Biosimilars for the treatment of patients with psoriasis: A consensus statement from the Biosimilar Working Group of the International Psoriasis Council

Belgian recommendations for managing psoriasis in a changing treatment landscape

Targeted biologic drugs and small molecules have transformed the psoriasis treatment landscape in recent years. The Belgian healthcare system, in common with many others across Europe, must balance the burgeoning use of these transformative, yet expensive, drugs with the sustainable use of limited resources. Drawing on recent updates to the EuroGuiDerm and the German S2 psoriasis guidelines, eight Belgian dermatologists experienced in treating patients with psoriasis undertook a quasi-Delphi initiative to provide perspectives on the current opportunities and challenges in psoriasis. This update focuses on responsible ways to rationalize the use of innovative treatments (e.g. biologics and small molecules). Inherently, this required viewpoints on the International Psoriasis Council's new definition of severe psoriasis, defining psoriasis severity and the concept of treating to target. It discusses the appropriateness of using older biologics classes, biosimilars and personalized dosing and lastly, how teledermatology may play a role in providing sustainable, patient-centric psoriasis care. In addition, this manuscript includes the updated Belgian evidence-based treatment advice in psoriasis (BETA-PSO) to reflect recent data and drug approvals. The recommendations reflect the best practices for clinicians when using systemic and biologic therapies to treat patients with psoriasis and offer guidance on how they may prescribe these drugs sustainably and efficiently.

A randomized, double-blind, phase III study assessing clinical similarity of SB17 (proposed ustekinumab biosimilar) to reference ustekinumab in subjects with moderate-to-severe plaque psoriasis

BACKGROUND

Ustekinumab (UST) is a safe and effective treatment for moderate-to-severe psoriasis.

OBJECTIVES

To compare efficacy, safety, pharmacokinetics (PK), and immunogenicity of the proposed UST biosimilar SB17 with reference UST in subjects with moderate-to-severe plaque psoriasis.

METHODS

In this randomized double-blind study, subjects were randomized to receive 45 mg of SB17 or UST subcutaneously at week 0, 4, and every 12 weeks. The primary endpoint was the percent change from baseline in Psoriasis Area and Severity Index at week 12 with an equivalence margin of [-15%, 15%]. Other secondary efficacy, safety, PK, and immunogenicity endpoints were measured through week 28.

RESULTS

Two hundred forty-nine subjects were randomized to SB17, 254 to UST. Adjusted difference of Psoriasis Area and Severity Index change from baseline at week 12 of -0.6% (95% confidence interval; -3.780, 2.579) was within the equivalence margin. Physician's Global Assessment and Dermatology Life Quality Index were also comparable. Overall treatment-emergent adverse events were comparable (SB17: 48.2%, UST: 48.8%). The overall incidence of antidrug antibodies up to Week 28 was 13.3% with SB17 and 39.4% with UST.

LIMITATIONS

Data were only through week 28.

CONCLUSION

SB17 was clinically biosimilar to UST up to week 28.

‘I don't know which is the chicken and which is the egg’: A qualitative study of weight loss‐related beliefs and behaviours among adults with psoriasis and comorbid obesity

OBJECTIVES

Obesity is a common (30%-40%) comorbidity of psoriasis. Weight loss is shown to improve the severity of psoriasis; however, little is known about the factors that may influence successful weight loss in the context of obesity and psoriasis. The current qualitative study aimed to explore the obesity-associated beliefs, perceptions, and behaviours related to weight loss in psoriasis. Preferences for a weight loss intervention were also explored.

DESIGN

Qualitative in-depth semi-structured interviews were conducted with 24 adults (62.5% male) with moderate-to-severe psoriasis and obesity (mean body mass index = 35.2 kg/m² , SD = 4.1), recruited through a patient organization website in the UK. Data were analysed using inductive thematic analysis.

RESULTS

Most participants viewed psoriasis as unrelated to obesity. A well-controlled psoriasis and improvements in psoriasis symptoms were considered as major motivators for engaging in a weight loss program by individuals who viewed psoriasis and obesity as related conditions. Comfort eating was perceived as an escape strategy from the psoriasis-induced negative emotions. Participants shared their dissatisfaction with current weight loss recommendations which were too generic. They suggested that a desirable weight loss program would require both emotional and behavioural support, with an emphasis on psoriasis' burden.

CONCLUSION

The findings accentuate the importance of (1) clinicians discussing the link between obesity and psoriasis with patients, (2) weight loss advice to include both behavioural and emotional support, and (3) a weight loss advice to consider the psoriasis burden and the perceived barriers which may potentially lead to improved outcomes to obesity management in psoriasis.

The importance of illness severity and multimorbidity in the association between mental health and body weight in psoriasis: Cross-sectional and longitudinal analysis

Background

High body weight is common in psoriasis and is associated with depression and anxiety. Past studies are mostly cross-sectional and may underestimate the role of demographic and illness-related factors in the association between mental health and body weight in psoriasis.

Objectives

This study explored the association between depression and anxiety with waist circumference and body mass index (BMI) cross-sectionally and at 12 months follow-up, adjusting for demographic and illness-related factors in people with psoriasis.

Method

Routine psoriasis care data were combined with data on depression and anxiety from a large specialist psoriasis centre. The analytical samples consisted of patients with complete data on either waist circumference (N = 326 at time 1; N = 191 at follow-up) or BMI (N = 399 at time 1; N = 233 at follow-up) and corresponding mental health, demographic, and illness-related information. Associations between weight-related outcomes and mental health variables were assessed at time one and at 12 months follow-up, after adjusting for demographic and illness-related factors.

Results

We found no evidence of associations between mental health and waist circumference or BMI, after adjusting for age, gender and illness-related factors. Higher age, male gender and illness-related factors, specifically multimorbidity and psoriasis severity, were positively associated with waist circumference and BMI at both time points.

Conclusion

This study revealed the important role of factors related to illness severity in body weight in psoriasis. The contribution of depression and anxiety to weight was not observed here likely due to the sample and methodology used. Future work should explore other psychosocial factors such as weight-related attitudes and emotional eating in the context of weight in psoriasis, to help inform the development of successful weight-management treatments.