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van den Reek JMPA, van der Leest RJT, Thomas SE, Prevoo R, Plantenga ME, de Jong EMGJ. Improved Quality of Life in Patients with Psoriasis Receiving Apremilast: Real-World Data from the Netherlands. Adv Ther 2024; 41:1594-1605. [PMID: 38402373 DOI: 10.1007/s12325-023-02759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/05/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition that can significantly impact the quality of life (QoL), regardless of the level of skin involvement. Apremilast is indicated for the treatment of moderate to severe psoriasis. Real-world data regarding the impact of apremilast on patient-reported outcomes in clinical practice in the Netherlands is lacking. METHODS The prospective, multicenter observational Apremilast in Real-Life Psoriasis Treatment (APRIL) study enrolled patients ≥ 18 years old with moderate to severe plaque psoriasis receiving apremilast in clinical practice in the Netherlands. Patients were followed-up for 12 months, with assessments scheduled at 6 and 12 months. The primary outcome was Dermatology Life Quality Index (DLQI) response (score ≤ 5 or ≥ 5-point improvement from baseline) at 6 months. Secondary patient-reported outcomes included EQ-5D and skin-specific parameters; exploratory outcomes were Patient Benefit Index (PBI) and Work Productivity and Activity Impairment (WPAI). RESULTS Of the 155 patients enrolled (February 2016-June 2019), 153 received apremilast; 69 (45%) and 39 (26%) continued treatment at 6 and 12 months, respectively. Psoriasis in special areas was common (scalp, 65%; nail, 51%; palmoplantar, 27%). Most patients (92%) had received prior systemic antipsoriatic therapies. Of the 151 patients with a baseline DLQI value, 56 (37%) achieved DLQI response at 6 months. Mean (standard deviation) PBI scores were 3.5 (1.2) and 3.8 (1.1) at 6 and 12 months, respectively. Improvements in DLQI, EQ-5D, and WPAI scores and disease signs and symptoms, including itch and special areas, were observed at 6 and 12 months. Adverse events were consistent with the known safety profile. CONCLUSIONS In the Netherlands, patients with moderate to severe psoriasis receiving apremilast for up to 12 months reported improved disease-related QoL, skin involvement, and patient-reported outcomes. These data add to the growing body of evidence demonstrating apremilast is an effective treatment for psoriasis, itch, and special areas (scalp and palms). TRIAL REGISTRATION ClinicalTrials.gov, NCT02652494.
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Affiliation(s)
| | | | - Sarah E Thomas
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud Prevoo
- Zuyderland Medisch Centrum, Limburg, The Netherlands
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Sanchez-Diaz M, Díaz-Calvillo P, Soto-Moreno A, Molina-Leyva A, Arias-Santiago S. Factors Influencing Major Life-Changing Decisions in Patients with Psoriasis: A Cross-sectional Study. Acta Derm Venereol 2023; 103:adv11640. [PMID: 37815093 PMCID: PMC10583836 DOI: 10.2340/actadv.v103.11640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/26/2023] [Indexed: 10/11/2023] Open
Abstract
Psoriasis is a chronic inflammatory disease associated with significant impairment in quality of life. Although quality of life in patients with psoriasis has been widely studied, there is little evidence regarding the impact of psoriasis on major life-changing decisions (MLCD). The aims of this study are to describe the impact of psoriasis on MLCD and to explore the potential clinical factors associated with MLCD. This cross-sectional study included 113 patients with psoriasis, regardless of disease severity, duration, or current treatment. The impact of the disease on different MLCD, including those related to professional career, decision of having children, choice of clothing, and leisure activities, was explored using Likert scales. Mean age was 51 years old and female to male ratio was 1.08 (54/50). The mean Psoriasis Area Severity Index was 3.75, and 30% (35/113) of the patients had psoriatic arthropathy. The most affected MLCD were career choice (median (interquartile range) score 3 (2-4)), social relationships (2 (1-3)), choice of clothing (2 (1-3)), job performance, absenteeism, and choice of holiday destination (1 (0-2)). Female sex, early age of onset and psoriatic arthropathy were associated with a greater impact of the disease on MLCD (p < 0.05). The results showed that a range of MLCD are affected in patients with psoriasis, such as career choice, job performance, absenteeism, or choice of clothing. Female sex, psoriatic arthritis and early age of onset are factors associated with a greater impact on MLCD. In order to limit the long-term negative effects of psoriasis on patients, special attention should be paid to detection of psoriatic arthritis, and to patients with early disease onset.
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Affiliation(s)
- Manuel Sanchez-Diaz
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain
| | - Pablo Díaz-Calvillo
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain
| | - Alberto Soto-Moreno
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain
| | - Alejandro Molina-Leyva
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.
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Bieber T. Disease modification in inflammatory skin disorders: opportunities and challenges. Nat Rev Drug Discov 2023; 22:662-680. [PMID: 37443275 DOI: 10.1038/s41573-023-00735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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Wang J, Zhu Q, Li F, Xiao M, Liu J. Clinical, dermoscopic, and ultrasonic monitoring of the response to biologic treatment in patients with moderate-to-severe plaque psoriasis. Front Med (Lausanne) 2023; 10:1162873. [PMID: 37435540 PMCID: PMC10330810 DOI: 10.3389/fmed.2023.1162873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background Assessment of therapeutic response of psoriasis has relied traditionally on clinical observation, and effective non-invasive tools are desirable. Objectives To investigate the value of dermoscopy and high-frequency ultrasound (HFUS) in the monitoring of psoriatic lesions treated with biologics. Methods Patients with moderate-to-severe plaque psoriasis treated with biologics were evaluated by clinical, dermoscopic, and ultrasonic scores at weeks 0, 4, 8, and 12. Clinical scores, including Psoriasis Area Severity Index (PASI) and target lesion score (TLS), were evaluated at representative lesions. Dermoscopy was performed to assess the red background, vessels, and scales on a 4-point scale as well as the presence of hyperpigmentation, hemorrhagic spots, and linear vessels. HFUS was performed to measure the thicknesses of the superficial hyperechoic band and subepidermal hypoechoic band (SLEB). The correlation between clinical, dermoscopic, and ultrasonic evaluation was also analyzed. Results In total, 24 patients were analyzed and achieved 85.3 and 87.5% reduction of PASI and TLS, respectively, after 12 weeks of treatment. The red background, vessels, and scales scores under dermoscopy were reduced by 78.5, 84.1, and 86.5%, respectively. Some patients developed hyperpigmentation and linear vessels after treatment. Hemorrhagic dots slowly subside over the therapeutic course. Ultrasonic scores were significantly improved with an average reduction of 53.9% in superficial hyperechoic band thickness and 89.9% in SLEB thickness. TLS in the clinical variables, scales in dermoscopic variables, and SLEB in ultrasonic variables decreased the most significantly in the early stage of treatment (week 4) with 55.4, 57.7, and 59.1% (P > 0.05), respectively. Most of the variables, including the red background, vessels, scales, and SLEB thickness, were strongly correlated with TLS. High correlations were also found between the SLEB thickness and the red background or vessels scores, and between the superficial hyperechoic band thickness and the scales scores. Conclusion Both dermoscopy and HFUS were useful in the therapeutic monitoring of moderate-to-severe plaque psoriasis.
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Affiliation(s)
- Juncheng Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Yang J, Hu K, Li X, Hu J, Tan M, Zhang M, Chen J, Kuang Y. Psoriatic Foot Involvement is the Most Significant Contributor to the Inconsistency Between PASI and DLQI: A Retrospective Study from China. Clin Cosmet Investig Dermatol 2023; 16:443-451. [PMID: 36815200 PMCID: PMC9939794 DOI: 10.2147/ccid.s396997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023]
Abstract
Background The Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) are important evaluation tools for assessing psoriasis severity and guiding treatment options. However, the scores of PASI and DLQI are often inconsistent. Objective This study aimed to identify the factors affecting the consistency between PASI and DLQI. Methods The retrospective study was based on 4125 patients. We collected the PASI, DLQI, demographic and clinical characteristics data. Results DLQI has a weak correlation with PASI (r=0.37; P<0.001). For the DLQI >10 groups, DLQI has almost no correlation with PASI (r=0.16; P<0.001). There are 43.60% of mild-to-moderate patients (PASI<10) in the DLQI>10 groups. Our adjusted model showed that foot (OR=2.109; 95% CI:1.581-2.815) involvement led to the greatest impairment of QoL except for PASI≥10 (OR=5.547; 95% CI:3.477-8.845). Furthermore, DLQI impairment was associated with female (OR=1.336; 95% CI:1.071-1.667); the age of 20-39 subgroup (OR=1.795; 95% CI:1.100-2.930); psoriatic arthritis (OR=1.718; 95% CI:1.208-2.443); higher income (OR = 1.408; 95% CI: 1.067-1.858); family history of psoriasis (OR=1.460; 95% CI:1.131-1.885). Moreover, the influence of exposed lesions (such as scalp; face; neck; nails; and hands) were positively associated with severely impaired QoL. Conclusion Dermatologists should recognize the underestimated disease burden of psoriasis patients and actively identify and treat mild-to-moderate patients with high burden. In particular, the foot was a significant contributor to the burden.
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Affiliation(s)
- Jing Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Kun Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Xingyu Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Jingjin Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Minjia Tan
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Mi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Junchen Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsa, Hunan, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsa, Hunan, People’s Republic of China,Correspondence: Yehong Kuang; Junchen Chen, Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People’s Republic of China, Tel +86-13574171102, Email ;
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Elbana AM, Elgamal E, Hashim O, Emran TM, Alkhrsawy AA. Pro-inflammatory versus anti-inflammatory cytokines in psoriatic patients (case-control study). J Cosmet Dermatol 2022; 21:6302-6307. [PMID: 35869799 DOI: 10.1111/jocd.15262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psoriasis (PsO) is a systemic autoimmune disease. Many pro-inflammatory and anti-inflammatory biomarkers have been associated with the pathogenetic process of psoriasis. IL-35 act as an anti-inflammatory cytokine through downregulation of TH-17 cell development and cytokine production. So, IL-35 might be utilized as potential future therapeutic agent for psoriasis. AIMS To investigate the association between inflammatory (IL-17, TNF-α, IFN-γ) and anti-inflammatory cytokines (IL-35, TGF-β) in psoriasis patients. PATIENTS AND METHODS A case-control study enrolled two groups: (Group I: 40 patients with psoriasis) and (Group II: 40 healthy age and sex-matched subjects). Full history was taken from all cases along with full dermatologic examination. The assessment of psoriasis severity was conducted by using PASI score. Assessment of inflammatory (IL-17, TNF-α, IFN-γ) and anti-inflammatory cytokines (IL-35, TGF-β) was performed by using ELISA technique. RESULTS There was a statistically significant increase of mean level of TNF-α, IL-17, and IFN-γ among psoriasis cases in comparison with controls. The mean level of TGF-β and IL-35 was statistically significantly reduced among the psoriasis cases in comparison with controls. TNF-α, IL-17, and IFN-γ showed a significant strong positive association in between and statistically significant strong negative relationship with IL-35 and TGF-β. CONCLUSION IL-35 has a significant role in the pathogenetic process of PsO, and it serves as a potential future therapeutic agent for psoriasis. The current results could be used as a clue for the utilization of inflammatory (IL-17, TNF-α, IFN-γ) versus anti-inflammatory cytokines (IL-35, TGF-β) in psoriasis patients as a diagnostic biomarker for severity of cases with psoriasis.
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Affiliation(s)
- Amaal Mohamed Elbana
- Damietta Dermatology and Leprosy Hospital, Ministry of Health and Population, Damietta, Egypt
| | - Emadeldin Elgamal
- Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Osama Hashim
- Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Tarek Mostafa Emran
- Clinical Pathology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
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