Thus, in clinical settings, patients with DLQI scores differing more than the MCID may have identical HRQoL. Improving the definition of moderate-to-severe disease and reconsideration of the DLQI in clinical assessment of psoriasis patients are suggested Keyword: Dermatology Life Quality Index. Keyword: Health-related quality of life. Keyword: Medical decision-making.
BACKGROUND: Data evaluating the impact of objectively measured psoriasis severity on type 2 diabetes mellitus (T2DM) risk are lacking.
OBJECTIVE: To determine the risk of T2DM in patients with psoriasis compared to adults without psoriasis, stratified by categories of directly assessed body surface area (BSA) affected by psoriasis.
METHODS: A prospective, population-based, cohort study from the UK. 8,124 adults with psoriasis and 76,599 adults without psoriasis were followed prospectively for approximately 4 years.
RESULTS: 280 (3.44%) incident cases of diabetes in the psoriasis group and 1867 (2.44%) incident cases of diabetes in those without psoriasis. After adjusting for age, sex and body mass index, the hazard ratios (95%CI) for developing incident diabetes were 1.21 (1.01-1.44), 1.01 (0.81-1.26), and 1.64 (1.23-2.18) in the ≤2BSA, 3-10%BSA, and >10%BSA groups compared to those without psoriasis, respectively (p=0.004 for trend). Worldwide, we estimate an additional 125,650 new diagnoses of T2DM per year in patients with psoriasis as compared to those without.
LIMITATIONS: Relatively short-term follow-up and exclusion of prevalence cases which may have masked associations in patients with less extensive psoriasis.
CONCLUSION: Clinicians may measure BSA affected by psoriasis in order to target diabetes prevention efforts for patients with psoriasis.
Dermatology (15), Endocrine Disorders (7), Anti-Obesity and Weight Loss (1) Psoriasis (15), Diabetes Mellitus (6), Diabetes Mellitus, Type 2 (1), more mentions
... selectively modulate immune function, targeted JAK inhibitors are promising candidates for some skindiseases such as psoriasis and atopic dermatitis... with NB-UVB which is considered a gold standard therapy for both diseases... In psoriatic patients, the JAK1 level positively correlated with the female participants, disease duration and PASI change.
AbstractText: A considerable disease period often precedes initiation of a biologic in patients with psoriasis. Little is known about this important period in patients' lives. Evaluation of this 'journey' can reveal important insights and opportunities for physicians and health care decision makers AbstractText: (1) To describe patient and treatment characteristics until the start of biologic treatment in patients with severe ...
BACKGROUND: Fumaric acid esters are (FAE) safe and effective in patients with moderate to severe psoriasis but have a slow onset of action. A short-term combination with narrow-band UVB (NB UVB) may substantially accelerate the therapeutic response in the induction phase of treatment.
OBJECTIVES: To assess the synergistic effect of a 6-week course of NB UVB phototherapy in addition to fumaric acid esters in adult patients with moderate to severe plaque psoriasis.
METHODS: In this randomized, assessor-blinded trial patients with a Psoriasis Area and Severity Index (PASI) of ≥10 and a body surface area (BSA) of ≥10 were randomized to either monotherapy with FAE (n=16) or a combination of FAE with NB UVB (n=14). The primary outcome parameter of the study was the mean PASI reduction after 6 weeks of treatment. In addition, the PASI 75 response, the psoriasis log-based area and severity index (PLASI) and the dermatology life quality index (DLQI) were assessed as secondary outcome measures.
RESULTS: Thirty patients (19 males, 11 females; median age 52 years, IQR 36;56) were analysed. The mean reduction in PASI after 6 weeks was significantly greater with the combination treatment as compared to FAE monotherapy (p=0.016). This was paralleled by a much faster improvement in DLQI in the combination group than in the FAE monotherapy group.
CONCLUSIONS: Adding a 6-week course of narrow-band UVB to FAE both accelerates and augments the therapeutic response during the early phase of treatment and increases quality of life in patients with moderate-to-severe plaque psoriasis. This article is protected by copyright. All rights reserved.
We read the letter to the editor by HS Butt and ST Butt titled "Beyond the burn: psychosocial factors as well as inflammation moderate depression in psoriasis," which was written in response to our review titled, "Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression." This article is protected by copyright. All rights reserved.
Health-related quality of life was measured by employing DLQI and EQ-5D-3L, while disease severity was graded by Psoriasis Area and Severity Index (PASI. Multivariate logistic regression was applied to determine the predictors of providing NRRs AbstractText: Mean age of the 428 patients was 49 years, and 65% were males.
Since 1982, the Japanese Society for Psoriasis Research has conducted annual epidemiological surveys of patients with psoriasis. Kawada et al. have reported data for 1982-2001 and Takahashi et al. have reported data for 2002-2008. The present study evaluated 9290 psoriatic cases according to age and sex (2009-2012). The male : female ratio was 2.08:1 (6281 male patients [67.6%] to 3009 female patients [32.4%]). The most prevalent type was psoriasis vulgaris (85.6% of all cases), which was followed by psoriasis arthropathica (6.0%), psoriasis guttate acuta (3.2%), Zumbusch-type generalized pustular psoriasis (1.8%) and psoriasis erythroderma (1.5%). Psoriasis vulgaris was the most prevalent type for all ages, while psoriasis arthropathica and psoriasis guttate acuta were most prevalent among patients aged less than 65 years. The present survey detected an increased number of cases with comorbid diabetes and/or arthritis symptoms compared with the previous surveys. We found that treatments frequently involved topical corticosteroids (89.7% of cases) and vitamin D3 ointments (78.0% of cases), with a notable increase in the use of vitamin D3 ointments. Systemic treatments were used in 33.3% of cases, including cyclosporin (33.6%), etretinate (19.5%), methotrexate (8.6%), infliximab (11.4%), adalimumab (10.9%) and ustekinumab (6.2%). Phototherapy was used in 30.9% of cases. Although psoralen plus ultraviolet A therapy was the predominant phototherapy during previous studies, the present survey revealed that narrowband ultraviolet B therapy was used in 84.5% of phototherapy-treated cases. Thus, the present survey revealed major changes in treatment trends.
Dermatology (12), Endocrine Disorders (1), Muscular and Skeletal Diseases (1) Psoriasis (10), Psoriatic Arthritis (2), Exfoliative Dermatitis (1), more mentions
... Relatively little is known about the risk for incident liver disease in psoriasis (PsO), psoriatic arthritis (PsA), and rheumatoid arthritis (RA... Outcomes of interest were any liver disease, non-alcoholic fatty liver disease (NAFLD), and cirrhosis (any etiology... 1,279,754), the adjusted hazard ratios for any liver disease were elevated among patients with PsO (without systemic therapy HR ...
Dermatology (4), Immune System Diseases (3), Muscular and Skeletal Diseases (3) Liver Diseases (6), Cirrhosis (5), Psoriasis (4), more mentions
OBJECTIVES: Smoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox.
METHODS: Using 1995-2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders.
RESULTS: Of 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=~1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9).
CONCLUSIONS: In this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis.
Dermatology (10), Muscular and Skeletal Diseases (3) Psoriasis (10), Psoriatic Arthritis (3), more mentions
BACKGROUND: Patients with psoriasis are at an increased risk for depression. However, the impact of treatment on this risk is unclear.
OBJECTIVE: Evaluate the incidence and impact of treatment on depression among patients with moderate-to-severe psoriasis.
METHODS: We defined a study population within the Psoriasis Longitudinal Assessment and Registry and measured the incidence of depressive symptoms (Hospital Anxiety and Depression Scale-Depression score ≥8) and adverse events (AEs) of depression within cohorts receiving biologics, conventional systemic therapies, or phototherapy. Patients were evaluated at approximately 6-month intervals. Multivariate modeling determined the impact of treatment on risk.
RESULTS: The incidence rates of depressive symptoms were 3.01 per 100 patient-years (PYs) (95% confidence interval [CI], 2.73-3.32), 5.85 per 100 PYs (95% CI, 4.29-7.97), and 5.70 per 100 PYs (95% CI, 4.58-7.10) for biologics, phototherapy, and conventional therapy, respectively. Compared with conventional therapy, biologics reduced the risk for depressive symptoms (hazard ratio, 0.76; 95% CI, 0.59-0.98), whereas phototherapy did not (hazard ratio, 1.05; 95% CI, 0.71-1.54). The incidence rates for AEs of depression were 0.21 per 100 PYs (95% CI, 0.15-0.31) for biologics, 0.55 per 100 PYs (95% CI, 0.21-1.47) for phototherapy, and 0.14 per 100 PYs (95% CI, 0.03-0.55) for conventional therapy; the fact that there were too few events (37 AEs) precluded modeling.
LIMITATIONS: Incomplete capture of depression and confounders in the patients on registry.
CONCLUSION: Compared with conventional therapy, biologics appear to be associated with a lower incidence of depressive symptoms among patients with psoriasis.
AbstractText: Psoriasis vulgaris is a common skindisease that is characterised by persistent localised erythematous scaly plaques. Yinxieling is a Chinese herbal formula for psoriasis that has been used for more than 20 years in China. To facilitate application, PSORI-CM01 was developed based on the optimisation and simplification of Yinxieling tablets performed in a previous study and in clinical ...
Abstract: The advances in psoriasis management currently allow achieving a good control of the disease... However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life. To optimize the treatment of psoriasis, it is not enough to define precisely the therapeutic objective, but also to adapt ...
The exclusion of a skin domain, as in the DAPSA measures, resulted in negligence of skindisease and a negative impact on the quality of life in ... same definition do differ in terms of allowance of residual disease. Inclusion of laboratory markers seems unnecessary, although exclusion of a skin domain may result in psoriasis not being assessed resulting in residual impactful skindisease Keyword: disease activity ...
Muscular and Skeletal Diseases (5), Dermatology (3) Psoriatic Arthritis (5), Psoriasis (3), Skin Diseases (2), more mentions
Abstract: Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skindisease of unknown etiology... After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP.
PURPOSE: Topical active vitamin D3 application alone or in combination with topical steroid application is widely used to treat psoriasis. In Japan, combined calcipotriol hydrate/betamethasone dipropionate ointment has been used for patients with psoriasis vulgaris since September 2014. Current evidence regarding the incidence of hypercalcemia due to the use of this combination product, however, is insufficient. We evaluated the incidence of hypercalcemia following combined calcipotriol hydrate/betamethasone dipropionate ointment in patients with severe psoriasis vulgaris. Methods Japanese patients (n = 22) with extensive plaque psoriasis (body surface area: 20%-30%) applied the combined calcipotriol hydrate/betamethasone dipropionate ointment once daily for 8 weeks, and their serum Ca concentrations were measured periodically. Results The mean serum Ca concentration changed only marginally, from 9.04±0.34 mg/dL before treatment to 9.08±0.39 mg/dL after 8 weeks of treatment. None of the patients had an elevated serum Ca concentration throughout the study. No cases of hypercalcemia were reported as an adverse event. No correlation was detected between the amount of the combined calcipotriol hydrate/betamethasone dipropionate ointment applied and changes in the serum Ca concentration. Conclusion The incidence of hypercalcemia due to topical application of a combined calcipotriol hydrate/betamethasone dipropionate ointment is low in Japanese patients with severe psoriasis vulgaris.
... Meier survival and Cox proportional hazards models AbstractText: One hundred and eighty-eight patients with PsA were prescribed TNFi therapy as first-line biologic therapy over a period of 635 person-years [46% male, mean (s.d.) age 47.3 (11.4) years; median (interquartile range) disease duration 11 (7-16) years.
Muscular and Skeletal Diseases (2) Psoriatic Arthritis (2), Necrosis (1), more mentions
Drug survival measures the length of time until discontinuation of a drug. The length of time a patient remains on a biologic drug is impacted by several factors such as tolerability, side effects, safety profile and effectiveness. To evaluate the long-term drug survival, data of the most commonly prescribed biologic medications used in the treatment of psoriasis, a systematic review was conducted. A literature search using PubMed, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature from January 1 2010 to October 28 2016 identified 3734 abstracts. Of which, 36 publications with over 40,000 patients met the inclusion criteria. The median overall drug survival for ustekinumab, adalimumab, infliximab and etanercept was 38.0, 36.5, 26.6 and 24.7 months, respectively. The mean annual drug survival rate of TNF inhibitors was 70%, 57%, 51%, 45% and 41% at years-1, 2, 3, 4 and 5, respectively. The 5-year mean annual drug survival rate of ustekinumab was 87%, 78%, 70%, 71% and 51%, respectively. Based on our findings, ustekinumab appears to have a longer drug survival with lower rates of discontinuation compared to tumor necrosis factor inhibitors.
Dermatology (3) Psoriasis (3), Necrosis (2), Neoplasms (2), more mentions
AbstractText: Secukinumab has demonstrated greater sustained skin clearance versus ustekinumab through Week 52, greater improvement in symptoms and health-related quality of life (HRQOL), and comparable safety profile AbstractText: To assess the impact of secukinumab versus ustekinumab on complete relief from psoriasis-related symptoms, time to HRQOL response, and cumulative ...
Abstract: Psoriasis is an autoimmune inflammatory skindisease... Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources ...
Dermatology (13), Immune System Diseases (1) Psoriasis (13), Skin Diseases (1), more mentions