biomarkers of effective systemic anti-psoriatic treatment, and IL-17A as potential marker of CVD.

CHARACTERISTICS OF PERIPHERAL NERVOUS SYSTEM IN PATIENTS WITH PSORIASIS

Psoriasis is a chronic non-infectious inflammatory dermatosis characterized by excessive proliferation of epithelial cells, impaired differentiation, often involving the musculoskeletal system. Materials and Methods. The authors examined 60 patients with psoriasis, 39 men and 21 women, aged from 21 to 69 (the average subject age was 46.3±13.94). All patients underwent a standard dermatological and neurological examination. Motor function was assessed according to knee jerk, elbow jerk and Achilles jerk. Pain sensitivity was established after pricking the thumb dorsum with a special blunt-end needle. Nonparametric methods were used for statistical analysis. The Mann-Whitney U-test was used to check the differences between independent groups of patients. The distribution of characteristic was assessed using a probability calculator. Differences were statistically significant at 95 % probability (p<0.05). Results. Mild psoriasis was found in 8 patients (13.3 %), moderate-to-severe psoriasis – in 14 patients (23 %) (PASI=11–30), severe psoriasis – in 38 patients (63.7 %) (PASI>30). Type I psoriasis was detected in 32 patients (53.2 %), type II – in 28 patients (46.8 %). Dysfunctions of the peripheral nervous system were found in 30 patients (50 %). In 12 subjects (20 %) symmetrical sensory and motor disturbances were observed in the distal parts of all four limbs. In 9 patients (15 %) symmetrical decrease in knee and Achilles jerks was observed. Symmetrical decrease in tactile and temperature sensitivity in the distal parts of the lower extremities was noted in 9 patients with psoriasis (15 %). Conclusion. Distal symmetric sensorimotor polyneuropathy is common in patients with psoriasis. Severe psoriasis is accompanied by distal symmetric sensorimotor polyneuropathy. Key words: psoriasis, comorbidity, demyelination, polyneuropathy. Псориаз – это хронический неинфекционный воспалительный дерматоз, характеризующийся избыточной пролиферацией эпителиоцитов, нарушением их дифференциации, нередко вовлекающий в процесс опорно-двигательный аппарат. Материалы и методы. Обследовано 60 больных псориазом, из них 39 мужчин и 21 женщина в возрасте от 21 до 69 лет (средний возраст обследуемых 46,3±13,94 года). Всем больным проводился стандартный дерматологический и неврологический осмотр. Двигательная функция исследовалась с помощью оценки коленного, локтевого и ахиллова рефлексов. Болевая чувствительность устанавливалась после укола тыльной поверхности большого пальца специальной иглой с притупленным концом. Для статистического анализа использовались непараметрические методы. Для проверки отличий между независимыми группами больных применялся Mann – Whitney U-test. Распределение признака оценивалось с помощью вероятностного калькулятора. Статистические значимыми считались отличия при уровне вероятности более 95 % (p<0,05). Результаты. Легкая степень псориаза установлена у 8 (13,3 %) больных, умеренно тяжелый псориаз – у 14 (23 %) пациентов (индекс PASI 11–30 баллов), тяжелая форма псориаза – у 38 (63,7 %) больных (индекс PASI более 30 баллов). Псориаз I типа определялся у 32 (53,2 %) больных, II типа – у 28 (46,8 %). У 30 (50 %) больных обнаружены нарушения функции периферической нервной системы. У 12 (20 %) чел. наблюдались симметричные сенсорные и двигательные нарушения в дистальных отделах всех четырех конечностей. У 9 (15 %) чел. отмечалось симметричное снижение коленного и ахиллова рефлексов. Девять (15 %) больных псориазом имели симметричное снижение тактильной и температурной чувствительности в дистальных отделах нижних конечностей. Выводы. У больных псориазом часто встречается дистальная симметричная сенсорно-моторная полинейропатия. Тяжелое течение псориаза сопровождается дистальной симметричной сенсорно-моторной полинейропатией. Ключевые слова: псориаз, коморбидность, демиелинизация, полинейропатия.

Total, longitudinal and transverse body sizes in men with psoriasis of different somatotypes

Using a constitutional approach to predict the onset of a disease can be key not only to solving the problem of late-stage lifestyle modification therapy but also to understanding the deep, seemingly incomprehensible links between organs and body structure. The aim of the study was to establish and analyze the differences in total, longitudinal and transverse body sizes between healthy and/or psoriatic men of different somatotypes depending on the severity of the disease. Anthropo-somatotypological examination was performed on Ukrainian men (aged 22 to 35 years) with psoriasis (n=100, including 32 with mild and 68 with severe). A clinical assessment of the severity and area of psoriatic lesions was performed using the PASI index. Anthropometric data of 82 practically healthy men of the same age group was taken from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya. Statistical processing of the obtained results was performed in the license package “Statistica 5.5” using non-parametric evaluation methods. In patients with mild and severe psoriasis, men of mesomorphic and endo-mesomorphic somatotypes in comparison with healthy men of the corresponding somatotypes, higher values of almost all total (in the endo-mesomorphs with severe disease), transverse (except for shoulder width) and lateral body size (except endo-mesomorphs with severe disease) was found. In patients with psoriasis, men of endo-mesomorphic somatotype with a mild course of the disease found greater than in patients with a similar course men of mesomorphic somatotype, body weight, length and surface area, height of acromial and finger anthropometric points, and transverse middle thoracic diameters and anteroposterior middle thoracic diameter; and in patients with psoriasis men of endo-mesomorphic somatotype with a severe course of the disease – only greater values than in patients with a similar course of the disease men of mesomorphic somatotype, interspinous distance. When comparing the total, longitudinal and transverse dimensions of the body between men with psoriasis of the corresponding somatotypes, in representatives of the mesomorphic somatotype with a mild course of the disease found greater than with severe course, body length values and lower – posterior middle thoracic diameter. The revealed differences in total, longitudinal and transverse body sizes between healthy and/or patients with mild or severe psoriasis Ukrainian men of mesomorphic and endo-mesomorphic somatotypes provide an opportunity to increase the effectiveness of the use of body structure and size to identify risk groups psoriasis.

Systemic Treatments for Adult Patients with Moderate-to-Severe Psoriasis: Consensus Statements for the United Arab Emirates

Background: Psoriasis is a chronic, immune-mediated disease characterized by mild localized plaques to severe plaques involving any part of the skin; it has a pronounced effect on patients’ quality of life. In the United Arab Emirates (UAE), there are limited local guidelines for the management of patients with psoriasis in daily clinical practice. Objectives: The study aimed to develop consensus statements for the evaluation and management of moderate-to-severe psoriasis in the UAE. Methods: To develop consensus statements, the Emirates Dermatology Society set up advisory board meetings in which local key opinion leaders (KOLs), including dermatologists from the UAE, participated. A targeted literature review was conducted to review current international and regional guidelines on the management of psoriasis, based on which the statements were formulated. A final consensus on each statement was reached based on collective agreement among the KOLs. Results : Consensus statements were generated with the intention of supporting physicians in clinical decision-making with respect to the classification of disease severity, treatment options including biologic and non-biologic systemic therapies, transitioning and adjusting of systemic therapies, and monitoring and management of psoriasis in special populations. Conclusion: These consensus statements could provide useful, practical guidance on the diagnosis and management of patients with moderate-to-severe psoriasis and would cater to the needs of physicians in the UAE.