Neue Studien: Europe PMC

Comparative Efficacy of Ustekinumab and Guselkumab in Improving Itch in Severe Psoriasis Patients.

Thu, 29 May 2025 18:10:57 +0000

Background

Biologics effectively improve psoriatic skin lesions, but their impact on itch relief remains unclear.

Objective

To evaluate itch improvement in severe psoriasis patients treated with ustekinumab or guselkumab.

Methods

This retrospective study analyzed patients with severe psoriasis who completed initial efficacy evaluations after treatment with either biologic. Itch severity was assessed using numerical rating scale (NRS), visual analog scale, and verbal rating scale. NRS improvement was evaluated after three injections.

Results

Among 108 patients (74 on ustekinumab, 34 on guselkumab), 77 (71.3%) had moderate-to-severe itch (NRS ≥4) at baseline. Of these, 63 (81.8%) achieved an NRS improvement of ≥4 points. Ustekinumab showed greater itch relief compared to guselkumab in NRS (p=0.033). On the other hand, guselkumab showed more reduction for psoriatic skin lesions than ustekinumab in the Psoriasis Area and Severity Index (p=0.040). In the moderate-to-severe itch group, patients with large plaques experienced significantly greater improvement in NRS than those with small plaques (p=0.012).

Conclusion

While guselkumab is generally preferred for psoriatic skin lesions, ustekinumab may provide superior itch relief.

Identifying characteristics for a cost-effective psoriatic arthritis biomarker test: a development-focused health technology assessment.

Thu, 29 May 2025 18:10:57 +0000

Objectives

This study aimed to evaluate the required test characteristics that a psoriatic arthritis (PsA) biomarker test would need to achieve to be considered cost-effective.

Methods

We adapted an existing Markov model to compare a hypothetical biomarker with current practice. The model followed a patient cohort aged 45 years with moderate psoriasis (PsO) in which PsA was prevalent but unrecognized over a 40-year time horizon. Patients were assumed to be routinely seen at a dermatology clinic. In the current practice arm, patients with PsA were clinically detected. In the biomarker arm, a hypothetical test was assumed to be administered at baseline. Patients who screened positive would accept a combination of conventional disease-modifying antirheumatic drugs and targeted treatment to slow disease progression. Progression was modeled as linear changes in Health Assessment Questionnaire (HAQ) scores. We varied the sensitivity, specificity, and biomarker price based on current development progress. Scenario analyses considered alternative patient cohorts with mild and severe PsO separately.

Results

The base case showed that a biomarker test with 70 percent sensitivity, 80 percent specificity, and a price of US$500 would be cost-effective (incremental cost-effectiveness ratio US$47,566 per quality-adjusted life-year [QALY]). Three-way analyses showed that a test with 80 percent specificity could be cost-effective at a US$50,000 per QALY threshold with a sensitivity as low as 66 percent at US$500. Only a near-perfect test would be cost-effective at a US$1,000 price point. Results were sensitive to HAQ progression under treatment, therapy costs, and the patient population.

Conclusion

This study supports the continued product development of candidate PsA biomarkers.

Prescribing Practices Among Psoriasis Experts for Patients with Concomitant Malignancy: A Survey of International Psoriasis Council Members.

Thu, 29 May 2025 18:10:57 +0000

Background

The management of moderate-to-severe psoriasis in patients with concurrent or previous malignancy presents a unique clinical challenge. Despite the transformative impact of biologic therapies on psoriasis treatment, the exclusion of patients with malignancy from clinical trials has led to a paucity of data regarding the safety and efficacy of systemic and biologic agents in this subgroup. Clinicians are thus often compelled to rely on registry data, real-world evidence, and expert opinion when navigating these complex cases.

Objectives

To investigate prescribing practices among psoriasis experts for systemic and biologic therapies in patients with severe psoriasis and concomitant malignancy. The study aimed to elucidate trends in decision-making, perceptions of treatment risks, and adherence to multidisciplinary approaches.

Methods

An electronic survey was disseminated to 141 members of the International Psoriasis Council (IPC) between December 2023 and June 2024. The self-administered questionnaire examined respondents' demographics, guideline familiarity, and preferences for systemic and biologic therapies across five malignancy types (breast cancer, melanoma, prostate cancer, lymphoma, and metastatic renal cell carcinoma) at varying remission intervals. Data were analysed descriptively.

Results

Fifty-seven IPC councillors completed the survey (40%). Anti-IL-17 agents were the most commonly selected therapies across all malignancy scenarios for patients in remission, reflecting growing confidence in their safety profiles. For active malignancies, apremilast was the most frequently chosen agent, particularly for breast cancer (61%), melanoma (56%), and metastatic renal cell carcinoma (49%). Tumour necrosis factor-alpha (TNF-α) inhibitors and fumaric acid esters were the least frequently selected treatments for active malignancies. The majority of respondents (70%) believed current guidelines lacked clarity on treating psoriasis in the context of malignancy. Nearly half (49%) reported always consulting oncology teams before initiating systemic therapy for patients with recent malignancy diagnoses, underscoring the importance of a multidisciplinary approach.

Conclusions

This study highlights significant variability in prescribing practices and a strong preference for biologics such as anti-IL-17 agents and apremilast. The findings underscore the urgent need for malignancy-specific guidelines informed by robust long-term safety data to support optimal decision-making and improve patient outcomes.

Psoriatic Arthritis - A Mortality Abstract.

Thu, 29 May 2025 17:42:59 +0000

Objective.—

To analyze a published study on all-cause mortality between psoriatic arthritis and matched population comparator-subjects to derive comparative mortality statistics applicable to life insurance underwriting.

Method.—

The pixel method was employed for extracting cumulative survivals. It was chosen for its capability to extract data from published graphs despite potential precision and reliability limitations.

Results.—

The mortality analysis indicated an increase in mortality starting in year 4, aligning with the Table rating for Psoriatic arthritis. Pharmacological treatment data from the study revealed only 28% were on advanced therapies such as targeted synthetic or biologic DMARDs. This low percentage suggests most of the cohort had milder PsA, as advanced treatments are generally reserved for moderate to severe psoriatic arthritis. The distribution of treatment regimens provides essential insights into disease severity and its implications for mortality assessment.

Conclusion.—

The comparative mortality findings correspond to Table rating for psoriatic arthritis. This finding underscores the importance of understanding treatment profiles and disease severity in life insurance underwriting to accurately assess risk.

Exploring the relationship between skin severity and PASDAS in psoriatic arthritis: a cross-sectional study in the BSR-PsA and GRACE cohorts.

Thu, 29 May 2025 17:42:59 +0000

Objectives

To explore the extent to which skin severity is reflected in the Psoriatic Arthritis Disease Activity Score (PASDAS).

Methods

Cross-sectional baseline data from the British Society for Rheumatology PsA register (BSR-PsA) and the GRAPPA Composite Exercise (GRACE) dataset was included. The body surface area score (BSA) and the Dermatology Life Quality Index (DLQI) were used to assess skin disease activity. BSA was categorized as none (0%), mild (<3%), moderate (3-10%) and severe (>10%) skin involvement. DLQI was categorized as no (0-1), small (2-5), moderate (6-10), large (11-20) and extreme (21-30) effect on quality of life. Mean and standard deviation PASDAS scores, physician and patient global VAS scores were calculated for each category of skin severity by both BSA and DLQI. Within each cohort, two groups were created based on the severity of skin disease (BSA cut-off of 10). Propensity score matching was applied to match groups for musculoskeletal disease activity and differences between the groups were assessed.

Results

In both the BSR-PsA (N = 1126) and GRACE (N = 588) datasets, PASDAS, VAS physician global and VAS patient global scores increased with increasing skin scores. For the subjects grouped by severity of skin involvement, and matched for musculoskeletal activity, significant differences in PASDAS, physician global score and DLQI were observed for the BSR-PsA, and physician and patient global scores, DLQI and age for the GRACE dataset.

Conclusion

These data suggest that psoriasis disease activity is represented in the composite PASDAS score, possibly through the global (patient and physician) VAS scores.

Immune-related hub genes and their role in psoriasis pathogenesis.

Thu, 29 May 2025 17:42:59 +0000

Psoriasis is a prevalent inflammatory skin disorder with immune-related mechanisms that remain incompletely understood. To elucidate the immune landscape of psoriasis, we analyzed expression profiles to identify 115 psoriasis susceptibility genes (PSGs) and subsequently pinpointing eight immune-related hub genes (IRHGs). A predictive model incorporating these IRHGs demonstrated promising prognostic potential for psoriasis. Additionally, extensive intercellular communication was observed among keratinocytes, dendritic cells, monocytes, and T cells. The cellular differentiation trajectory revealed a complex interplay among various cell types and states, highlighting genes such as CXCL8, CCL2, STAT3, and STAT1 emerging as closely associated with the cellular composition and functional status within the psoriatic immune microenvironment. The present study may shed light on the understanding of the immunopathological dynamics of psoriasis and the development of novel therapeutic strategies and biomarkers for this multifaceted skin disorder.

Total-body positron emission tomography: a tool for systemic, quantitative evaluation of the inflammatory burden of psoriatic arthritis.

Thu, 29 May 2025 17:42:59 +0000

Objectives

To test the hypothesis that recently-developed total body-positron emission tomography (TB-PET) imaging with integrated computed tomography (CT) will enable low-dose, quantitative, domain-specific evaluation of the total inflammatory burden of psoriatic arthritis (PsA) and associate with established outcome measures of the clinical domains of PsA.

Methods

Seventy-one adult participants (40 with PsA, 16 with rheumatoid arthritis (RA), and 15 with osteoarthritis (OA)) underwent 20-min TB-PET/CT scans using [18F]FDG, a glucose analogue radiotracer. [18F]FDG uptake was assessed qualitatively and quantitatively. Rheumatological examinations were performed prior to the scan. For both evaluations, domain-specific assessments included 68 joints, 6 entheses, 20 nails, axial disease and dactylitis.

Results

[18F]FDG PET uptake consistent with joint involvement and enthesitis was noted in 100% of participants with PsA. Other features included nail matrix pathology (53%), spinal involvement (60%), active sacroiliitis (13%) and dactylitis (10%). Patterns of [18F]FDG uptake in PsA differed from those in participants with RA or OA. There was a high concordance between TB-PET measures and the domain-specific assessments of the joint (75%), entheseal (79%) and nail (65%) pathology. TB-PET was positive for an additional 15% of joints, 20% of entheses and 13% of nails that were negative on clinical assessments.

Conclusion

TB-PET/CT identified inflammatory pathologies characteristic to all clinical domains of PsA and thus provided an in vivo evaluation of systemic PsA inflammatory burden. This promising tool may further contribute to identifying pathologies that may be occult, provide biomarkers to diagnose and differentiate PsA at an early stage, and to monitor early treatment response.

Association of psoriasis and genetic predisposition with the risk of cardiometabolic diseases: a population-based cohort study.

Thu, 29 May 2025 17:42:59 +0000

The correlation between psoriasis with individual cardiometabolic diseases (CMDs), including coronary heart disease (CHD), stroke, hypertension, heart failure (HF), and type 2 diabetes mellitus (T2DM), have yielded conflicting results, and genetic susceptibility's role in modifying these relationships remains unexplored. To investigate the association of psoriasis with the risk of CMDs, and to assess the modified effect of genetic susceptibility on these associations. A total of 390,165 participants from the UK Biobank cohort were enrolled. Cox proportional hazards models were used to examine the association between psoriasis and the incidence of CMDs. The genetic risk score for these diseases was incorporated as tertiles to assess potential effect modification in these association. The outcome was CMDs. During a median 12.0-year follow-up, a total of 23,811 incident CHD events, 6,941 HF, 82,963 hypertension, 6,902 stroke, and 16,788 T2DM were recorded. Participants with psoriasis had an increased risk of incident CHD (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.03-1.21), HF (HR 1.20, 95% CI 1.06-1.35), hypertension (HR 1.10, 95% CI 1.05-1.15), and T2DM (HR 1.22, 95% CI 1.11-1.34) compared to those without psoriasis. The adverse impact of psoriasis was pronounced among individuals with a high genetic predisposition. The elevated risk of CMDs associated with psoriasis may be partially explained by inflammation and dyslipidemia. Psoriasis was associated with the incidence of CMDs, particularly among individuals with higher genetic predisposition. Hence, our study emphasized the significance of preventing and managing CMDs among psoriasis patients, particularly those with high genetic risk.

Epidemiology of Psoriasis in Poland: Prevalence, Incidence, and Mortality Rates.

Thu, 29 May 2025 17:42:59 +0000

Background

Although the data on psoriasis epidemiology included in the Global Psoriasis Atlas (GPA) provide valuable information on psoriasis prevalence worldwide, the GPA database is still incomplete. Therefore, the aim of the study was to assess the prevalence, incidence, and mortality rates of psoriasis and its types in Poland based on the data registered by the National Health Fund (NHF).

Methods

The study included psoriasis patients registered at least twice in the Polish NHF database between 2010 and 2023.

Results

At the end of 2023, 639,662 living psoriasis patients had been registered in the Polish NHF database, which constituted 1.70% of the Polish general population. The percentage of female psoriasis patients was found to be higher (54.95%) than male patients (45.05%). Of all the Polish NHF-registered psoriasis patients, plaque psoriasis affected 95.66%, pustular psoriasis 3.05%, psoriatic arthritis 7.20%, and guttate psoriasis 0.27%. In comparison to the general Polish population, psoriasis prevalence was observed to be lower in children (0.84%). The all-cause mortality rate among psoriasis patients was found to be higher in comparison to the general Polish population, with a higher mortality rate noted in male psoriasis patients.

Conclusions

The NHF database we studied suggests a direct relationship between the prevalence, incidence, and all-cause mortality rates in psoriasis and patients' age and sex. However, the study also revealed a decrease in mortality rates and a slow increase in the prevalence of psoriasis in the Polish population, which calls for further studies.

MASLD and liver fibrosis in patients with psoriasis receiving IL-17 or IL-23 inhibitors: a systematic review.

Thu, 29 May 2025 17:42:59 +0000

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters.

Objectives

To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis.

Design

We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Data sources and methods

A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials.

Results

Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase.

Conclusion

IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings.

Trial registration

PROSPERO CRD42024599350.

The causal association between psoriasis and 32 types of cancer: a mendelian randomization study.

Thu, 29 May 2025 17:42:59 +0000

Background

Psoriasis is a systemic immune disease associated with the development of various cancers. However, the causal nature of this association remains unclear. This study aims to systematically investigate the potential causal relationship between psoriasis and 32 types of cancer.

Methods

We utilized data from two large genomic databases, the UK Biobank and FinnGen, to extract GWAS summary statistics for 32 cancer types as outcomes and psoriasis-related data as exposures. Mendelian randomization (MR) analysis was performed to assess the causal effects of psoriasis on cancer risk. Sensitivity analyses, including heterogeneity and horizontal pleiotropy tests, were conducted to ensure robustness. Additionally, meta-analysis and FDR correction were applied to enhance the reliability of the results.

Results

Our findings revealed significant causal relationships between psoriasis and four cancer types: Psoriasis was associated with an increased risk of laryngeal cancer (OR = 1.15, 95% CI: 1.05-1.26). Psoriasis exhibited a protective effect against oral cavity and pharyngeal cancer (OR: 0.91; 95% CI: 0.86-0.97), prostate cancer (OR: 0.97; 95% CI: 0.95-0.99), and malignant non-melanoma cancer (OR: 0.89; 95% CI: 0.82-0.96).

Conclusion

Psoriasis may exert bidirectional effects on the development of specific cancers through distinct mechanisms. Specifically, psoriasis may increase the risk of laryngeal cancer while reducing the risk of oral cavity and pharyngeal cancer, prostate cancer, and malignant non-melanoma cancer. These findings provide new insights into the causal relationship between psoriasis and cancer and could inform prevention and treatment strategies for these diseases.

Bidirectional association between uveitis and psoriasis: a systematic review and meta-analysis.

Thu, 29 May 2025 17:42:59 +0000

Background

In recent years, the prevalence of uveitis among patients with psoriasis has shown a noticeable upward trend. Previous studies have investigated the immunological mechanisms underlying the potential connection between psoriasis and uveitis, but systematic studies exploring their bidirectional relationship is absent. This study aims to systematically evaluate the bidirectional association between psoriasis and uveitis to provide evidence.

Methods

We thoroughly searched PubMed, Embase, and the Cochrane Library for relevant observational studies published from the inception of these databases up to Mar 11th, 2024. Our systematic review was based on priori protocol pre-registered in PROSPERO (No. CRD42024522464). Risk and bias assessments were analyzed using STATA 16.0.

Results

We analyzed the results from 7 studies involving 81,775,820 subjects. The results showed that the incidence of uveitis was higher in patients with psoriasis compared to patients without psoriasis (OR = 1.16, 95% CI: 1.11-1.21). At the same time, patients with uveitis showed heightened susceptibility to psoriasis (OR = 1.52, 95% CI: 1.34-1.70, I²: 90.6%, P < 0.01). The subgroup analysis found that uveitis affects the severity and type of psoriasis.

Conclusions

The current systematic review and meta-analysis found a bidirectional association between psoriasis and uveitis. Notably, patients with severe psoriasis and psoriasis with joint symptoms should be informed about their increased risk to developing uveitis.

Combining Clinical, Genetic and Protein Markers Using Machine Learning Models Discriminates Psoriatic Arthritis Patients From Those With Psoriasis.

Thu, 29 May 2025 17:42:59 +0000

Background

Psoriatic Arthritis (PsA), an immune mediated inflammatory arthritis, affects a quarter of patients with cutaneous psoriasis, usually after psoriasis onset. Early diagnosis of PsA is challenging. A biomarker-based diagnostic test may facilitate early diagnosis.

Objectives

We aimed to determine whether specific clinical features or genetic and protein markers, alone or in combination, can distinguish patients with PsA from those with psoriasis without PsA (PsC).

Methods

Patients with PsA and PsC were identified from a database of patients with psoriatic disease. Detailed demographic and clinical information were collected at time of assessment. Single-nucleotide polymorphisms (SNPs) of 19 "PsA weighted" genes were genotyped. Serum samples were used to assess 15 protein markers by ELISA. Association between clinical, genetic and protein markers and PsA were determined, and models were developed to discriminate PsA from PsC using machine learning algorithms.

Results

Demographic and clinical information had low predictive value in distinguishing PsA from PsC (AUC - 0.607, P < .01). SNP and protein panels also had low value in discriminating PsA from PsC (AUC - 0.691, P < .001 and AUC - 0.694, P < .001, respectively). Combining protein, SNPs and clinical features provided better discriminatory value (best performing model: Random Forest, AUC - 0.733, P < .001).

Conclusion

Combining previously identified clinical, genetic and protein markers have a fair ability to differentiate PsA from PsC. Further studies are required for identifying better diagnostic signatures.