From skin clearance to psychological wellbeing: real-world outcomes of biologic therapy in psoriasis
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Skin is the largest organ of the human body. It continuously encounters environmental toxicants, including airborne pollutants, which may induce many skin disorders, such as psoriasis. However, evidence on the association between airborne pollutants and psoriasis prevalence in China remains limited.Methods
We used nationwide inpatient diagnostic data on psoriasis from 2021 to 2023, encompassing 149 744 cases across 31 provinces, municipalities, and autonomous regions in China, along with corresponding air pollution data. We analysed the spatial distribution and clustering patterns of psoriasis using the spatial autocorrelation analysis. We employed Pearson correlation analysis and Geodetector to explore the spatial heterogeneity of psoriasis and its association with airborne pollutants at the provincial level. We assessed the explanatory power of individual airborne pollutants and their combined effects on psoriasis prevalence.Results
Pearson correlation analysis revealed that PM10 (r = 0.604), PM2.5 (r = 0.429), air quality index (AQI) (r = 0.542), and NO2 (r = 0.476) have significant positive correlations with psoriasis prevalence. Psoriasis and its subtypes exhibited significant spatial heterogeneity and diverse clustering patterns across regions. Geodetector identified PM10 (q = 0.357; P = 0.000), AQI (q = 0.315; P = 0.000), and O3 (q = 0.264; P = 0.000) as key contributors to this spatial heterogeneity. Interactive detection analysis further revealed that the combined effects of specific pollutant pairs, including PM2.5 and SO2 (q = 0.790), PM10 and SO2 (q = 0.727), as well as O3 and SO2 (q = 0.704), played a pivotal role in explaining the prevalence of psoriasis. The other combinations also showed an important impact on psoriasis subtypes, including psoriasis vulgaris (PM2.5 and SO2) (q = 0.792), psoriasis erythematous (PM2.5 and SO2) (q = 0.852), psoriatic arthritis (PM10 and O3) (q = 0.840), and nail psoriasis (PM10 and O3) (q = 0.789).Conclusions
The airborne pollutants influence psoriasis prevalence and its subtypes. With the largest global study of the Asian population, we provide novel insights into the impact of air pollution on psoriasis, guiding future public health policies and clinical interventions.Weiterlesen
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Biologic therapies have transformed the management of moderate-to-severe psoriasis but are associated with long-term treatment burden and substantial healthcare costs. Dose spacing, defined as extending dosing intervals in patients with controlled disease, has emerged as a potential optimization strategy. However, data on real-world implementation and clinician perspectives remain limited.Methods
We conducted a national, cross-sectional survey among Portuguese dermatologists experienced in prescribing biologic therapies for psoriasis. An anonymous, web-based questionnaire assessed clinicians' perspectives and real-world practices regarding biologic dose spacing, including eligibility criteria, preferred biologic classes, implementation strategies, outcomes after loss of disease control, and limiting clinical factors.Results
Seventy-five dermatologists completed the survey (response rate 48.4%). All respondents considered dose spacing feasible. The most frequently cited eligibility criteria were absolute Psoriasis Area and Severity Index (PASI) ≤ 1, body surface area (BSA) ≤ 1%, and a 90% improvement in PASI (PASI 90). Interleukin-23 (IL-23) inhibitors were perceived as the most suitable class for dose spacing (93.3%). In routine practice, dose spacing was applied frequently by 30.7% of respondents and occasionally by 48.0%. Most clinicians (69.3%) required more than 12 months of sustained disease control before initiating dose spacing, predominantly using progressive extension of dosing intervals (96.0%). IL-23 inhibitors were the biologics most frequently dose-spaced in current practice. Following loss of disease control, 86.7% reported successful recapture of response after reintroduction of standard dosing. The main factors limiting dose spacing were a history of difficult-to-control psoriasis (77.3%) and concomitant psoriatic arthritis (72.0%).Conclusion
Biologic dose spacing is already integrated into clinical practice in Portugal. Further prospective studies are needed to establish standardized criteria and guide safe implementation.Weiterlesen
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To evaluate the long-term efficacy of interleukin (IL)-17A inhibition with secukinumab on structural bone changes and clinical outcomes in psoriatic arthritis (PsA).Methods
We conducted a phase-IV non-interventional study on adult patients with active PsA using high-resolution peripheral quantitative CT (HR-pQCT) and MRI of the hand over 48 months. All participants received secukinumab treatment and were followed up according to clinical practice, with repeated HR-pQCT and MRI. Number and volume of erosions, bone density, cortical and trabecular microarchitecture and bone biomechanical properties were assessed based on HR-pQCT scans. MRI synovitis, tenosynovitis, osteitis, periarticular inflammation, erosions and osteoproliferation were quantified by Psoriatic Arthritis MRI Score (PsAMRIS)-Outcome Measures in Rheumatology (OMERACT) score. Study outcomes included drug survival and changes from baseline in disease activity, functional status and imaging-detected inflammation and damage.Results
32 patients with PsA (40.6% female, mean age 56±7.5 years) were enrolled. Drug survival rate was 68.8% at 48 months. Secukinumab was highly effective in all PsA disease domains, with significant improvements in Disease Activity Score 28 (p<0.001), Leeds Enthesitis Index (p=0.027), Psoriasis Area and Severity Index (p=0.001), C reactive protein (p=0.09), Psoriatic Arthritis Impact of Disease (p<0.001) and pain (p<0.001). Functional status measured by the Health Assessment Questionnaire remained stable. On HR-pQCT, bone density, microarchitecture and biomechanics were preserved. There was no progression of bone erosions (all changes were not significant). On MRI, PsAMRIS erosion and osteoproliferation subitems increased marginally (+1.4 and +0.8, respectively), while inflammatory changes remained stably low. No major safety signals emerged.Conclusion
Multimodal imaging with HR-pQCT and MRI showed no relevant progression of structural bone damage over 48 months in patients with PsA treated with secukinumab, suggesting that anti-IL-17A therapy induces sustained osteoprotective effects in PsA.Weiterlesen
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Psoriasis is a persistent, chronic autoimmune skin disease that affects around 2% of the global population. Conventional therapies often exhibit limited efficacy, systemic side effects, and poor patient compliance due to long-term treatment needs.Materials & methods
This study focused to develop and optimize a sulfasalazine-loaded microemulsion (SSZ-ME) for topical delivery to enhance skin penetration and therapeutic efficacy in psoriasis. Pseudo-ternary phase diagrams were prepared to identify the optimal surfactant mixture, with Tween 80 and Polyethylene Glycol 400 selected in a 2:1 ratio. A 23 factorial design was used to optimize formulation parameters, focusing on oil and surfactant mixture effects on globule size and viscosity.Results and conclusions
The resulting microemulsions showed globule sizes between 60 ± 0.42 to 349 ± 0.13 nm, with optimal viscosity. In vitro release studies confirmed sustained drug release over 24 hours, following first-order kinetics. Skin permeation studies demonstrated enhanced drug penetration with SSZ-ME, while histopathological analysis revealed significant improvements in psoriatic symptoms in mice treated with 4% SSZ-ME compared to 2% SSZ-ME and marketed formulation. Blood analysis confirmed minimal systemic absorption and localized action. These results suggest that SSZ-ME offers a promising, patient-compliant, and effective topical therapy for psoriasis with improved therapeutic outcomes and minimal systemic exposure.Weiterlesen
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Perceptions over biologics for psoriasis after 5 years of access in Brazil: a cross-sectional study.
Biologic therapies have transformed psoriasis management, and their incorporation into Brazil's public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptions remain incompletely understood.Objectives
To evaluate perceptions, barriers, and prescription patterns regarding biologic therapy among Brazilian dermatologists and patients five years after universal incorporation, while quantifying the prevalence of undertreatment.Methods
We conducted two independent cross-sectional online surveys throughout 2024 among dermatologists (n = 225) and patients with psoriasis or psoriatic arthritis (n = 1,001). Data on demographics, clinical characteristics, and perceived barriers were analyzed.Results
Overall, 64.9% of dermatologists prescribed biologics, with higher prescribing rates among younger physicians (p = 0.022), those with fewer years of practice (p = 0.013), higher patient volumes (p < 0.001), and practice in tertiary centers (p = 0.001). Only 25.5% of patients were receiving biologics, strongly associated with psoriatic arthritis (p < 0.001), with no difference between public and private care. Key barriers included perceptions that conventional therapies are sufficient (59.5%), insufficient training (38.0%), and administrative burden (45.5%), while patients mainly reported safety (45.7%) and cost (30.9%) concerns. Undertreatment was prevalent, affecting over 50% of patients with moderate-to-severe disease. While 71.3% of non-users were willing to start biologics, only 28.0% had received a medical recommendation.Conclusions
Persistent educational and structural barriers continue to limit optimal biologic use despite formal availability, highlighting the need for targeted education, streamlined care pathways, and improved physician-patient communication to achieve equitable outcomes.Weiterlesen
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The clinical definition of moderate psoriasis is debated, affecting treatment eligibility and patient outcomes.Objective
A panel of Italian dermatologists aimed to propose practical criteria to define moderate psoriasis, based on a comprehensive literature review and clinical experience.Methods
The panel reviewed publications between 2016 and 2024 focusing on key severity scores, including the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), Dermatology Life Quality Index (DLQI), and Physician's Global Assessment (PGA), along with special area involvement and patient-reported outcomes.Results
Despite variability among studies, and the lack of universally accepted thresholds, the panel defined moderate psoriasis as a BSA of 5%-10%, DLQI of 5-10, a PGA score of 3, and involvement of at least two special areas (e.g. scalp, face, genitals, nails, hands, or feet). Distressing itch and psychosocial impact were also recognized as critical elements influencing perceived disease burden. A composite PGA-based approach, integrating objective measures with patient-centered criteria, is proposed for identifying patients with moderate psoriasis who may benefit from systemic therapy.Conclusion
This pragmatic approach may help bridge the gap between guidelines and real-world clinical practice, ensuring more accurate treatment allocation and reducing undertreatment of psoriasis.Weiterlesen
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Activation of NF-κB signaling in tissue-resident memory T cells promotes recurrent psoriasis in mice
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To compare on-label persistence among adults with psoriasis who switched from other advanced therapies to guselkumab versus subcutaneous tumor necrosis factor inhibitors (SC TNFi), subcutaneous interleukin-17 inhibitors (SC IL-17i), or apremilast.Materials and methods
This retrospective cohort study used U.S. claims data from the IQVIA PharMetrics® Plus database (2016- 2023). Overlap propensity score weights were used to balance cohorts on baseline characteristics. On-label persistence was defined as the absence of drug discontinuation (event) and any dose change relative to the U.S. label (censoring). Survival analyses were used to assess on-label persistence from the start of the maintenance phase.Results
At 12, 18, and 24 months after the start of the maintenance phase, respectively, on-label persistence was 190%, 180%, and 179% more likely on guselkumab versus SC TNFi; 78%, 87%, and 91% more likely on guselkumab versus SC IL-17i; and 187%, 199%, and 193% more likely on guselkumab versus apremilast (all p < 0.001).Conclusions
Patients experiencing suboptimal outcomes with other psoriasis-indicated advanced therapies achieved higher on-label persistence after switching to guselkumab, raising the potential for improved disease control relative to other treatment options.Weiterlesen
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The Psoriatic Disease Assessment Index (PSODAI) Score to Evaluate Systemic Involvement of Psoriasis.
To the best of our knowledge, no validated scoring instrument currently exists that comprehensively evaluates both cutaneous manifestations and systemic comorbidities of psoriasis. This multicenter study aimed to develop and validate a novel multidimensional scoring system addressing this clinical gap.Methods
Under the guidance of the Shenzhen Psoriasis Academy, we conducted seven expert meetings to analyze existing evidence from PubMed, Wanfang, and CNKI databases. Through iterative Delphi consensus processes involving 26 specialists across 10 disciplines, we established the Psoriasis Disease Assessment Index (PSODAI). This 60-point composite instrument evaluates cutaneous involvement and nine key organ/system comorbidities. An accompanying online calculator (http://www.psodai.com.cn/) was developed for clinical implementation. Validation involved 254 psoriasis patients from six tertiary centers, with comparative analyses against PASI and DLQI metrics.Results
The PSODAI framework stratifies disease severity as mild (0-20), moderate (21-40), and severe (41-60). Comparative analysis revealed comparable proportions of moderate-to-severe cases between PSODAI and conventional tools (PASI/DLQI) (p>0.05). Notably, 11 patients (4.3%) classified as severe by PASI were re-categorized as mild through PSODAI's systemic evaluation, primarily due to limited extracutaneous manifestations.Conclusion
As the first comorbidity-integrated assessment tool, PSODAI enables cross-specialty collaboration for holistic patient management. Its clinical adoption may facilitate timely comorbidity detection and preventive interventions. Further multicenter validation is warranted to confirm these preliminary findings.Weiterlesen
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Psoriasis is frequently accompanied by depression. However, the role of specific symptom domains, including cognitive-affective and somatic symptoms, as well as potential metabolic mediators between psoriasis and depression, remains unclear.Methods
We analyzed data from the National Health and Nutrition Examination Survey (NHANES, n = 14,964) and the Health and Retirement Study (HRS, n = 4364). Depressive symptoms were classified into cognitive-affective and somatic domains. Cross-sectional associations were evaluated in NHANES, and longitudinal symptom trajectories were identified in HRS using group-based trajectory modeling. Based on genome-wide association study summary statistics, bidirectional and two-step Mendelian randomization (MR) were performed to assess causality and identify plasma metabolite mediators.Results
In NHANES, total depressive symptoms (OR = 1.03, 95% CI: 1.01-1.06, P = 0.018) and somatic symptoms (OR = 1.08, 95% CI: 1.03-1.12, P = 0.003) showed positive associations with psoriasis, but not cognitive-affective symptoms. In HRS, persistently high trajectories of total (OR = 1.58, 95% CI: 1.08-2.32, P = 0.018) was associated with psoriasis, with no significant association for the cognitive-affective and somatic domains after full adjustment. MR supported a causal relationship of psoriasis on depression and identified sphingomyelin (d17:2/16:0, d18:2/15:0) and urate as mediators, accounting for 10.2% and 6.8% of the total effect, respectively.Conclusion
Depressive symptoms were linked to psoriasis in both cross-sectional and longitudinal analyses. Lipid and antioxidant-related pathways involving sphingomyelin and urate may mediate the relationship between psoriasis and depression, offering potential targets for intervention.Weiterlesen
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Psoriasis, a chronic autoimmune condition, can severely impact patients' well-being. It is characterized by erythema, thickening, and scaling of the skin. Plaque psoriasis, the most prevalent type, affects 80%-90% of psoriasis patients, ranging from localized to severe cases. Although corticosteroids are commonly used to treat psoriasis, prolonged use poses risks. Therefore, alternative therapies are needed. Roflumilast, a potent phosphodiesterase 4 inhibitor, is currently being considered as a treatment for plaque psoriasis.Methods
We searched four electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Scopus, and Web of Science) up to March 2024 for relevant articles evaluating the efficacy and tolerability of roflumilast in the management of psoriasis. The quality of evidence from trials was assessed using the Cochrane Risk of Bias tool (RoB1). Data from the included studies were extracted into a standardized online sheet and analyzed using RevMan 5.4.Results
Roflumilast significantly increased the proportion of patients achieving an Investigator's Global Assessment score of 0 or 1 and a 2-point improvement score at both weeks 4 and 8 compared to placebo (RR = 3.48, 95% CI [2.04 to 5.92], P < 0.00001, and RR = 4.02, 95% CI [3.17 to 5.11], P < 0.00001, respectively). The pooled studies demonstrated homogeneity at both weeks 4 (P = 0.17, I² = 38%) and 8 (P = 0.38, I² = 5%). Regarding the results of the Psoriasis Area and Severity Index, 75% favored roflumilast over placebo (RR = 2.72, 95% CI [1.18 to 6.28], P < 0.00001, and RR = 3.41, 95% CI [2.19 to 5.32], P < 0.00001, at weeks 4 and 8, respectively). Subgroup analysis addressed the observed heterogeneity in the results.Conclusion
This meta-analysis represents the first investigation into the efficacy and safety of roflumilast for treating psoriasis. Results suggest that roflumilast is both effective and well-tolerated in managing psoriasis. However, additional robust clinical trials are needed to validate these observations..Weiterlesen
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