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Conventional systemic agents remain the cornerstone treatment for psoriasis because of their availability and cost-effectiveness. However, few studies have compared the effectiveness and drug persistence of these agents in Asian populations.Objectives
To evaluate the effectiveness and drug persistence of methotrexate, cyclosporine, and acitretin, and to identify factors associated with these outcomes.Methods
We reviewed data from 338 psoriasis patients treated with methotrexate, cyclosporine, or acitretin.Results
Out of 473 treatment courses, 239 (50.5%) involved methotrexate, 123 (26%) involved acitretin, and 111 (23.5%) involved cyclosporine. After 1 year, the proportion of patients who achieved absolute Psoriasis Area and Severity Index (PASI) ≤ 2 was greater with methotrexate (30.6%) and cyclosporine (22.2%) than with acitretin (9.5%). For absolute PASI ≤ 4, methotrexate (57%) and cyclosporine (47.2%) showed greater effectiveness than did acitretin (34.9%), with a significant difference only between methotrexate and acitretin (P = .017). The effectiveness findings were consistent in both the 1- and 3-year analyses. Multivariate analysis revealed that a high baseline PASI score significantly reduced the effectiveness of both methotrexate and cyclosporine. For methotrexate, a high body mass index was also associated with reduced effectiveness, whereas for acitretin, scalp involvement and male sex were key factors. Methotrexate demonstrated the longest drug survival at 1 year. Higher ages at psoriasis onset and systemic treatment-naive status were correlated with longer drug survival. Conversely, a higher body mass index and psychiatric comorbidities were linked to shorter survival.Limitations
Methotrexate is typically the first-line systemic therapy in Thailand, which may underestimate the true efficacy of cyclosporine and acitretin when used subsequently.Conclusion
Methotrexate was more effective and persistent than were cyclosporine and acitretin in a real-world setting.Weiterlesen
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Sternoclavicular joint (SCJ) involvement in psoriatic arthritis (PsA) is poorly characterized. We aimed to assess its prevalence and clinical associations in a longitudinal PsA cohort.Methods
We retrospectively analyzed prospectively collected data from the Gladman Krembil Psoriatic Arthritis Program. Patients with SCJ involvement (tender and/or swollen SCJ) were identified, and their demographic, clinical, laboratory, and treatment details were retrieved. Univariable and multivariable generalized estimating equation models were used to assess associations with clinically swollen SCJ. Results are reported as odds ratios (OR) with 95% confidence intervals (CI).Results
Among 1,737 patients, 182 (10.5%) had SCJ involvement, including 36 (2.1%) with clinically swollen SCJs ever over follow-up. SCJ involvement was present at enrolment into the cohort (baseline) in 33.1% of affected individuals. The mean age was 41.4 ± 12 years, and 42% were male. In univariable analyses, SCJ involvement was significantly associated with higher swollen joint count (SJC) (OR 1.142, 95% CI 1.08-1.16), dactylitis (4.51, 2.02-10.05), and enthesitis (6.74, 3.45-13.15). No significant associations were observed with sex, disease duration, axial and nail disease, PASI, pustular psoriasis, or HLA markers. In multivariable analysis, SCJ swelling remained associated with higher SJC (1.08, 1.03-1.14), enthesitis (4.54, 1.98-10.45), dactylitis (4.54, 1.98-10.45) and lower biologic or targeted synthetic DMARD use (0.30, 0.10-0.88).Conclusion
SCJ involvement is an underrecognized but clinically meaningful manifestation of PsA, associated with greater disease burden and enthesitis, often requiring escalation to advanced therapies.Weiterlesen
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Although testing for latent tuberculosis (TB) infection has been standard practice for psoriasis patients being treated with IL-17 or IL-23 inhibitors, evidence for this practice is weak.Objectives
To review evidence on safety of IL-17 and IL-23 inhibitors in the setting of latent TB infection, and to provide a new Joint Position Statement on this topic.Methods
Experts from the National Psoriasis Foundation (NPF) and the International Psoriasis Council (IPC) reviewed evidence regarding progression of latent TB infection to active disease in psoriasis patients receiving IL-17 or IL-23 blockers. A Joint Position Statement was formulated and approved to provide updated guidance to clinicians.Results
87.5% of the members from the NPF Medical Board and IPC approved a new Joint Position Statement regarding psoriasis patients being treated with IL-17 or IL-23 inhibitors, stating that testing for latent TB infection is not required.Limitations
This position statement allows for exceptions where continued testing for latent TB infection could be considered, including for patients on concomitant immunosuppressive therapy and for those living in TB endemic areas.Conclusion
Psoriasis experts reached consensus that routine testing for latent TB infection is not required in psoriasis patients being treated with IL-17 or IL-23 inhibitors.Weiterlesen
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/Objectives: Plaque psoriasis is a chronic immune-mediated inflammatory disease affecting approximately 3% of the global population and resulting in a significant deterioration in quality of life. Systemic therapy with monoclonal antibodies (mAbs) targeting TNF-α, IL-23, and IL-17 improves clinical outcomes and patients’ quality of life. Treatment strategies commonly include different mAbs and different sequencings approaches between agents, which are well-established in clinical practice. In contrast, evidence supporting the switch from intravenous to subcutaneous administration of the same mAb remains limited. Herein, we report data from a retrospective case series of patients with plaque psoriasis treated with intravenous infliximab (IV-IFX; Anti TNF-α) and transitioned to subcutaneous infliximab (SC-IFX) to compare clinical and patient-reported outcomes across routes. Methods:
11 plaque psoriasis patients were retrospectively analyzed. The scores of Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and Physician Global Assessment (PGA) were assessed during IV-IFX and after switching to SC-IFX. To evaluate patients’ satisfaction, the Score of Treatment Satisfaction Questionnaire Medication-9 (TSQM-9) was evaluated. Both Student’s t-test and ANOVA were used to assess statistically significant differences between the two routes of administration (p<0.05). Results:
scores for PASI, DLQI and PGA were lower with SC-IFX compared to IV-IFX, indicating improved disease control and quality of life after the switch. PASI and DLQI improved in 81% and 100% of patients treated with SC-IFX, respectively. TSQM-9 total scores increased significantly by 24% (P<0.001). In particular, the questions addressing the “convenience” of treatment, revealed a marked advantage for the SC-IFX formulation (p<0.001). No treatment-emergent adverse events were registered. Conclusions:
In this retrospective case series, switching from IV-IFX to SC-IFX appeared to be safe and to maintain or improve clinical response and enhanced treatment satisfaction. Thus, these findings highlight the potential of SC-IFX as a viable maintenance option for patients with plaque psoriasis previously treated with IV-IFX.Weiterlesen
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Delays remain in patients receiving effective treatment strategies that have potential to clear their skin of psoriasis, improve their quality of life (QoL) and change the psoriatic disease course, which, if uncontrolled, can irreversibly alter an individual's life course (i.e. cumulative life course impairment [CLCI]). This study explored current international awareness and consideration of the potential impact of psoriasis over the life course within clinical assessments and decisions about its management.Methods
Cross-sectional surveys collated insights from people with psoriasis and healthcare professionals (HCPs) treating psoriasis (dermatologists and primary care physicians [PCPs]) across 29 countries.Results
Data were collected from 487 people with psoriasis, 574 dermatologists and 618 PCPs. Despite people with psoriasis highlighting a range of daily activities that are 'very frequently' or 'always' affected by their psoriasis, 37% were never or rarely asked by their HCPs how the disease affects their life. Fewer than half of people with psoriasis had a high understanding of the potential future impact of psoriasis (or CLCI-contributing factors), and 44% were unaware that clear/almost clear skin is now a realistic treatment target. Almost half of HCPs considered psoriasis to be of early onset when it presented at ≤ 15 years of age. Despite HCP awareness of the impact of psoriasis on QoL, many of the contributing factors to CLCI were not addressed routinely in clinical practice nor considered when deciding on treatment; 40% of dermatologists set treatment goals (such as clear skin/almost clear skin/target Dermatology Life Quality Index [DLQI]) sometimes, less frequently, or not at all.Conclusions
Misalignment exists in the experience of people living with psoriasis versus its assessment in clinical practice. Support is needed for assessment and monitoring of elements that may contribute to CLCI in clinical practice worldwide, to guide early psoriasis treatment decision-making to mitigate the risk for CLCI. Infographic available for this article. INFOGRAPHIC.Weiterlesen
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The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is widely used to assess axial disease activity in psoriatic arthritis (PsA). However, 5 of its 6 questions reflect general disease activity rather than axial-specific symptoms. We aimed to evaluate the performance of BASDAI and its back pain subscore in assessing axial disease in PsA.Methods
Patients with BASDAI scores were identified from a longitudinal PsA cohort initiated in 1978. Axial disease was defined radiographically. Trends in BASDAI and back pain scores were compared between patients with and without axial involvement. Associations of total BASDAI and back pain subscore with axial disease were assessed using univariable and multivariable linear mixed models in the entire cohort and stratified subgroups.Results
Of 1059 patients, 449 (42.4%) had axial and 610 (57.6%) had peripheral disease only. The mean age was 44.4 years (SD 12.8), and 55.9% were male. No difference in the BASDAI and back pain trends was observed between the axial and peripheral disease groups. Axial involvement was not associated with total BASDAI scores (β = -0.14, 95% CI -0.05 to 0.33). However, it was associated with a small, yet significant increase in back pain subscore (0.30, 0.06-0.55). Both BASDAI and back pain scores were associated with active peripheral joints, enthesitis, dactylitis, age, Psoriasis Area and Severity Index, and inversely with male sex. These associations were consistent across axial and peripheral disease subgroups.Conclusions
BASDAI and its back pain subscore are influenced by peripheral musculoskeletal and skin disease activity in PsA, limiting their utility for assessing axial activity.Weiterlesen
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