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Neue Studien
Topical drugs containing corticosteroids are recommended first-line treatment for patients with mild-moderate psoriasis. However, the optimal recommended dosage of topical drugs has not been well established.Objectives
To investigate the effect of topical drug application quantity and treatment duration on psoriasis treatment outcome.Methods
We conducted a post-hoc analysis of two randomized controlled trials investigating 214 patients with psoriasis using topical drugs containing corticosteroids and/or calcipotriol for up to 48 weeks. We measured the amount of topical drugs used during the study period and calculated the mean amount of applied drugs per 1% affected body surface area (BSA) divided by number of days in the study period. Improvement in severity of psoriasis was measured by Lattice-System Physician's Global Assessment (LS-PGA) (where affected BSA was divided into seven categories) from baseline to last study visit. Descriptive results were reported as counts with proportions, and as means with normality-based confidence intervals (CI). Associations were analyzed using linear regressions.Results
Most study participants had a duration of psoriasis greater than 20 years, moderate psoriasis, and no history of using systemic psoriasis treatment. They had applied a mean of 1.0 g per 1% BSA per day (95% CI 0.9; 1.2). Daily use of topical drugs for four-weeks reduced severity of psoriasis. However, extended daily use for up to 48 weeks provided further reduction in disease severity (coefficient --0.30 (95% CI -0.51, -0.09)) and -0.73 (95% CI -1.09; -0.38) (P= 0.028). Greater amount of applied topical drugs reduced severity of psoriasis in a linear manner. Every increase of 1 g of topical drugs applied per 1% BSA per day reduced LS-PGA by 0.43 (95% CI 0.24; 0.61). Finally, patients who had never used systemic drugs experienced a greater reduction in psoriasis when applying the same mean amount of topical drugs (coefficient -0.7 (95% CI -1.1, -0.4) compared to those who had a history of taking systemic treatment (-0.3 (95% CI -0.5; -0.1), P=0.026).Conclusions
A mean application amount of at least 1.0 g of topical drugs per 1% BSA per day seems safe and effective and can be used daily until clearance.Weiterlesen
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The approach to pediatric psoriasis requires special considerations, given the potential for negative consequences on overall physical and psychosocial health.Objective
The aim of this study was to systematically review the literature to characterize the burden of pediatric psoriasis.Methods
Papers assessing associations between pediatric psoriasis (in children <18 years old) and quality of life, physical symptoms (e.g., skin pain, itch, sleep disruption), and adverse psychological, social, and financial effects were searched with no date restrictions through July 2023. Databases searched included Ovid MEDLINE®, CENTRAL, the Cochrane Database of Systematic Reviews, and PsycInfo. Articles were excluded if they focused on comorbidities (including psoriatic arthritis/enthesitis), were of low quality, or were not in English.Results
64 publications met eligibility criteria. Composite quality of life was the most frequently reported domain (40 publications) and was negatively impacted by psoriasis as a function of severity. Physical burdens, especially itch, occurred in 44.1-96.3% of children with psoriasis, while skin pain was less common. Psychosocial and family burdens were less frequently assessed and often with non-validated tools. Children with psoriasis participated less in social activities, but there were no clear associations between psoriasis and school performance or interpersonal relationships. Psoriasis was associated with a higher mental health burden on caregivers and greater family financial burden.Conclusions
Psoriasis leads to high burden for pediatric patients and caregivers. Evaluation and management decisions should include and incorporate a thorough assessment of burden. Additional studies using validated tools are necessary to fully assess psychosocial and family burdens of psoriasis.Weiterlesen
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Bimekizumab (BKZ), a monoclonal antibody targeting interleukin (IL)-17A and IL-17F, has shown high efficacy in clinical trials. However, real-world data on its use in psoriatic arthritis (PsA) are limited. This study aimed to evaluate the effectiveness and safety of BKZ over 24 weeks in a real-world setting.Methods
A retrospective, multicenter study was conducted at two Italian rheumatology centers, enrolling adult patients with PsA who initiated BKZ treatment between January 2023 and February 2025. Clinical data were collected at baseline, week 12, and week 24.Results
Forty patients with PsA were included. Of these, 75% had failed at least two biologic and/or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prior to BKZ and 25/40 (62.5%) had failed at least one IL-17A inhibitor (IL-17Ai). Among these 25 patients, 32% experienced a primary failure and 68% a secondary failure. The median baseline Disease Activity in Psoriatic Arthritis (DAPSA) score was 22.9 (17.5-27.2), decreasing to 6.0 (3.1-12.8) at week 24 (p < 0.001). By week 24, 72.5% achieved DAPSA low disease activity (LDA), and 25% achieved DAPSA remission. The median swollen joint count (SJC) decreased from 3.0 (0.8-5.3) to 0.0 (IQR 0.0-1.0), and median tender joint count (TJC) decreased from 4.5 (3.0-7.3) to 1.0 (0.0-2.0) (both p < 0.001). Pain visual analog scale (VAS) and Patient Global Assessment (PGA) improved significantly, from 7.0 (6.0-8.0) and 7.5 (6.5-8.0) at baseline to 2.0 (1.0-5.0) and 2.0 (1.0-4.5) at week 24 (both p < 0.001). Skin involvement also improved, with 51.5% achieving Psoriasis Area and Severity Index (PASI) 100 by week 24. The safety profile was favorable; 15% of patients developed mild oral candidiasis, none of which required treatment discontinuation.Conclusion
BKZ demonstrated rapid and sustained improvements in PsA symptoms in a challenging real-world population, with a favorable safety profile.Weiterlesen
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Psoriasis is frequently associated with non-communicable disease (NCD) comorbidities, prompting interest in how these concurrent conditions may influence psoriasis treatment outcomes.Objectives
To assess NCD prevalence and their influence on psoriasis treatment outcomes.Methods
From 2022 to 2024, we recruited psoriasis patients in Shanghai Skin Disease Hospital. Data on demographic features, NCD comorbidities and treatment outcomes at week 4 and week 8 were systematically collected through questionnaire, physical examination, and clinical severity assessment (psoriasis area and severity index [PASI], body surface area [BSA], physician's global assessment [PGA]).Results
Among 1116 patients, 48.4% had at least one NCD comorbidity. NCD-free patients exhibited higher PASI50 response rates at both week 4 (46.5 vs. 39.1%) and week 8 (72.2 vs. 70.9%). Log binomial regression revealed that NCDs significantly reduced the likelihood of achieving PASI50 at week 4 (relative risk [RR] = 0.84, 95% confidence interval [CI]: 0.73-0.96), with a similar but non-significant trend at week 8 (RR = 0.98, 95% CI: 0.92-1.06).Conclusion
NCDs negatively impact early treatment outcomes in psoriasis patients. So we propose that dermatologists should integrate systematic NCD management into psoriasis treatment regimen.Weiterlesen
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Continuous biologic treatment is recommended for patients with psoriasis; however, treatment interruption in daily practice is inevitable. The impact of treatment interruption is difficult to study in a real-world setting. In Taiwan, biologics are reimbursed by the National Health Insurance for moderate-to-severe psoriasis for a 2-year course, followed by regulatory discontinuation. Thus, our study provides pragmatic data on the impact of the interruption of biologics treatment for non-medical reasons on therapy effectiveness.Patients and methods
This single-center retrospective cohort study recruited patients who underwent two consecutive 2-year courses of biologics between 2012 to 2021.Results
A total of 192 treatment courses from 61 patients were analyzed, with secukinumab and ustekinumab being the most frequently administered biologics. Among patients who continued with the same biologic across two consecutive courses, the time to achieve PASI 75 was shorter during the first course compared to the second, while overall maintenance effects remained similar. Switching to a different biologic usually produced superior results in the second course of treatment.Conclusions
Although the overall effectiveness after interruption and resumption of treatment with secukinumab or ustekinumab was comparable, the time to achieve PASI 75 was longer following an interruption. Continuous, uninterrupted treatment with a given biologic is therefore recommended whenever possible.Weiterlesen
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Knowledge on patient care gaps of prurigo nodularis (PN) is limited. This retrospective chart review (ADVANCE PN) investigated unmet medical needs and gaps in diagnostics, treatment, and management of patients with PN in routine care in Germany.Patients and methods
Medical records for adults newly diagnosed with PN between January 2012 and December 2022 from dermatologic clinics and office-based dermatologists were analyzed. Baseline demographics, treatment patterns, diagnostics, symptoms, patient-reported outcomes (PROs), and disease-specific scores are reported.Results
Records of 363 patients from 42 sites were analyzed. Median age (range) was 67 (19-95) years; most patients were female (61.7%), Caucasian (73.4%), and retired (57.3%). Overall, 209 (62.2%) patients had comorbidities (most common: hypertension [28.3%]). Clinically, most patients had nodules (81.1%) or papules (66.7%). PROs, disease-specific scores, and laboratory assessments were performed for 32 (8.8%), 12 (3.3%), and 71 (19.7%) patients, respectively. Topical corticosteroids (TCS) were the most common overall (90.9%) and first-line therapy (84.9%); for second-line therapy, 'no further treatment' was most commonly documented (58.6%).Conclusions
The findings of ADVANCE PN indicate a high unmet need in the current state of medical care, evidenced by shortcomings in PRO assessment, PN documentation, and adherence to guidelines on PN.Weiterlesen
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The IL-17A inhibitors target aberrant immune responses in psoriasis but also impacts the host's defense against infections. The effects of this treatment on skin microorganisms and microbiome-encoded metabolic pathways remain unclear.Objectives
This was an exploratory clinical study designed to investigate whether Psoriasis is associated with skin microbiota, as well as a longitudinal cohort study aimed at revealing the effects of IL-17A inhibitor treatment on skin microbiota in Psoriasis.Methods
In this study, we recruited 26 patients with moderate to severe psoriasis and 15 healthy controls. We collected skin microbiome samples from both greasy and dry skin regions. All samples were analyzed using 16S rDNA gene sequencing to determine the microbial profiles.Results
Compared with healthy controls, the composition and function of skin microbiome in psoriasis patients are heterogeneous. Treatment with IL-17A inhibitors significantly increases the alpha diversity of the skin microbiota in psoriasis patients, indicating potential restoration of microbial community richness and evenness. However, this treatment does not entirely alter the taxonomic composition of the skin microbiota; rather, it shifts the relative abundance of specific microbial species, indicating that certain core microbial features remain relatively stable. Moreover, IL-17A inhibitors help adjust the functional profile of the skin microbiome in psoriasis patients, bringing it closer to that of healthy individuals.Conclusions
Psoriasis patients exhibit significant heterogeneity in both the composition and functionality of their skin microbiota. Although IL-17A inhibitor treatment fails to fundamentally alter its taxonomic composition, this therapy effectively enhances microbial community stability by increasing alpha diversity and modulating the relative abundance of various taxa. Additionally, it adjusts the functional profile of the skin microbiota towards a healthier state, thereby contributing to the restoration of microecological balance.Weiterlesen
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Psoriasis is a chronic immune-mediated skin condition that has a substantial impact on patients' quality of life. The Saudi Arabia Psoriasis Registry (PSORSA) was established to address long-term real-world data (RWD) on systemic and biologic therapies in the region. This observational cohort study provides a comprehensive analysis of baseline disease characteristics, comorbidities, and treatment efficacy among patients enrolled in PSORSA, with an emphasis on risankizumab.Methods
Data were sourced from a governmental online database covering multiple healthcare centers. Patients eligible for biologics were followed at baseline and at weeks 16, 28, 40, and 52 to evaluate disease severity, quality of life, and adherence. Statistical analyses were conducted using Jamovi and R. Descriptive statistics were performed for categorical and continuous variables. p-Values < 0.05 were considered significant.Results
The study cohort included 313 patients. Plaque psoriasis was the most prevalent clinical type (93.9%). An analysis of treatment history revealed that 39.6% of patients had prior therapy exposure, and all patients received risankizumab as a biologic therapy. At baseline, the mean Psoriasis Area and Severity Index (PASI) score was 25.49. By week 52, it had decreased to 0.358, indicating complete clearance. PASI scores showed a steady and substantial reduction over time, with an 88% reduction at week 16, 96% at week 28, 97.5% at week 40, and 98.5% by week 52, demonstrating a strong and sustained treatment effect (p < 0.001). Additionally, risankizumab exhibited a favorable drug survival profile, with many patients maintaining treatment beyond 122 weeks.Conclusion
This study represents the first real-world assessment of risankizumab for moderate-to-severe psoriasis in Saudi Arabia. The findings demonstrate that risankizumab is an effective and well-tolerated treatment for moderate-to-severe psoriasis in this Saudi Arabian cohort. However, future studies should explore long-term safety outcomes and the comparative effectiveness of risankizumab and emerging biologics in diverse patient populations.Weiterlesen
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