A Retrospective Study on the Effectiveness of Ixekizumab After Treatment With Secukinumab for Patients With Active Psoriatic Arthritis

Objectives: This study aims to evaluate clinical responses in patients with active psoriatic arthritis who, despite secukinumab 300 mg subcutaneous monthly, are switched to ixekizumab 80 mg subcutaneous every four weeks. Methods: We conducted a chart review of adult patients with psoriatic arthritis treated at one clinical center. We identified all patients with active inflammatory arthritis who were switched from secukinumab to ixekizumab. Baseline demographics such as disease duration, age, gender, number of previous DMARDs, and previous time on secukinumab were collected. We collected clinical outcome data such as tender and swollen joint count, enthesitis based on SPARCC score, dactylitis, psoriasis severity, CRP, and BASDAI if axial involvement was present. Results: Eight of 10 patients were included in the analysis. Most patients were female, average age 62 years old, and had been on secukinumab for an average of 79 weeks. Twelve weeks following switch to ixekizumab, 6/8 had improvement in tender joint count, 6/8 improved in swollen joint count, 2/2 had resolution of enthesitis, 4/4 had resolution of dactylitis, 5/6 had improvement in psoriasis severity, 1 patient had absolute improvement of 2.3 in BASDAI, and 7/8 had improvement in the CRP level. Conclusions: Patients with active psoriatic arthritis despite treatment with secukinumab may still have a clinical response following treatment with another anti-IL17 agent. Larger studies will be required to confirm this finding, and studies which emphasize dactylitis and enthesitis outcomes will be needed as most patients did not have activity in these domains.

The Impact of Hypertension, Diabetes, Lipid Disorders, Overweight/Obesity and Nicotine Dependence on Health-Related Quality of Life and Psoriasis Severity in Psoriatic Patients Receiving Systemic Conventional and Biological Treatment

Psoriasis, a chronic disease, is associated with a higher prevalence of comorbidities and has negative impact on health-related quality of life (HRQOL). The objective was to investigate the effect of comorbidities on HRQOL, and psoriasis severity measured appropriately by the dermatology life quality index (DLQI) and the psoriasis area severity index (PASI) before, and after a 3-month treatment and the median DLQI or PASI reduction from baseline in the adult psoriatic patients receiving various types of treatment. The study included 184 adult plaque psoriatic patients. DLQI and PASI scores were assessed in the studied patients before the therapy (a baseline visit) and after a 3-month treatment (a control visit) depending on the presence of comorbidities. Psoriatic patients with comorbidities had worse HRQOL and more severe skin lesions. The presence of comorbidities had a negative effect on the outcome of treatment with the use of conventional therapy. The outcome of therapy with biological agents was independent of each of the analyzed factors. Biological treatment had a high effectiveness on the psoriatic skin lesions improvement despite the presence of comorbidities, whereas methotrexate was effective even if the patients had co-existing hypertension. In psoriatic patients receiving systemic conventional treatment but not biological treatment, comorbidities had a negative impact on HRQOL and psoriasis severity.

Overall Prevalence and Prevalence Compared among Psoriasis Treatments of Onychomycosis in Patients with Nail Psoriasis and Fungal Involvement

Background. Whether nail psoriasis can increase the risk of onychomycosis is still being debated, and data relating to the prevalence of onychomycosis among psoriasis patients receiving different treatments is limited. Objectives. To investigate the overall prevalence and prevalence compared among psoriasis treatments of onychomycosis in patients with nail psoriasis and fungal involvement. Methods. A prospective study of three groups of nail psoriasis being treated with only topical medication, methotrexate, or biologics (25 patients per group, 150 nails) was conducted at Siriraj Hospital (Bangkok, Thailand) during November 2018 to September 2020. Demographic data, psoriasis severity, and nail psoriasis severity were recorded. The nail most severely affected with psoriasis on each hand was selected for mycological testing. Potassium hydroxide, periodic acid-Schiff stain, and fungal culture were performed. Results. The prevalence of onychomycosis in nail psoriasis was 35.3%. Among the treatment groups, the prevalence of onychomycosis was significantly higher in the methotrexate group than in the topical treatment and biologic treatment groups ( p = 0.014 ). Candida spp. was the main causative organism, followed by Trichophyton rubrum. Thumb was most commonly affected (59.3%). The most common abnormality of the nail matrix and the nail bed was pitted nail (71.3%) and onycholysis (91.3%), respectively. Multivariate analysis revealed diabetes, wet-work exposure, and methotrexate treatment to be predictors of onychomycosis. Conclusions. Several factors, including psoriasis treatment, were shown to increase the risk of onychomycosis in nail psoriasis. Further research is needed to determine whether biologic agents, especially interleukin-17 inhibitors, can increase risk of onychomycosis and Candida infection/colonization of the nails.

Evaluation of Psoriasis Area and Severity Index Thresholds as Proxies for Systemic Inflammation on an Individual Patient Level

<b><i>Background:</i></b> Psoriasis is a chronic and systemic inflammatory disease with a loss of up to 5 life years, which is thought to be reduced by biologic treatment. Disease severity and eligibility for systemic treatment are often based on the cutaneous psoriasis area and severity index (PASI) with a cut-off of 10 in several European countries. However, it is unclear how well this cut-off reflects systemic inflammation and, consequently, the risk for the development of comorbidity. <b><i>Objectives:</i></b> (1) To assess whether specific PASI thresholds, in particular PASI 10, predict elevated biomarkers of systemic inflammation and cardiovascular risk on an individual patient level. (2) To assess the association of PASI and psoriatic arthritis with biomarkers of systemic inflammation and cardiovascular risk. <b><i>Methods:</i></b> Retrospective cross-sectional study of 72 psoriasis patients without systemic treatment. <b><i>Results:</i></b> Overall, 68, 42, and 50% of patients had cardiovascular risk level neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, and elevated platelet-to-lymphocyte ratio (PLR) values, respectively. The respective positive predictive values of PASI 10 were 70, 45, and 70. The performance of the optimal PASI cut-offs according to the Youden index was similarly weak. Subgrouping of patients with a PASI below 10 did not result in a considerably improved reflection of systemic inflammation. PLR was significantly higher in patients with moderate-to-severe compared to mild psoriasis and significantly correlated with PASI in patients with a PASI above 2 (<i>r</i>_s = 0.266, <i>n</i> = 64). NLR was significantly higher in patients with psoriatic arthritis. <b><i>Conclusion:</i></b> Specific PASI thresholds were not well suited to predict elevated biomarkers of systemic inflammation and cardiovascular risk on an individual patient level. Therefore, PASI, and possibly other purely cutaneous measures, may not be ideal as stand-alone parameters to define disease severity and eligibility for systemic treatment. Our results are relevant for the ongoing discussion on the definition of psoriasis severity and eligibility for systemic treatment. Further research addressing the added value of a set of biomarkers of systemic inflammation in the assessment of psoriasis severity would be desirable.

Management of Moderate and Severe Forms of Psoriasis in Children: New Opportunities of Genetically Engineered Biologic Drugs

The article shows the key role of IL-17 in the psoriasis pathogenesis and the opportunities of its management via monoclonal antibodies product secukinumab. The review of international randomized trials on clinical efficacy and safety of genetically engineered biologic drug secukinumab in children and adolescents with psoriasis is presented. During treatment periods of 12 to 52 weeks, secukinumab has shown high therapeutic efficacy for psoriasis severity and skin lesion areas and has improved quality of life of children and adolescents according to dynamic assessments of PASI, IGA 0/1 mod 2011 indices, CDLQI questionnaire. The safety profile of secukinumab in children is estimated as favorable and comparable to using it in adults.

Cardiometabolic Comorbidities in Patients With Psoriasis: Focusing on Risk, Biological Therapy, and Pathogenesis

Psoriasis is a chronic inflammatory disease characterized by erythematous scaly plaques, accompanied by systemic damage that leads to the development of multiple comorbidities. In particular, the association between psoriasis and cardiometabolic comorbidities, including cardiovascular diseases (CVDs), obesity, diabetes mellitus, and metabolic syndrome, has been verified in a considerable number of clinical trials. Moreover, the increased risk of cardiometabolic comorbidities positively correlates with psoriasis severity. Biologic therapy targeting inflammatory pathways or cytokines substantially improves the life quality of psoriasis patients and may affect cardiometabolic comorbidities by reducing their incidences. In this review, we focus on exploring the association between cardiometabolic comorbidities and psoriasis, and emphasize the benefits and precautions of biologic therapy in the management of psoriasis with cardiometabolic comorbidities. The pathogenic mechanisms of cardiometabolic comorbidities in psoriasis patients involve common genetic factors, lipid metabolism, insulin resistance, and shared inflammatory pathways such as tumor necrosis factor-α and interleukin-23/Th-17 pathways.

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up.

Relationships between psoriasis severity indices and dermatological life quality index in children with psoriasis

Objective — to аssess the impact of dermatosis on the quality of life of children with psoriasis. Materials and methods. Psoriasis severity indices (BSA, PASI, PGA) and dermatological life quality indices (DLQI, CDLQI) in children with psoriasis aged 4 to 17 years depending on the clinical and epidemiological features of dermatosis were determined. A correlation analysis of the presence of a relationship between the obtained indicators was carried out. Results and discussion. In 73.81 % of children, the BSA index was higher than 10, which provided an average BSA of 25.85 (8.78—38.38). The calculated PASI index at the beginning of treatment averaged 9.3 (3.6—18.9). 53.06 % of children had PASI < 10. The PASI index at the first diagnosis was almost 1.5 times lower than in relapses (p = 0.043). The average PGA index was 3 (2—3), namely, 32.99 % of children had PGA 1—2, 43.20 % had PGA 3 and 23.81 % of children had PGA 4. In the group of children aged 4—7 years, there was the smallest number of participants with the PGA index 4 (7.69 %), while in the group aged 16/17—17 years, this number was the largest (41.49 %) (p = 0.039). The calculated DLQI in children with psoriasis was 5 [3—9]. The average DLQI indicator in the group of girls was statistically higher than in the group of boys (p = 0.016). Statistically significant differences were identified between DLQI in the age groups, where the highest impact on quality of life was found for the children aged 16—17 years (p < 0.001) and depended on the clinical form of psoriasis: in scalp psoriasis, the impact on quality of life was moderate, and in inverse psoriasis, it was insignificant (p = 0.021). It was found that in moderate­severe/severe psoriasis, the impact on the quality of life in children increased and was assessed as moderate, while in mild psoriasis, the impact was assessed as minor (p < 0.05). Conclusions. The course of psoriasis in children can be assessed as moderate and severe, but in the first episodes of psoriasis in droplet and inverse forms, the course is mostly mild. The intensity of skin manifestations increases with age, especially in case of the disease recurrences in the plaque form. On the whole in children, psoriasis has an ambiguous impact on the quality of life: in boys, the impact of the disease is minor; in girls, it is moderate. Damage to the visible skin areas caused by psoriasis, an increase in the area affected by the pathological process and an increase in the intensity of skin manifestations with age leads to a more negative impact on the quality of life of a child.