Quality of life in psoriasis patients

Validity of the EQ-5D in patients with pemphigus vulgaris and pemphigus foliaceus

BACKGROUND

No studies to date have employed the EuroQoL EQ-5D questionnaire to assess health-related quality of life (HRQoL) in patients with pemphigus.

OBJECTIVES

To evaluate the HRQoL of patients with pemphigus by the EQ-5D and to analyse the convergent and known-groups validity of the EQ-5D in this patient population.

METHODS

Between 2014 and 2017, a multicentre cross-sectional study was carried out. Outcome measures included the five-level EQ-5D (EQ-5D-5L), Dermatology Life Quality Index (DLQI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and an average pain intensity visual analogue scale (VAS) for the past 3 months.

RESULTS

In total, 109 consecutive patients with pemphigus participated in the study (mean age 57 years; 64% women). Among the EQ-5D dimensions, the most problems were reported regarding pain/discomfort (50%), mobility (43%) and anxiety/depression (43%). No significant difference was found in mean EQ-5D index scores between patients with pemphigus vulgaris and those with pemphigus foliaceus (0·81 vs. 0·86, P = 0·14). The mean EQ-5D index scores of patients with limited, moderate, significant and extreme pemphigus were 0·88, 0·82, 0·72 and 0·67, respectively (P = 0·001). The number of comorbidities was associated with greater impairment in EQ-5D index scores (P < 0·001). DLQI (r_s = -0·62, P < 0·001) and the average pain intensity VAS (r_s = -0·59, P < 0·001) more strongly correlated with the EQ-5D index scores than did ABSIS (r_s = -0·40, P < 0·001).

CONCLUSIONS

This is the first study employing the EQ-5D questionnaire in pemphigus. The EQ-5D is a valid measure of HRQoL in patients with pemphigus that can be useful both in clinical practice and in economic evaluations to assess the health gains associated with new effective treatments.

A cross-sectional study in young adults with psoriasis: potential determining factors in quality of life, life course and work productivity

BACKGROUND

Psoriasis can have a substantial impact on health-related quality of life (HRQoL), life course, and work productivity. Young adulthood is a critical, sensitive period of development that includes major life changing decisions. The impact of psoriasis on this vulnerable population is yet unknown.

OBJECTIVES

To assess QoL, life course, and work productivity in young adults with psoriasis and identify characteristics influencing these patient-reported outcomes (PRO).

METHODS

An explorative, cross-sectional study was performed in psoriasis patients aged 18-30 years. Individuals completed a set of questionnaires regarding their health status (DLQI, SF-36, EQ-5D), achievement of developmental milestones (COLQ), and work productivity (WPAI-PSO, PRODISQ).

RESULTS

Seventy-five patients (22 males, 53 females; median age [IQR], 21.0 [8.0]). Median PASI and BSA, respectively, were 4.4 [4.9] and 4.5 [8.4]. Young adults experienced feelings of embarrassment, impairments in physical health and work productivity, and difficulties in social development. Patients with more severe psoriasis, longer disease duration, higher body mass index (BMI), female patients and patients closer to their thirties tended to be more affected.

CONCLUSION

In the young adult psoriasis population, substantial QoL impairments were found. Female patients, patients with high BMI, or long disease duration in particular tended to experience more difficulties. These exploratory findings indicate the need for further studies in young adults to detect potential clinical predictors for severe HRQoL impairments.

Role of betamethasone valerate 2.250 mg medicated plaster in the treatment of psoriasis and other dermatological pathologies: a review

Treating dermatological pathologies with topical corticosteroids under occlusion is often more effective than nonocclusive therapy, especially in the treatment of psoriasis. Betamethasone valerate medicated plaster provides a controlled and localized method of dosing betamethasone valerate, a well-established corticosteroid with vasoconstrictive, anti-inflammatory, immunosuppressive, and antiproliferative properties. This self-adhesive plaster is approved for the treatment of inflammatory skin disorders that do not respond to treatment with less potent corticosteroids. As a patch, it offers all the clinical benefits of occlusive therapy such as increased penetration of topical agent into the area requiring treatment, enhanced skin hydration, and protection from local trauma or scratching. This translates into improved patient compliance, which is notoriously low in patients with dermatological conditions. This review presents the available clinical data from studies with betamethasone valerate medicated plaster in the treatment of psoriasis and other dermatoses and discusses its place in therapy for dermatological conditions.

Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis

BACKGROUND

The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self-esteem and reduced work productivity.

OBJECTIVES

To examine direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity and activity impairment based on psoriasis severity and symptoms.

METHODS

Analyses were based on data from the CLEAR study. Structural equation modelling examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area and Severity Index (PASI) severity and symptoms (pain, itching and scaling) as potential mediators. Analyses were conducted primarily for patients achieving a PASI 90 response (90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75 and 100.

RESULTS

Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by the PASI 90 response and by improvements in itching, pain, and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching and scaling were correlated (r = 0·51-0·68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab.

CONCLUSIONS

The results underscore the important role of both PASI response and reduction in symptoms on improvements in health-related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab.

[Optimization of therapy for hepatobiliary disorders in psoriatic patients]

AIM

To optimize management tactics in patients with diseases of the liver and gallbladder in the presence of progressive psoriasis.

SUBJECTS AND METHODS

The investigation enrolled 78 patients with nonalcoholic fatty liver disease (NAFLD) and different forms of gallbladder abnormality in the presence of progressive moderate and severe psoriasis. The patients were randomly divided into 2 groups: 1) phosphogliv; 2) ursosan with the main active ingredient ursodeoxycholic acid (UDCA). A prospective follow-up study accompanied by dynamic clinical, laboratory, and instrumental monitoring was carried out for 24 weeks. Clinical, biochemical, and ultrasound studies, including liver elastography, were applied.

RESULTS

The use of UDCA (Ursosan 15 mg/kg for 24 weeks) to treat NAFLD and gallbladder abnormality in methotrexate-treated patients with progressive moderate and severe psoriasis contributed to the normalization of hepatic steatosis index, lipid composition, and lithogenic index, to the reduction of biliary sludge, and to the stabilization of liver fibrosis. Improvement in the functional status of the liver and gallbladder has contributed to the achievement of a more complete remission of dermatosis.

CONCLUSION

The effects of UDCA in the therapy of NAFLD and gallbladder abnormality in patients with progressive psoriasis were greater than those of phosphogliv.

Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment

Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.

Spotlight on brodalumab in the treatment of moderate-to-severe plaque psoriasis: design, development, and potential place in therapy

Brodalumab is a novel fully human immunoglobulin G2 monoclonal antibody that antagonizes the interleukin (IL)-17 pathway by binding with high affinity to human IL-17RA. The role of IL-17A in the pathogenesis of psoriasis, as well as the remarkable effectiveness of IL-17 inhibitors in the treatment of moderate-to-severe plaque psoriasis, is well established. The mechanism of action of brodalumab is unique in that it inhibits the IL-17 receptor compared to the two other currently FDA-approved IL-17 inhibitors, secukinumab and ixekizumab, which inhibit the IL-17A molecule itself. The efficacy of brodalumab in the treatment of moderate-to-severe plaque psoriasis has been demonstrated in phase 2 and 3 trials, and subsequently the FDA approved this medication in February 2017. Brodalumab was approved in Japan in July 2016 and approval is pending in Europe. The safety and adverse effects of brodalumab were reviewed across several clinical trials, which, similar to other IL-17 inhibitors, demonstrated increased rates of neutropenia and Candida infections. Brodalumab treatment, similar to ixekizumab and secukinumab, showed no improvement in inflammatory bowel disease patients, and on the contrary, more exacerbations were encountered. Suicidal ideation and behavior events have been reported with brodalumab treatment and are of significant concern. Brodalumab provides another highly effective treatment option for moderate-to-severe plaque psoriasis.

First-in-human randomized study of bimekizumab, a humanized monoclonal antibody and selective dual inhibitor of IL-17A and IL-17F, in mild psoriasis

AIMS

To assess safety, pharmacokinetics (PK) and clinical efficacy of bimekizumab (formerly UCB4940), a novel humanized monoclonal antibody and dual inhibitor of interleukin (IL)-17A and IL-17F, in subjects with mild plaque psoriasis.

METHODS

Randomized, double-blind, first-in-human study of bimekizumab in 39 subjects who received single-dose intravenous bimekizumab (8-640 mg) or placebo (NCT02529956).

RESULTS

Bimekizumab demonstrated dose-proportional linear PK and was tolerated across the dose range assessed. No subject discontinued due to treatment-emergent adverse events and no severe adverse events were reported. Bimekizumab demonstrated fast onset of clinically-meaningful effects on skin of patients with mild psoriasis as early as Week 2. Maximal improvements (100% or near 100% reductions from baseline) in all measures of disease activity were observed between Weeks 8-12 in subjects receiving 160-640 mg bimekizumab. The duration of effect at doses ≥160 mg was evident up to Weeks 12-20 after a single intravenous dose, dependent on endpoint.

CONCLUSIONS

This is the first study to demonstrate the safety, tolerability and clinical efficacy of a dual IL-17A and IL-17F inhibitor, in subjects with mild psoriasis. Bimekizumab showed fast onset of clinically-meaningful efficacy by Week 2, with a maximal or near-maximal magnitude of response that was maintained up to study Weeks 12-20. These findings support the continued clinical development of bimekizumab for diseases mediated by both IL-17A and IL-17F, including psoriasis.

Evaluating Dosage Optimality for Tofacitinib, an Oral Janus Kinase Inhibitor, in Plaque Psoriasis, and the Influence of Body Weight

Tofacitinib is an oral Janus kinase inhibitor. An integrated analysis was conducted to evaluate dosage optimality for tofacitinib in patients with moderate‐to‐severe plaque psoriasis and the impact of body weight on optimality in this patient population. Data were pooled from one phase IIb trial (2, 5, and 15 mg twice daily (b.i.d.)) and four phase III trials (5 and 10 mg b.i.d.). A longitudinal exposure–response model for Psoriasis Area and Severity Index (PASI) improvement (percent change from baseline) was established. Body weight influenced potency; heavier subjects require higher doses to achieve comparable benefit to lighter subjects. Disease severity, sex, and prior biologic usage were also predictive of response. The 10 and 5 mg doses were predicted to achieve 81% and 65%, respectively, of the maximum effect based on a 75% improvement in PASI. The greater efficacy of 10 mg over 5 mg was clinically meaningful.

Secukinumab sustains early patient-reported outcome benefits through 1 year: Results from 2 phase III randomized placebo-controlled clinical trials comparing secukinumab with etanercept

BACKGROUND

Psoriasis is a chronic condition with negative impact on patients' quality of life that most often requires lifelong effective and safe treatment.

OBJECTIVE

This analysis focused on the effect of secukinumab treatment on patient-reported health-related quality of life as assessed by the Dermatology Life Quality Index (DLQI) in patients with moderate to severe psoriasis.

METHODS

The proportion of subjects achieving DLQI score 0/1 response at week 24, time to DLQI score 0/1 response, and sustained DLQI score 0/1 response up to week 52 were compared between secukinumab and etanercept.

RESULTS

Of 1470 subjects, 1144 received secukinumab and 326 received etanercept. DLQI score 0/1 response rates were significantly higher for secukinumab than for etanercept at week 24. The median time to DLQI score 0/1 response was significantly shorter for secukinumab versus etanercept (12 vs 24 weeks; P < .01). The majority of secukinumab-treated subjects achieved DLQI score 0/1 response at week 24 and sustained it through week 52 along with a 90% to 100% reduction in the Psoriasis Area and Severity Index total score response.

LIMITATIONS

Placebo comparisons are limited during the maintenance period because of rerandomization at week 12.

CONCLUSION

Secukinumab treatment provided faster and greater sustained improvements in quality of life than etanercept over 52 weeks, consistent with greater clinical response.

Under-Treatment of Patients with Moderate to Severe Psoriasis in the United States: Analysis of Medication Usage with Health Plan Data

Introduction

Psoriasis is a chronic inflammatory disorder with significant morbidity and mortality, but a persistent gap appears to exist for the adequate treatment of patients with moderate to severe disease. As the extent of under-treatment is unknown, we attempted to determine overall treatment patterns and estimate under-treatment using a large database.

Methods

Data from the US National Health and Wellness Survey was used to estimate the proportion of patients with mild, moderate or severe psoriasis. The proportion with moderate to severe disease was estimated by excluding those with mild disease, and projecting this to the total insured US population, weighted by age and gender. Using US health plan claims data, patient totals by treatment type were determined between October 1, 2007 and September 30, 2012. Patients had to be continuously enrolled in a health plan and be ≥18 years at the end of the analysis window. Psoriasis was confirmed if patients had at least one claim of any type of psoriasis except psoriatic arthropathy (ICD-9 code 696.1). A monthly treatment history, classified by biologic, traditional oral systemic, phototherapy and topical therapy, was recorded for each patient.

Results

There were an estimated 1.7 million insured US patients with moderate to severe psoriasis. Of these, 1 million (59%) were not treated for their condition in the preceding year. Among 695,488 patients who were treated for psoriasis in the preceding year, 346,201 were currently receiving treatment and 349,287 had lapsed treatment. Of the patients lapsed and currently treated in this period, the numbers who received each treatment type were 156,409 (biologic), 222,657 (traditional oral systemic), 22,911 (phototherapy), and 293,511 (topical). A limitation of the study was that only insurance claims were analyzed.

Conclusion

Moderate to severe psoriasis remains persistently untreated or under-treated. We suggest that potential barriers preventing access to care be explored.

Funding

This study was sponsored by Pfizer Inc.

Reliability and validity of the Psoriasis Itch Visual Analog Scale in psoriasis vulgaris

INTRODUCTION

The single-item Psoriasis Itch VAS was developed to measure itch intensity within the last 24 hours in psoriasis vulgaris to assess treatment benefit. Its psychometric properties were explored in two trials.

METHODS

Data from two randomized, parallel-group phase 3 trials with subjects suffering from psoriasis vulgaris on the body (n = 426, 463) were analyzed. Cross-sectional distributional properties and construct validity of the Psoriasis Itch VAS as well as longitudinal test-retest reliability and sensitivity to change of the Psoriasis Itch VAS were investigated. All statistical tests were two-tailed.

RESULTS

Across both trials, acceptable distributional properties were observed. Convergent-validity correlations between the Psoriasis Itch VAS and other patient-reported and clinician-reported outcomes provided strong endorsement for construct validity as did tests of known-groups validity. Longitudinal measurement properties, involving test-retest reliability and sensitivity to change, also offered evidence for the measurement integrity of the Psoriasis Itch VAS.

DISCUSSION

Results from the assessment of validity, reliability, and sensitivity to change support the use of the Psoriasis Itch VAS to measure itch intensity in psoriasis vulgaris. Data from two trials provided evidence that the Psoriasis Itch VAS is well-defined and reliable for measuring itch in psoriasis vulgaris to assess treatment benefit (i.e. therapeutic response).

FamilyPso - a new questionnaire to assess the impact of psoriasis on partners and family of patients

BACKGROUND

Psoriasis is a lifelong disease for which there is no cure. It has been conclusively shown across all ethnicities that patients suffering from psoriasis have a significantly reduced health-related quality of life and a high disease burden.

OBJECTIVE

Surprisingly little is known about the impact of a patient's psoriasis on partners or family members.

METHODS

To address this issue a systematic literature search has been conducted and interviews with relatives of psoriasis patients living in the same household were performed. From this collected information, items were generated that were commonly mentioned to affect living and tested in a large group of relatives before the final item selection was done.

RESULTS

A first set of 29 items was selected and tested in a study with 96 patient relatives. After adjustment and statistical analysis, the final FamilyPso questionnaire was condensed to 15 items to assess the burden of partners or family members living together with psoriasis patients.

CONCLUSION

The FamilyPso enables physicians to achieve a better understanding of the impact of psoriasis as a lifelong chronic disease on partners and the family environment.

Interleukin-17 inhibitors. A new era in treatment of psoriasis and other skin diseases

Psoriasis is a chronic skin disease caused by the excessive secretion of inflammatory cytokines. Available therapeutic options include biologic drugs such as tumor necrosis factor alpha inhibitors and interleukin 12/23 (IL-12/23) inhibitors. The recent discovery of IL-17, which contributes to development of psoriasis, opened new possibilities for further treatment modalities. Currently, one anti-IL17 biological agent is approved for the treatment – a fully human monoclonal antibody that targets IL-17A (secukinumab). Further clinical trials, including a humanized IgG4 specific for IL-17 (ixekizumab) and a fully human antibody that targets the IL-17 receptor A (brodalumab).

The Lived Experience of Psoriasis Patients from Social Stigma and Rejection: A Qualitative Study

BACKGROUND

Psoriasis is a common, chronic skin disease that causes challenges such as stigma and labeling from both the community and individuals due to its effects on appearance.

OBJECTIVES

The objective of this study was to describe and explain the social stigma and rejection experienced by patients with psoriasis.

PATIENTS AND METHODS

The present research is a qualitative study with a hermeneutic phenomenological approach conducted among psoriasis patients referring to the dermatology clinic and ward of Imam Khomeini hospital in Ahvaz, Iran between June and December 2014. In this study, 15 patients with psoriasis were selected by purposeful sampling, and they were asked to express their experience of stigma and rejection. The data were collected through in-depth semi-structured interviews, and Diekelmann and colleagues' method was used for data analysis.

RESULTS

After analysis of interviews, four themes were extracted: lack of social support, unrealistic and inappropriate labeling, rejection and isolation, and feeling of absurdity and futility. These can be indicative of the patients' experience from social stigma and rejection phenomena.

CONCLUSIONS

Patients' experiences of stigma and rejection phenomena indicated that all aspects of their lives are affected. Moreover, these findings highlight the significance of stigma and rejection concepts in providing better care to these patients.

Effect of a family history of psoriasis and age on comorbidities and quality of life in patients with moderate to severe psoriasis: Results from the ARIZONA study

Psoriasis is a chronic inflammatory skin disease whose clinical characteristics vary from patient to patient. We aimed to analyze how comorbidities and quality of life (QoL, as per the Dermatology Life Quality Index [DLQI]) may be affected by a family history of psoriasis and by age. The ARIZONA study was a multicenter, cross-sectional study in 1022 adult patients diagnosed with moderate to severe psoriasis at least 6 months prior to inclusion. The severity of psoriasis and the proportion of patients with comorbidities were not affected by the presence of a family history. The regression analysis revealed that the presence of a family history of psoriasis was associated with the effect on the patient's QoL (P = 0.002), regardless of disease severity. The mean DLQI total score varied significantly across age groups (5.1 ± 5.3 for the 18-30-year group, 5.7 ± 6.5 for the 31-60-year group and 3.8 ± 5.1 for the >60-year group; P = 0.001). In conclusion, the presence of a family history of psoriasis appears to disrupt QoL in patients with moderate to severe psoriasis, but it hardly affected the prevalence of comorbid conditions. The effect of age on QoL was particularly noticeable in younger patients, highlighting its negative impact. As expected, older patients appeared to be burdened with a higher number of comorbidities than their younger counterparts.

Assessment of pruritus in patients with psoriasis and atopic dermatitis: subjective and objective tools

Pruritus is a major symptom of skin disease. The quest to identify a valid and reliable method to assess this important symptom has led to the development of a myriad of measurement tools. Some clinical trials using subjective measurements of itch intensity have reported itch intensity levels in psoriasis that are close to severity levels found in atopic dermatitis. Although it is possible that we have previously underestimated the severity of pruritus in psoriasis, these unexpected findings prompted us to review and evaluate these subjective methodologies. We provide an overview of the current tools available to measure itch severity, including subjective rating scales and questionnaires and objective measures of scratch activity through videotape observation and wrist actigraphy. We discuss the advantages and limitations of these methods and encourage consideration of a novel objective method of evaluation.