Health‐related quality of life in adolescents with psoriasis: an interview‐based study

Psoriasis is a common skin disease affecting the physical, psychological and social well‐being of patients and their families. Most research so far has been limited to adults, and little is known about the experiences of young people with psoriasis. The aim of this study, from Denmark, was to provide an in‐depth understanding of the impact of psoriasis on adolescents’ health‐related quality of life (HRQoL). Thirty‐sixs interviews were conducted with 18 adolescents with psoriasis (aged 12–17 years), 14 of their parents and four health professionals working with psoriasis. The interview guide included broad, open‐ended questions asking about different life domains (e.g. physical, emotional and social) rather than specific issues previously addressed in existing (e.g. questionnaire‐based) research. However, when participants raised issues previously addressed in existing questionnaires, the authors prompted them to provide more information on these issues. The participants reported that psoriasis affected their quality of life within six main themes: physical symptoms (e.g. itching and flaking, fluctuation of symptoms), feeling different (e.g. feeling alone, body image issues), psoriasis‐related worry about the future (e.g. disease worsening, education and work, starting a family), increased attention (e.g. comments, staring, bullying), attempts to conceal skin (e.g. choosing specific clothing, avoiding swimming) and treatment‐related frustrations and worry (e.g. side‐effects and inconvenience). Taken together, a broad range of the reported difficulties appeared to arise from appearance‐related concerns. The impact of psoriasis and its treatment on the adolescents’ daily lives varied considerably. The authors believe that dermatologists during consultations could help by including patients’ HRQoL concerns in planning treatment, and also simply asking about these factors. In more complicated cases, referral to psychologists or counselling might be necessary.     

Long‐term efalizumab therapy for patients with moderate‐to‐severe,chronic plaque psoriasis: results from an Australian expanded access program

Background Psoriasis is a chronic skin disease that can impact heavily on a patient’s well‐being. Efalizumab, a unique, targeted, biological therapy, has demonstrated efficacy in treating moderate‐to‐severe, chronic plaque psoriasis with ≤36 months of continuous therapy. The objective of this Extended Access Program (EAP) was to evaluate further the benefit of efalizumab as long‐term therapy in a real‐world clinical setting. Methods After an initial conditioning dose of efalizumab (0.7 mg/kg subcutaneously), a weekly dose of efalizumab (1.0 mg/kg) was administered for ≤21 months. Patients with reduced Psoriasis Area and Severity Index (PASI) scores (≥50%, or a score ≤8) at month 3 entered the long‐term maintenance treatment period. Results In total, 101 patients (>18 years) with severe plaque psoriasis enrolled on the EAP, of these 93 (92.1%) met all the inclusion criteria. After 3 months of treatment, 84/101 (83.2%) patients had evaluable data and entered the maintenance period. After 3 months, 57/84 (67.9%) patients had achieved PASI‐50. Using an intent‐to‐treat analysis, after 21 months of treatment, PASI‐75 and PASI‐50 were achieved by 43/101 (42.6%) and 69/101 (68.3%) of patients, respectively. Efalizumab was generally well tolerated during the 21 months of continuous therapy. Conclusion Efalizumab, 1.0 mg/kg/week, is effective and well tolerated in a ‘real world’ clinical setting, providing enduring reduction of psoriasis symptoms for up to 21 months.     

Co‐morbidities in psoriasis: a hospital‐based case‐control study

Background Recent researches show that psoriasis is frequently associated with systemic co‐morbidities. Objectives This study aimed to identify possible associated co‐morbidities in psoriatic patients stratified by age and sex. Methods In this retrospective hospital‐based case‐control study, patients diagnosed as psoriasis at the Kaohsiung Veterans General Hospital in Taiwan between January 2008 and December 2009 were enrolled as cases and classified into severe and mild based on their use of systemic therapy. The controls were the patients without psoriasis matched the cases in 1 : 1 ratio with same birth year, sex and calendar date. Odds ratios (ORs) and 95% confidence intervals (CIs) from the conditional logistic regression method were used to assess the risk of co‐morbidities between psoriatic and non‐psoriatic patients. Results A total of 447 cases and 447 matched controls, with mean age of 51.3 ± 18.3 years and male‐to‐female ratio of 2.17 : 1 were enrolled. The ratio of mild‐to‐severe was 3.5 : 1. Compared with non‐psoriatic patients, psoriatic patients had significantly higher OR of hypertension (1.85), diabetes mellitus (2.88) and obesity (1.66). Among those aged ≥51 years old, there was significant risk in male psoriatic patients with ischaemic and hypertensive heart disease (IHHD) (OR = 2.167) after eliminating female IHHD psoriatic patients (OR = 0.125). Psoriasis was significantly negatively associated with cancers (OR = 0.267). Psoriasis patients often had the usual drinking habit (OR = 2.23) and seldom had an occasional drinking habit (OR = 0.25). Conclusions Psoriasis is strongly associated with hypertension, diabetes mellitus and obesity. The association between psoriasis and IHHD, stroke, cancers, smoking and alcohol habits warrant more investigation.     

Efficacy and safety of guselkumab in psoriasis patients who failed ustekinumab and/or anti‐interleukin‐17 treatment: A real‐life 52‐week retrospective study

Recent major research advancements have significantly expanded our understanding of psoriasis pathophysiology, resulting in the development of highly effective, targeted therapies. Guselkumab is the first interleukin (IL)‐23 inhibitor approved for the treatment of moderate‐to‐severe‐psoriasis, providing a new therapeutical option for psoriasis. The aim of our study was to evaluate the efficacy of guselkumab in psoriatic patients who previously failed anti‐IL‐12/23 and/or anti‐IL‐17 treatment. A 52‐week single‐center retrospective study was performed enrolling moderate‐to‐severe patients attending our Psoriasis Care Center from October 2018 to May 2020. Study population included 13 patients; 46.1% have been previously treated with ustekinumab, while 69.2% have previously failed an anti‐IL‐17 treatment (38.5% secukinumab, 30.8% ixekizumab, and 38.5% both). At baseline, mean Psoriasis Area and Severity Index was 13.2 ± 6.8, reducing up to 0.5 ± 0.7 at week 52 (P < .001). Body surface area reduced from 22.3 ± 10.5 (baseline) to 0.8 ± 1.1 at week 52 (P < .001). No statistically significant differences have been found between patients previously treated with anti‐IL‐12/23 compared to anti‐IL‐17 or both. Only one patient discontinued guselkumab at week 36 due to secondary inefficacy. This is a single institution study with a relatively small sample size. Our real‐life data confirm trial results, showing guselkumab as a safe and effective option in patients with moderate‐to‐severe psoriasis even in those who previously failed ustekinumab and/or anti‐IL‐17 treatment.     

Methotrexate versus traditional Chinese medicine in psoriasis: a randomized,placebo‐controlled trial to determine efficacy,safety and quality of life

Background. Psoriasis is a common and chronic immune‐mediated skin disorder, for which there is currently no cure. To our knowledge, this is the first randomized placebo‐controlled trial comparing methotrexate and traditional Chinese medicine (TCM) in terms of efficacy, safety, and quality of life for the treatment of psoriasis. Methods. In total, 61 patients with moderate to severe plaque psoriasis were randomized to receive treatment with methotrexate, TCM or placebo for 6 months. The primary outcome measure was the Psoriasis Area and Severity Index (PASI), and secondary outcome measures were the Physician’s Global Assessment (PGA) and the Psoriasis Disability Index (PDI). Results. In all, 50 patients completed the study and were included in the analysis. Dropout rates were highest in the TCM group. Mean PASI change from baseline at 6 months revealed an improvement of 73.9% of the methotrexate group, 15.1% of the TCM group and 32.0% of the placebo group. There was a significant difference between the three groups, with methotrexate showing greater effectiveness than the other two groups. No significant difference was found between the TCM and placebo groups. The methotrexate group also had greater improvement when assessed using the PGA and PDI. Conclusions. Our results verify the therapeutic effect of methotrexate for the management of psoriasis. Despite widespread belief and use of TCM in Asia for the treatment of psoriasis, we were unable to confirm the efficacy of TCM in this study.     

Internet‐supported gathering of treatment data and patient benefits in psoriasis

Background Studies about health care of psoriasis patients in Germany are predominantly carried out in dermatological centres, which results in a certain selection bias. To collect data from other sources of patients, the German Centre of Health Services Research in Dermatology conducted a series of web‐based studies. The extent of how data on health care on psoriasis gathered online vary from paper and pencil data is yet to be explored. Objective

• 1 To collect reliable treatment and benefit online data from psoriasis patients in Germany.
• 2 To compare these with data gathered at dermatological centres.

Methods On the ‘psoriasis‐hilfe.de’ web portal, psoriasis patients were asked to complete the online version of a questionnaire, which has already been used as a paper and pencil version in the national psoriasis study ‘PsoHealth’. Subsequently, difference analyses were conducted between the two data sets. Results The PsoWeb sample (n = 1071) varies to a high extent from the PsoHealth sample (n = 2009) regarding the achievement of treatment goals and treatment satisfaction. Irrespective of age, sex and duration of disease, the online sample showed lower treatment satisfaction and fewer patient‐defined benefits. Conclusion The findings suggest that patients in the online sample are less satisfied with their health care, which also could have been their motive for participating online. It is important to gather data online because it increases the data pool and permits inclusion of people who are not incorporated in clinical settings. However, online data cannot directly replace data collected in clinics because they are also subject to selections.     

Cost‐effectiveness of psoriasis therapy with etanercept in Germany

Background: We estimated the cost‐effectiveness of intermittent therapy with etanercept in patients with moderate‐to‐severe plaque‐type psoriasis in comparison to non‐systemic therapy in Germany. Patients and Methods: We performed a cost‐utility analysis using the endpoint costs per quality‐adjusted life year gained (costs/QALY). For this purpose, we adapted a UK‐based Markov model by means of resource use data that we derived from a German cost study. Efficacy data, information on frequency of adverse events and changes in quality of life were derived from three pooled clinical trials. We extrapolated the further course of the disease and its treatment over a 10 year course. Results: For patients with an initial Psoriasis Area and Severity Index (PASI) > 10 and a Dermatology Life Quality Index (DLQI) > 10 the incremental cost‐effectiveness ratio (ICER) for etanercept compared to non‐systemic therapy was 45,491 €/QALY. For patients with PASI and DLQI > 15 costs/QALY were 32,058 € and among patients with severe plaque psoriasis (DLQI and PASI > 20) 18,154 € . Conclusions: According to internationally accepted levels of cost‐effectiveness thresholds, the intermittent treatment of (moderate to) severe plaque‐type psoriasis with etanercept is a cost‐effective measure within the German healthcare system.     

Impact of ustekinumab on health‐related quality of life and sexual difficulties associated with psoriasis: results from two phase III clinical trials

Background Ustekinumab, a human anti‐interleukin‐12/23 monoclonal antibody, has been shown to effectively treat moderate‐to‐severe psoriasis which significantly affects health‐related quality of life (HRQoL), including patients’ sexual lives. Objectives The aim of this study was to determine if sexual difficulties associated with psoriasis are related to disease severity and whether sexual difficulties improve with skin disease during ustekinumab treatment. Methods  In phase III PHOENIX 1 and 2 trials, psoriasis patients were randomized to ustekinumab (n = 1334) at weeks 0 and 4 and q12 weeks thereafter or placebo (n = 662) at weeks 0 and 4 with crossover to ustekinumab at week 12. Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were used to assess psoriasis severity and patient‐reported HRQoL respectively. Based on DLQI Question #9, impaired sexual function was defined as ‘very much’ or ‘a lot’ of sexual difficulties. Results At baseline, mean DLQI was 12.0, indicating a very large negative effect on patients’ lives. Impaired sexual function was reported by 22.6% (women = 27.1%; men = 20.8%) and was significantly associated with increased psoriasis severity. At week 12, ustekinumab‐treated patients had a greater mean improvement in DLQI (?9.13 vs. ?0.53 with placebo, P < 0.001) and the proportion of patients with impaired sexual function decreased from 22.4% to 2.7% compared with no change with placebo (P < 0.001). Patients with greater PASI improvement experienced a greater reduction of sexual difficulties due to psoriasis. A similar pattern of improved sexual function was observed at weeks 24–28 in placebo crossover patients. Conclusions Ustekinumab treatment is associated with significant improvement in HRQoL and sexual difficulties due to psoriasis.     

Fumaric acid esters in combination with a 6‐week course of narrowband ultraviolet B provides an accelerated response compared with fumaric acid esters monotherapy in patients with moderate‐to‐severe plaque psoriasis: a randomized prospective clinical study

Psoriasis is a chronic recurring inflammatory skin condition with a significant impact on patients’ quality of life. It affects about 2–3% of the population in Western countries and is due to a dysregulation of the immune system. The cause and development of psoriasis is complex and involves both genetic and environmental factors. Plaque psoriasis is the most common type of psoriasis and causes raised red skin lesions with a silvery white flaky surface. There is no cure for psoriasis but current treatments can hold symptoms at bay. Fumaric acid esters (FAE) are amongst the first‐line treatments in European countries where this medication is available. FAE are effective and generally safe but take a while to start working. A short‐term combination with narrow‐band ultraviolet (NB‐UVB) phototherapy might overcome this drawback and help to accelerate the response in the early stage of treatment. Our randomized controlled prospective trial was designed to investigate whether an initial addition of NB‐UVB to FAE improves the clinical response and quality of life in patients with plaque psoriasis. The researchers who performed this study are based at the Department of Dermatology, Medical University of Vienna, Austria. The patients were randomly (by chance) assigned to two treatment groups: one group received treatment with FAE alone and the second group received a combination of FAE and a 6‐week course of narrow‐band UVB. We found that adding a short course of NB‐UVB to FAE both accelerated and improved the clearing of psoriasis and the patients’ quality of life.     

A randomized, ‘head‐to‐head’ pilot study comparing the effects of etanercept monotherapy vs. etanercept and narrowband ultraviolet B (NB‐UVB) phototherapy in obese psoriasis patients

Background Etanercept is a tumour necrosis factor‐alpha antagonist used for the treatment of moderate‐to‐severe psoriasis. Current opinion suggests that etanercept may have reduced efficacy in obese patients. Narrowband ultraviolet B (NB‐UVB) phototherapy is unaffected by body weight and the addition of NB‐UVB to etanercept therapy may supplement the efficacy of etanercept in these patients. Objective To evaluate the efficacy and safety of NB‐UVB phototherapy when administered in conjunction with 50 mg of etanercept once weekly in the treatment of obese patients with moderate‐to‐severe plaque psoriasis. Methods Thirty psoriasis patients with a body mass index (BMI) greater than 30 were enrolled into this randomized, ‘head‐to‐head’ comparison study. All subjects received 50 mg of etanercept twice weekly for 12 weeks and then randomized to receive either etanercept monotherapy or combination etanercept and NB‐UVB three times weekly for an additional 12 weeks. Treatment response was evaluated using Psoriasis Area and Severity Index (PASI), body surface area (BSA) and Physician’s Global Assessment (PGA) scores. Results Twenty‐five subjects completed the study. At 12 weeks, 48% of all patients achieved PASI 75. By Week 24, 62.5% of all patients achieved PASI 75. Patients in the etanercept monotherapy and combination etanercept and NB‐UVB phototherapy arms had similar rates of achieving PASI 75 (46.7% vs. 53.3% of each group, respectively). Conclusion Combination etanercept and NB‐UVB has similar efficacy to etanercept monotherapy in obese patients. This result indicates that even in the setting of obesity, the majority of patients respond well to etanercept, with or without NB‐UVB.     

Developing a protocol to identify and prioritize research questions for psoriasis: a James Lind Alliance Priority Setting Partnership

Psoriasis is a common condition that affects over two million people in the UK and causes red, flaky patches of skin which can sometimes feel sore or itchy. People with psoriasis can be affected by their disease physically, emotionally and socially. There are many unanswered questions about psoriasis. To find out what the most important questions are, a Psoriasis Priority Setting Partnership PSP is being carried out now. The PSP involves patients, families, carers and healthcare professionals working together to follow a process outlined by the James Lind Alliance. The first step is for all groups with an interest in psoriasis to complete a survey about what they think the important research questions are. Survey responses are then checked against existing evidence. Questions raised in the surveys, but which have already previously been answered, will be shared with relevant organisations who may consider how this information can be better shared with clinicians, patients and their families. Questions raised in the surveys, which have not already been answered will be compiled into a list. This list will be sent round to stakeholders in a second survey where they will be ordered by importance. At a final workshop, a ‘top ten’ list of unanswered questions will be agreed by patients, their carers and health professionals. This ‘top ten’ list will be shared widely with psoriasis researchers and funders, to encourage research that focuses on tackling the key issues which really matter to patients, families, carers and healthcare professionals.     

Health literacy in psoriasis care

Psoriasis is a long-lasting (chronic) skin disease, which affects 2% to 3% of the population in Scandinavia as well as the UK. Treatment generally requires a high level of self-management by patients, such as applying medications at home. Psoriasis can have several different treatment options, comorbidities (other diseases occurring alongside psoriasis) and lifestyle recommendations, which can be hard for patients to process. Health literacy (HL) is the ability to seek, understand and apply health information. Lower HL has been linked with poorer health outcomes (meaning less successful treatment) in several chronic conditions, but has not been studied in psoriasis. This study from Norway aimed to investigate the HL strengths and weaknesses of patients with psoriasis. The study included 825 patients with moderate to severe psoriasis who had participated in ‘climate helio therapy’ (use of natural sunlight) in Gran Canaria from 2011 to 2016. All completed questionnaires and The Health Literacy Questionnaire (HLQ) assessed HL. The study found that higher HL predicted higher quality of life and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy. The study shows that improving HL may be a useful strategy for strengthening psoriasis self-management. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self-management and quality of life may positively increase HL.     

Comorbidities,metabolic risk profile and health‐related quality of life in German patients with plaque‐type psoriasis: a cross‐sectional prospective study

Background Patients with psoriasis experience a higher risk of cardiovascular and metabolic comorbidities and have a high burden of treatment. There is still a gap between treatment options and quality of care. The purpose of this study was to determine the demographic data, comorbidities, and the limitations of quality of life in patients with plaque‐type psoriasis. Materials and methods This epidemiological evaluation was designed as a single‐center, cross‐sectional, prospective study in Marburg, Germany. To investigate the association between mild to severe psoriasis and comorbidities, data were obtained from 133 patients. Results The average Psoriasis Area and Severity Index was 13.4, and the average Dermatology Life Quality Index was 6.3. Among the patients with severe psoriasis, 95% had been prescribed systemic treatments. Comorbidities were evaluated, with depression 30.8%, arterial hypertension 39.1%, and hypercholesterolemia 20.3% in all patients. Conclusions Our findings underscore the importance of cardiovascular and metabolic risk screening for all patients with psoriasis. There is still a need for systemic treatments and the definition of treatment goals for psoriasis as a systemic inflammatory disease. Such goals should integrate parameters that include comorbidities and an improvement in health‐related quality of life.     

Efficacy and safety of ixekizumab treatment for Japanese patients with moderate to severe plaque psoriasis,erythrodermic psoriasis and generalized pustular psoriasis: Results from a 52‐week,open‐label,phase 3 study (UNCOVER‐J)

Psoriasis, a chronic, immune‐mediated skin disease characterized by red, scaly plaques, affects approximately 0.3% of the population in Japan. The aim of this open‐label study was to evaluate the long‐term efficacy and safety of ixekizumab, a humanized, anti‐interleukin‐17A monoclonal antibody, in Japanese patients with plaque psoriasis (n = 78, including 11 psoriatic arthritis), erythrodermic psoriasis (n = 8) and generalized pustular psoriasis (n = 5). Ixekizumab was administrated s.c. at baseline (week 0, 160 mg), from weeks 2 to 12 (80 mg every 2 weeks), and from weeks 16 to 52 (80 mg every 4 weeks). At week 52, 92.3% of patients with plaque psoriasis achieved Psoriasis Area and Severity Index (PASI) 75, 80.8% achieved PASI 90, 48.7% achieved PASI 100, and 52.6% had remission of plaques (by static Physician Global Assessment, sPGA [0]). Difficult to treat areas of psoriasis (nail or scalp) also responded to ixekizumab. All patients with psoriatic arthritis who were assessed (5/5) achieved an American College of Rheumatology 20 response. Most patients with erythrodermic psoriasis or generalized pustular psoriasis responded to ixekizumab and the clinical outcome was maintained over 52 weeks (75% and 60% of patients achieved sPGA [0, 1] at week 52, respectively). Mostly mild or moderate treatment‐emergent adverse events were reported by 79 of 91 patients; the most common were nasopharyngitis, eczema, seborrheic dermatitis, urticaria and injection site reactions. In conclusion, 52‐week ixekizumab treatment was efficacious and well tolerated in Japanese patients with plaque psoriasis. Efficacy was also observed in patients with erythrodermic psoriasis, generalized pustular psoriasis and psoriatic arthritis.     

Psoriasis: is the impairment to a patient’s life cumulative?

Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient’s life – relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self‐perpetuating social disconnection and failure to achieve a ‘full life potential’ in some patients. Health‐related quality of life studies have quantified the burden of psoriasis providing predominantly cross‐sectional data and point‐in‐time images of patients’ lives rather than assessing the possible cumulative disability over a patient’s lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co‐morbidities and stigma over a patient’s life course, we propose the concept of ‘Cumulative Life Course Impairment’ (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co‐morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health‐related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case–control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from ‘Life Course Epidemiology’ to psoriasis research.     

Guselkumab,a human interleukin‐23 monoclonal antibody in Japanese patients with generalized pustular psoriasis and erythrodermic psoriasis: Efficacy and safety analyses of a 52‐week,phase 3, multicenter,open‐label study

Generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP) are the rare and severe subtypes of psoriasis, which are often difficult to treat. The aim of this phase 3, open‐label study was to evaluate efficacy and safety of guselkumab, a human interleukin‐23 monoclonal antibody, in Japanese patients with GPP and EP. Guselkumab 50 mg was administrated to GPP (n = 10) and EP (n = 11) patients at weeks 0, 4 and thereafter every 8 weeks (q8w). Beginning at week 20, patients were escalated to 100 mg q8w if they met the dose escalation criteria. The primary end‐point was the proportion of patients achieving treatment success (Clinical Global Impression score of “very much improved”, “much improved” or “minimally improved”) at week 16. Safety evaluations included assessment of treatment‐emergent adverse events (TEAE) through week 52. At week 16, the proportions of GPP and EP patients achieving treatment success were 77.8% (7/9) and 90.9% (10/11), respectively. Furthermore, guselkumab treatment consistently showed improvement in responses of secondary end‐points such as Psoriasis Area and Severity Index, Investigator's Global Assessment, Japanese Dermatological Association severity index and improvement in body surface area involvement. Improvements in quality of life, as assessed by the Dermatology Life Quality Index, were also observed through week 52. The most commonly reported TEAE was nasopharyngitis (28.6%, 6/21). Safety findings were consistent with those observed previously in other studies. In conclusion, guselkumab treatment demonstrated efficacy and showed no safety concerns in Japanese patients with GPP and EP through week 52.     

‘Upgrading’ psoriasis responsibly

Psoriasis is a ‘pacemaker’ in dermatology. Substantial progress has been made regarding our understanding of its pathophysiology and genetic background, fuelling developments in cutaneous biology in general. Besides, the clinical perspective on psoriasis is currently changing, taking into consideration comorbidity and the systemic dimensions of this seemingly organ‐specific inflammation. The availability of drugs exhibiting fewer contraindications and improved long‐term safety opened a discussion around replacing a relatively limited (regarding both objectives and duration) ‘therapeutic’ by a much broader ‘management’ approach when it comes to treating psoriasis as a systemic disease. The question arises whether this ‘upgrade’ is warranted.     

Use of topical antipsoriatic drugs in Denmark: a nationwide drug utilization study

Psoriasis is a common chronic inflammatory skin disease, affecting about 2-4% of the population in Europe. Psoriasis negatively affects patients’ quality of life and is linked to several psoriasis-associated comorbidities (diseases that occur alongside psoriasis). Topical drugs, which means they are applied directly to the skin, are a recommended first-line treatment for mild-to-moderate psoriasis, but their reported real-life use is conflicting. This study investigated psoriasis patients’ real-life use of topical drugs and other antipsoriatic treatments. Danish researchers conducted a drug utilization study based on the nationwide Danish health registry data, including data on all patients above 18 years of age who received a first-time hospital diagnosis of psoriasis and were prescribed at least one topical drug in the period 2005-2015 (7,743 patients). The patients were followed for a three-year period after the time of diagnosis. Among many findings, the authors reported that the most frequently used topical antipsoriatic drugs were combinations containing corticosteroid with calcipotriol, accounting for 31% of the total use. Patients’ use of topical drugs increased around the time of hospital diagnosis. The use also varied considerably between geographical regions as well as for the individual patients, with 25% of the patients using 70% of the total amount of topical treatment. The total use of topical antipsoriatic drugs decreased by 19% during the study period, while use of a drug called methotrexate which is taken by tablet or injection, increased by 70%. The authors concluded that the use of topical antipsoriatic drugs shows considerable diversity over time, regional practices and differences between patients.     

A systematic review of the use of quality‐of‐life instruments in randomized controlled trials for psoriasis

Planners of interventional studies in psoriasis face the dilemma of selecting suitable quality‐of‐life (QoL) measures. Systematic reviews have the potential of identifying psychometrically sound measures in a given therapeutic area, while guiding the development of practice guidelines. The aim of this systematic review was to generate evidence of the use of QoL instruments in randomized controlled trials (RCTs) for interventions in psoriasis. The methodology followed the PRISMA guidelines. Six databases were searched with 388 search terms. Abstracts of articles were reviewed independently by two assessors, and a third adjudicator resolved any opinion differences. Risk of bias was assessed using the Jadad scale. Of 3646 screened publications, 99 articles (100 trials) met the eligibility criteria for inclusion, describing research on 33 215 patients. Thirty‐three trials tested topical therapy, 18 systemic, 39 biologics, nine phototherapy and 10 other interventions. The Dermatology Life Quality Index (DLQI) was the most commonly used QoL instrument (83 studies, 83%), followed by the 36‐Item Short Form Survey (SF‐36) (31, 31%), EuroQoL‐5D (EQ‐5D) (15, 15%), Psoriasis Disability Index (14, 14%) and Skindex (five, 5%). There was widespread inconsistency in the way that QoL data were reported. Of the 100 trials identified, 37 reported minimal clinically important difference (MCID): 32 for DLQI, 10 for SF‐36 and six for EQ‐5D. QoL measurement is increasingly being reported in RCTs of psoriasis. Formal guidelines are needed for assessment and publishing of QoL data. Researchers should consider whether MCID information is available, and development of MCID data should be encouraged.     

Risk and predictors of cardiovascular disease in psoriasis: a population‐based study

Background  Emerging evidence suggests that severe psoriasis is associated with increased risk of cardiovascular disease. The goal of this study was to examine the risk and predictors of clinical cardiovascular events in psoriasis. Methods  We performed a historical cohort and a nested case–cohort study using the population‐based resources in Olmsted County, Minnesota. The study population included a population‐based incidence cohort of patients with psoriasis first diagnosed between January 1, 1970, and January 1, 2000, and 2678 age‐ and sex‐matched non‐psoriasis subjects. Cardiovascular events, including hospitalized myocardial infarction, coronary revascularization procedures, stroke, heart failure, and cardiovascular death. Results  Psoriasis was associated with an increased risk of myocardial infarction based on diagnostic codes (hazard ratio 1.26; 95% confidence intervals: 1.01, 1.58) but not when the analyses were restricted to validated myocardial infarction (hazard ratio 1.18; 95% confidence intervals: 0.80, 1.74). Psoriasis was not associated with an increased risk of heart failure or cardiovascular death. Traditional cardiovascular risk factors were significantly associated with cardiovascular risk in psoriasis. Each 1% increase in Framingham risk score at psoriasis incidence corresponded with a 5–10% increase in risk of cardiovascular events. Conclusion  In this large incidence cohort of patients with psoriasis representing the full disease severity spectrum, psoriasis was not associated with an increased cardiovascular risk.