Category Archives: Psoriasis

Dermavants tapinarof launch will need to withstand some turbulence, but it still has a chance of breaking through the atmosphere.

This is according to analysts at Jefferies, who forecast stormy weather ahead for the topical psoriasis drug that is looking for a second-quarter approval and a swift launch.

There is a troika of challenges on the horizon for tapinarof. First, COVID: The pandemic is not over, as omicron has reminded us, and this will continue the pressure we have seen on all drug launches.

Jefferies notes that the COVID chaos means many launches have disappointed even from large cap biotechs and pharma, so dont be surprised if Dermavanta small biotech that's part of the Roivant cluster of biopharmasalso ends up struggling.

RELATED: Arcutis' topical cream hits goal in psoriasis phase 3, setting up FDA filing and market showdown

The psoriasis market is already a competitive and a tight one, with high efficacy biologics from several Big Pharmasincluding the $20 billion-a-year Humira from AbbVieJohnson & Johnsons Remicade and its biosimilars along with newer follow-up drugs like Skyrizi and Tremfya. That all combines to put significant pressure on any new drug entry.

Third, Jefferies says that when you look back, past topical launches have generally looked mixed. Older topical creams for the condition include Bausch Healths Duobrii and Almirall/MC2s Wynzora, with the former making just $88 million in 2020 (and the latter only nabbing approval in mid-2020 and yet to report full-year sales).

Jefferies sees tapinarof revenue this year hitting $10 million at the high end, should it launch around mid-2022, and ramping up to $50 million in 2023 for its psoriasis label.

But Dermavant is clearly focused on a strong trajectory and is currently building out a sales team, adding 75 to 100 reps and looking to strengthen market access over the next few months, the analysts said in a note to clients.

Dermavant forked over 150 million pounds sterling ($198 million) upfront in 2018 to get its hands on what was then GlaxoSmithKlines phase 3-ready psoriasis cream. Since then, Dermavant ran its own tapinarof trials, which have broadly shown efficacy, but it's hoping the big win will be on safety.

The current crop of blockbuster psoriasis and plaque psoriasis biologics all need injecting, and the systemic nature of these drugs can lead to immune system-related side effects. A topical cream should, in theory, be safer overall.

RELATED: Dermavant shows deepening effects of tapinarof on psoriasis ahead of FDA filing

But Dermavant already has topical rivals waiting in the wings. Arcutis Biotherapeutics is also anticipating an FDA decision this yearJuly 29, to be exactfor its hopeful ARQ-151, a topical formulation of the PDE4 inhibitor found in AstraZenecas chronic obstructive pulmonary disease treatment Daliresp.

There are also pills for psoriasis on the market, including Amgens Otezla, another PDE4 inhibitor that it bought from Bristol Myers Squibb in 2019.

And then there's Bristols own oral follow-up to that drug, deucravacitinib, a TYK2 drug and a member of the JAK family.

Pfizers Xeljanz, as a JAK inhibitor, is facing the same scrutinyand was all the way back in 2015 slapped with an FDA complete response letter for its oral psoriasis med, with the Big Pharma later giving up on getting it approved for that indication.

Dermavant's new sales team will have to chart a difficult course but will hope to rise to the challenge.

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Dermavant faces a perfect storm of pressures for tapinarof, but there is hope for the psoriasis drug - FiercePharma

Introduction

Psoriatic arthritis (PsA) is a chronic autoinflammatory condition distinguished by a variety of clinical phenotypes. It is most frequently associated with patients who have psoriasis (PsO). It is a devastating form of spondyloarthropathy that significantly affects patients life and increases cardiovascular mortality and mortality in general.1,2 Based on a rising awareness and knowledge of the immunologic mechanism, psoriatic disease is increasingly being regarded as a systemic disease, the consequences of which impact more than skin and joint health.3,4 The interest in determining the cardiovascular (CV) disease risk factors linked to PsA and PsO has intensified, with most of the early data and the underlying pathogenetic theories informed by the literature on rheumatoid arthritis (RA).5,6 Retrospective and prospective data from the large observational cohort, and evidence gleaned from various imaging techniques, show that PsO and PsA are linked to increased CV risk.4,7,8 Previous studies also indicate that CV diseases are the leading etiology for deaths in PsA patients, accounting for between 20% and 56% of those deaths.9,10 A relationship has been established in previous studies between increased risk of contracting CV disease in PsA and the existence of cardiometabolic risk factors, namely high blood pressure, adiposity, diabetes, hyperlipidemia, and chronic system inflammation.11 Moreover, the prevalence of MetS, described as an amalgamation of the risk factors mentioned above, is also higher in individuals diagnosed with PsA.

Metabolic syndrome denotes a collection of metabolic risk factors that increase the probability that CV disease will develop. Since the 1940s, there has been evidence that some metabolic abnormalities are associated with CV disease. Insulin resistance (IR), hypertension (HTN), abnormal cholesterol levels, and obesity are examples of these metabolic factors.

Metabolic syndrome is a grouping of five traditional CV risk factors. There are five distinct MetS definitions.1214 However, it has been proven that the various definitions of MetS are comparable in terms of prognosis and therapy.15 According to the most widely used current guidelines, which were revised by the National Heart, Lung, and Blood Institute (NHLBI) as well as the American Heart Association (AHA) in the United States in 2005, the diagnosis of MetS can be made if an individual has a minimum of three out of five of the conditions listed in Table 1.13

Table 1 Definition of Metabolic Syndrome According to AHA/NHLBI Revised in 2005

Metabolic syndrome is increasing in importance as a worldwide health concern. It is typically asymptomatic but significantly influences general health, mainly by increasing the risk of CV disease.

Psoriatic arthritis, Metabolic syndrome, and atherosclerosis may have overlapping inflammatory pathways and genetic predispositions in their underlying pathophysiology (Figure 1). There is an increased prevalence of chronic inflammation mediated by Th1 and Th-17 with cytokine dysregulation in PsA.16,17

Figure 1 The link between inflammation, psoriatic arthritis, and metabolic syndrome; Obesity is one of the important components of metabolic syndrome and is a well-known risk factor for psoriatic arthritis. Both obesity and PsA share a complex relationship that is likely bidirectional. Increased pro-inflammatory cytokines, secretion of adipocytokines from adipose tissue, increased of oxidative and endoplasmic reticulum stress, and dysbiosis of intestinal microbiota all play a role in the development of MetS and increase the risk of cardiovascular disease in psoriatic patients.

The pathogenesis of PsA is complicated and poorly known; The most widely acknowledged hypothesis involves an interplay between genetic predisposition and environmental exposures, resulting in immune-inflammatory pathway dysfunction. In individuals with a certain genetic history, the gut microbiota may be the missing piece in pathogenesis of PsA.

Recent evidence has emerged supporting the gut microbiomes pathogenic role in a different immune-mediated inflammatory disorders, such as diabetes mellitus, spondyloarthritis, and CV disease, the majority of which are well-known comorbidities of PsO and PsA.1820

So far, several studies on the intestinal microbiome of psoriatic patients have already been published, and four of them have demonstrated an imbalance between the two most prevalent intestinal flora, Firmicutes (F) and Bacteroidetes (B), with an increased F/B ratio.21 This kind of gut dysbiosis has been linked to diabetes, obesity, and CV disease.2224 Moreover, the presence of intestinal firmicutes was linked to a higher BMI and greater levels of the proatherogenic chemical trimethylamine-N-oxide, that raises the risk of CV events by enhancing endothelial dysfunction and interfering with cholesterol homeostasis at several levels.25,26

Furthermore, considering the comparable pathogenic aspects of obesity and psoriatic disease, both of which are characterized by similar cytokine profiles, an elevated F/B ratio might be another significant factor contributing to the pathogenesis of both of these diseases.27

Insulin resistance can be caused by a release of different cytokines, for example, tumor necrosis factor-, interleukin-17, or interleukin-6.28 Leptin is another adipokine that has a role in MetS and PsA pathogenesis.29 Increased BMI and IR have been linked to a high level of leptin.30 Endothelial dysfunction and the development of atherosclerotic plaques are caused by these inflammatory cytokines, which produce adhesion molecules and an elevated risk of CVS events in PsA.31

Metabolic syndrome has been discovered to be much more prevalent among people with PsA, PsO, and other inflammatory illnesses than in the overall population.3234 Raychaudhuri et al explored in their study, which included 105 patients with PsA that 58.1% of them diagnosed with MetS based on the AHA/NHLBI guidelines, and 61 of them satisfied a minimum of three out of five criteria for the diagnosis of the condition.35

Previous research by Haroon et al detected MetS in 44% of 283 PsA patients. They also discovered that around half of those diagnosed with MetS showed 4 MetS risk factors, with HTN (74%), increased circumference of the waist (56%), and hypertriglyceridemia (43.5%) appearing more frequently. Moreover, the study found that MetS was correlated with increased odds in patients with severe underlying disease (OR 4.47, p=0.001).7

An increasing amount of clinical research has established that PsO is frequently linked with MetS. Patients with more extensive PsO were shown to have an increased chance to have MetS than those with mild disease.3638 A large cohort study from Toronto investigated the MetS prevalence in PsA and compared them to PsO patients who did not have arthritis, finding a higher but not statistically significant prevalence of MetS in the former.39 Evidence from the literature and recent cross-sectional research indicates that those with PsA with apparent PsO had a higher frequency of MetS compared to PsA patients who did not have PsO (40.48% vs 13.16%, p = 0.006, respectively).40

The association between MetS and chronic inflammatory arthritis has also been studied. According to research and growing evidence, higher CV risk is not only attributable to an increase in conventional risk factors; it is also associated with factors involving disease and its therapy, such as chronically high pro-inflammatory cytokines and prolonged glucocorticoid therapy.41,42

A large previous study on the MetS frequency incorporated 930 individuals diagnosed with chronic inflammatory arthritis, with PsA having the highest prevalence (38%) followed by RA (20%) and ankylosing spondylitis (11%). Additionally, no significant correlation was discovered between MetS prevalence and disease longevity in the three inflammatory disorders.43 The frequency of MetS was also increasing in PsA patients than in the RA group in a large corona registry study (27% vs 19%; p = 0.02, respectively), even after demographic variables and BMI adjustments. Moreover, among the components of MetS, diabetes, hypertriglyceridemia, and high BMI were more frequent in PsA patients.33

Obesity is a critical element of MetS that can ultimately cause other conditions to develop, including IR, HTN, and increased lipids. It was described as a chronic slow inflammatory state connected to elevated pro-inflammatory cytokine production that follows a common pathway with psoriatic diseases and has a detrimental effect on disease prognosis.44

The connection between adiposity and PsA is difficult to comprehend. For instance, PsA might increase the risk of obesity by decreasing physical activity levels due to the functional and psychological restrictions of the disease. In contrast, obesity may have occurred before PsA developed, emphasizing that it may be a risk factor for the disease.45

Previous serial case studies indicated an increased likelihood of developing PsA in individuals with PsO whose BMI was higher when they were young adults, regardless of other risk factors or current BMI. Hence, patients who had high BMI at the age of 18 are threefold more likely to acquire PsA during PsO course than those with an average weight at 18. However, the study did have several significant limitations, including the way PsA cases were defined, challenges in identifying a temporal connection between the examined factors, and insufficient verified data regarding how accurately patients could remember their BMI at age 18.46

Li et al conducted a 14-year prospective study that discovered a significant link between BMI and an increased incidence of PsA. Furthermore, they found an ascending positive relationship between weight changes started at the age of 18 and PsA risk. They also discovered an analogous relationship in individuals who acquired PsO during a study follow-up.45

Additionally, a large population study showed a link between obesity and an increased chance of acquiring PsA in both PsO patients and the general population, regardless of other characteristics such as gender or age.47

Insulin resistance is a significant cardiometabolic risk for CVS disease, which causes considerable morbidity and death in individuals with inflammatory arthritis. It is uncertain whether IR is a disease-specific feature or linked to high disease activity phases. Inflammatory cytokines, including TNF, IL-6, and IL1, which have frequent involvement in PSA pathophysiology, have been linked to IR in the liver and adipose tissues, impaired insulin action in human skeletal muscle, and an increased risk of DM.48,49

An observational cohort study found a significant prevalence of IR (16%) among patients with PsA. Additionally, multiple regression analysis was conducted, the results of which indicated a significant relationship between IR and increased severity of underlying PsA disease, elevated BMI, and late-developing PsO.50 Furthermore, Eder et al discovered that diabetes mellitus was 43% more common in the PsA group than the total population. Notably, the severity of underlying psoriatic disease was identified as an important factor for developing diabetes across 11,006 overall person-years of follow-up.51

Additionally, Diabetes was shown to be more frequent in PsA patients than in sex- and age-matched persons without the disease (72%, HR 1.72) in a large population-based cohort study. Interestingly, when controlling for BMI, alcohol consumption, smoking, initial glucocorticoid utilization, and co-morbidities, the relationship was considerably decreased but remained significant (33%, HR 1.33) in PsA patients.52 As a result, the presence of inflammatory mediators cannot be entirely blamed for the development of diabetes; nevertheless, other variables, such as overweight and lifestyle habits, may also play an important role.

Furthermore, after controlling for atherosclerosis risk factors in individuals with PsA vs RA or ankylosing spondylitis, Mok et al discovered that PsA patients had more significant impairment in glucose tolerance (OR 2.58, P.001) compared to RA or ankylosing spondylitis patients.43

Hypertension is another essential component of MetS that is linked with an elevated risk of developing CVS disease. Studies indicated that HTN prevalence among PsA patients ranges from 25% to 49%.43,53,54 Furthermore, a large population study reported an increase in the frequency of HTN among those with PsA than in the general population (45.6% vs 35.8%, P < 0.0001 respectively).55 Moreover, individuals with PsA had a higher frequency of HTN than patients having only PsO (29% vs 18%, OR 1.7).56 Similarly, a study of a large cohort from the University of Toronto found also an increase in the HTN frequency among those with PsA in comparison to PsO patients with no arthritis (adjusted OR 2.17), even after controlling for known CVS traditional factors, medication history, as well as PsO duration and severity.32

In a large meta-analysis, the odds ratio of HTN was higher in individuals whose PsO was severe (OR 1.13) than those whose PsO was milder (OR1.09). Therefore, this finding emphasizes the significant contribution of inflammation-promoting arterial stiffness, which is linked to elevated hazard of CV events.57

Hypertension prevalence studies in patients diagnosed with different kinds of arthritis revealed a greater prevalence and incidence of HTN in PsA. A higher frequency (19.9% vs 18.6%) and incidence was reported in patients who had PsA than those with RA. Moreover, there was also an increased incidence of HTN among PsA patients in comparison to controls (HR 1.37) than among individuals with RA compared to controls (HR 1.16).11

Dyslipidemia is well known as an independent cardiometabolic risk for CV disease.58 The relationship between dyslipidemia and PsA has been controversial and inconsistent in previous studies. One explanation for this might be that various definitions of dyslipidemia are used throughout the research, making it impossible to compare data concerning the relative prevalence. Furthermore, it has yet to be confirmed if dyslipidemia considered as a distinct cardiometabolic risk factor for CVD in PsA beyond obesity.

According to the findings of a large PsA cohort study conducted in the Middle East, participants with PsA had a greater prevalence of hyperlipidemia than the total population (OR 1.5, P.0001).55 In addition, Kimhi et al discovered a rise in the prevalence of hypertriglyceridemia, hypercholesterolemia, and low-density lipoprotein (LDL) among PsA patients in their study (p < 0.005, p < 0.0001, and p < 0.0001, respectively).53 Based on data from a previous study on PsA, hypercholesterolemia and hypertriglyceridemia were linked with subclinical atherosclerosis.42

In large HUNT research, hypertriglyceridemia was more frequent in PsA groups when compared to controls. However, it was not statistically relevant after controlling for BMI. Other lipid values were comparable in both groups.59 In contrast, another study indicated that PsA patients had reduced total and LDL cholesterol levels but increased high-density lipoprotein (HDL) cholesterol, apolipoprotein A1 (Apo A1), and Apo B levels in PsA patients than in controls. Moreover, after controlling for BMI and hsCRP, the Apo B/Apo A1 ratio was considerably more elevated among the PsA groups than in the control groups. However, triglyceride levels were comparable across the two groups.54

Apo A1 is regarded to be a significant indicator of increased CV events with possible benefits above HDL cholesterol since it is responsible for transferring and functioning as the principal protein inhibiting atherogenesis in HDL particles.60

Apo B also carries all particles of lipoproteins that are potentially atherogenic. Although there is no consensus on the Apo B/Apo A1 ratio real use in previous studies, the cholesterol balance calculated based on the ratio has been demonstrated to be a superior measure compared with total lipids and lipoproteins levels.61 There is not yet a comprehensive understanding of the mechanisms behind these alterations in patients lipid levels with inflammatory diseases in the literature.

Additionally, multiple factors influence serum lipid levels, such as the patients diet and their usage of biologics or DMARDs. Apo B and triglyceride were elevated in those with PsA after commencing therapy with TNF inhibitor (TNFi), indicating a possible link between inflammation intensity and lipid abnormalities.62 Thus, because disease activity and anti-inflammatory medications can cause changes in lipid components, it is recommended that lipid profiling should ideally be performed when a patient is in stable condition or has entered remission.63

Metabolic syndrome raises the hazard of CV disease and atherosclerosis in PsA patients.6467 A persistent underlying inflammatory state and pathogenetic pathways are shared by MetS, atherosclerosis, and inflammatory arthropathies.68,69 A persistent low-grade inflammatory condition with imbalanced immuno-inflammatory pathways and fatty acid metabolism in the artery wall promotes endothelial dysfunction.70

An increase in the carotid artery intima-media thickness(c-IMT), a predictor of pre-atherosclerosis with greater sensitivity, has been seen in PsA. More crucially, a higher risk of inflammation has been linked to the production of atherosclerotic plaques in individuals with PsA over time.7173

Those with PsA disease had a greater likelihood of atherosclerosis, endothelial dysfunction, and c-IMT, both with or without MetS components.42,53 Atherosclerosis is also linked to the severity of both PsA and MetS components, including obesity, diabetes, and hypertension.53

In addition, those with PsA had a greater frequency of MetS and significantly higher c-IMT levels than people with PsO. Furthermore, when PsA and PsO patients with or without MetS were compared, it was shown that PsA individuals with the coexistence of MetS had the highest c-IMT levels.74

In PsA patients, it has been established that the existence of carotid atherosclerosis has a clear association with CV events, which is related to the duration of PsA as well as the inflammatory condition, and it materializes regardless of the existence of conventional CV risk factors.54,64 Thus, chronic inflammation is crucial for the advancement of atherosclerosis in PsA, which works in an independent and/or synergistic manner with traditional risk factors. Furthermore, Eder et al demonstrated that the c-IMT and carotid plaque area were better than the Framingham risk score in predicting an elevated hazard of acquiring CV events in a population of PsA, which adds credence to the hypothesis that CV morbidity is not purely mediated by standard CVD risk factors in such patients.75

Metabolic syndrome and PsA may have a shared predilection for low-grade inflammation; thus, it is crucial to find a suitable therapy that effectively decreases both clinical and subclinical chronic inflammation.

Data from previous studies support the role played by Methotrexate (MTX) in lowering inflammation in patients with chronic inflammatory conditions and consequently reducing CV risk. However, most of the data were derived from rheumatoid arthritis patients.76,77

An observational study that included patients diagnosed with inflammatory arthritis and confirmed to have endothelial dysfunction indicated that all patients experienced a marked improvement in endothelium function following six months of therapy with MTX monotherapy, MTX combined with TNFi, or only TNFi. Nevertheless, after six months of therapy, endothelial function improvement was more sustained and significant in the MTX- treated patient compared to those treated with combination therapy.78

A 12-week pilot study explored the safety of MTX in terms of glucose metabolism in PsA and MetS patients and reported no difference in glycated hemoglobin levels before and after therapy. Thus, MTX usage in this patient group is safe, with no hyperglycemic consequences. In fact, MTX seems to have a beneficial effect on glucose metabolism because commencing MTX therapy reduced glycated hemoglobin levels compared to the use of metformin.79

There is significant debate surrounding the efficacy of TNFi in MetS patients. Numerous studies have demonstrated that TNFi is less effective in obese people.80 In a large meta-analysis, a relationship was established between being an obese and inadequate response to treatment among PsA patients.80 Additionally, Obesity was linked to reduced chances of attenuating lower disease activity in PsA, highlighting the critical need of patients with PsA decreasing weight.81 In contrast, data from another study discovered that the coexistence of MetS did not influence the anti-inflammatory role of TNFi or the risk that minimal disease activity would be attained.82

In a cohort study in which the follow-up period was 24 months, Costa et al found that patients who received etanercept (ETN) and adalimumab treatment exhibited considerable improvements in metabolic syndrome components (circumference of the waist, triglycerides, HDL-C, and glucose) in comparison to MTX group.83 Furthermore, some few studies have revealed that patients managed with TNFi had a decreased chance of getting diabetes than those managed with disease-modifying antirheumatic medication (except hydroxychloroquine).84

The influence of TNFi on the cholesterol level in individuals with the underlying chronic rheumatic disease remains unclear; a comprehensive meta-analysis identified that the use of TNFi increased total cholesterol by 10% and HDL-C by 7% over six months. Moreover, LDL-C and ApoB levels have been shown to increase in small studies.85

Agca et al evaluated 118 PsA patients who had received ETN treatment for a period exceeding five years. They found that LDL-C, HDL-C, and triglyceride levels were all increased. Additionally, the ratio for ApoB to ApoAI was reduced, a finding that may have clinical implications given that an elevated ratio is linked to an increased likelihood of CVD events.86

Numerous large population-based studies have demonstrated that TNFi reduces the frequency of CV events in patient with psoriatic diseases. Armstrong et al found that PsO patients who used TNFi had a lower risk of MI than those who solely used topical therapy.87 In another study from Denmark, TNFi and MTX were linked with lower CV risk relative to topical medicines and phototherapy in PsO patients.88

In accordance with these findings, Wu and Poon found that patients with Psoriatic diseases who used TNFi had a reduced risk of new CV events than those who used other systemic medications or phototherapy.89

So, TNFi appears to have CV safety and maybe benefit, and it is favored over other treatments in patients at elevated CV risk, even though relatively little is known.

There is not enough evidence to indicate whether inhibiting IL-17 or IL12/23 improves metabolic syndrome in PsA patients. However, it has been demonstrated that being obese promotes the growth of T cells that produce IL-17 in fat and peripheral tissues. Furthermore, in patients with MetS, the IL-17R expression levels in the skeletal muscles and liver were linked to insulin resistance.56 Therefore, according to a large multi-center study, PsO patients who are obese have a lower response to secukinumab.90 However, another study found that obese PsA individuals may respond better to secukinumab than non-obese patients.91

Concern has been raised about the anti-IL-12/23 class of medications and the incidence of CV disease in PsA. However, a large, randomized trial on people with PsO found no association between ustekinumab usage and the risk of CV disease.92 More evidence on the CV safety of anti-IL-12/23 medications in psoriatic individuals is needed.

For therapy in PsA patients to be optimized, it is necessary to treat the skin and joint condition and identify and effectively manage co-morbidities.63 Much additional research must be done to fully grasp the complicated connection between PsA and MetS. The specific PsA variables linked to MetS must be identified, and it must be determined whether anti-inflammatory treatment approaches have any beneficial effect on MetS. Additionally, despite the existence of various DMARDs for the treatment of PsA, other factors, including the presence of co-morbidities, particularly MetS and CVS disease, must be taken into account when choosing suitable drugs for PsA management.93,94 The European Alliance of Associations for Rheumatology strongly encourages the adoption of lifestyle changes to mitigate CV risk factors.63 However, more investigation is needed to determine whether these strategies can augment or alter the effect of therapy on patients with MetS burden.

Psoriatic arthritis can present with various extra-articular symptoms that can manifest in isolation or together and that may take variable courses. Metabolic syndrome is intricately linked to systemic inflammation and has multiple inflammatory pathways in common with Psoriatic disease. The link between several components of MetS and psoriatic arthritis has been established, addressing the needs of screening, evaluating, and closely monitoring for co-morbidities. Therefore, rheumatologists should collaborate with other experts to detect MetS and its components as early as possible. In PsA patients with co-morbidities, the most appropriate therapy must be chosen for managing disease activity. Lifestyle changes, including smoking cessation and weight loss, are essential to decreasing CV events in PsA patients.

The author reports no conflicts of interest in this work.

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32. Husted JA, Thavaneswaran A, Chandran V, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res. 2011;63(12):17291735. doi:10.1002/acr.20627

33. Labitigan M, Bahe-Altuntas A, Kremer JM, et al. Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis. Arthritis Care Res. 2014;66(4):600607. doi:10.1002/acr.22185

34. Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. Int J Rheum Dis. 2021;24(9):11121120. doi:10.1111/1756-185X.14147

35. Raychaudhuri SK, Chatterjee S, Nguyen C, Kaur M, Jialal I, Raychaudhuri SP. Increased prevalence of the metabolic syndrome in patients with psoriatic arthritis. Metab Syndr Relat Disord. 2010;8(4):331334. doi:10.1089/met.2009.0124

36. Rodrguez-Ziga MJM, Garca-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol. 2017;77(4):657666.e8. doi:10.1016/j.jaad.2017.04.1133

37. Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutr Diabetes. 2012;2(12):e54. doi:10.1038/nutd.2012.26

38. Caroppo F, Galderisi A, Moretti C, Ventura L, Belloni Fortina A. Prevalence of psoriasis in a cohort of children and adolescents with type 1 diabetes. J Eur Acad Dermatology Venereol. 2021;35(9):13. doi:10.1111/jdv.17318

39. Eder L, Jayakar J, Pollock R, et al. Serum adipokines in patients with psoriatic arthritis and psoriasis alone and their correlation with disease activity. Ann Rheum Dis. 2013;72(12):19561961. doi:10.1136/annrheumdis-2012-202325

40. Caso F, Del Puente A, Oliviero F, et al. Metabolic syndrome in psoriatic arthritis: the interplay with cutaneous involvement. Evidences from literature and a recent cross-sectional study. Clin Rheumatol. 2018;37(3):579586. doi:10.1007/s10067-017-3975-0

41. Del Rincn I, Freeman GL, Haas RW, OLeary DH, Escalante A. Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis. Arthritis Rheum. 2005;52(11):34133423. doi:10.1002/art.21397

42. Gonzalez-juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57(6):10741080. doi:10.1002/art.22884

43. Mok CC, Ko GTC, Ho LY, Yu KL, Chan PT, To CH. Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res. 2011;63(2):195202. doi:10.1002/acr.20363

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Metabolic syndrome and its components in psoriatic arthritis | OARRR - Dove Medical Press

A WOMAN has been left feeling embarrassed after she was refused a massage at a Windsor spa.

Rubina Latif, 55, of London, visited Thy Spa, on Windsor High Street, to celebrate one of her friends birthday on February 9.

The group of five, all from different areas, planned to go to the town as it was middle ground for them all to meet up.

But little did Ms Latif know that she was going to have a truly disturbing experience when she went.

Ms Latif, who has psoriasis, a skin condition which causes red, itchy scaly patches, has been a massage therapist herself for 35 years.

Rubina Latif has been a massage therapist herself for 25 years. Picture: Rubina Latif

She said she has never been refused a massage at previous spas.

The therapists are always very understanding, and will ask if anything irritates my skin, but oils never do, and in fact are good for the condition, she said.

When she went into the treatment room,she pulled up her robe to wash her feet and said the "look of distaste"was apparent.

And when the therapist asked what the skin condition was, Ms Latif explained it was psoriasis, which she had informed reception upon arrival.

"It was so embarrassing, she said.

Two of my friends could hear the whole conversation and the therapist just told me my skin was sensitive and by now I was starting to feel extremely uncomfortable.

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The staff member went to speak to another colleague who then asked Ms Latif to remove her towel and show her skin.

She said: At this point I was so upset with the way I was being treated, I got up in tears, and left the room. I have never ever been treated this way and I was left sobbing in the changing room.

Ms Latif added her two friends who heard the situation asked their therapists to stop their treatments so they could comfort her.

This is an appalling way to treat someone, she said.

I wonder whether the therapists are adequately trained, but they clearly lack the ability to deal with customer with empathy and compassion. This has had a serious effect on my confidence, and also gave me a huge panic attack.

Thy Spa on Windsor's High Street

Ms Latif received a response from the spa manager Baz on the same day explaining it would have been difficult to massage the area due to her skin condition.

Thy Spa Windsortold the Observerthey regularly treat clients with autoimmune conditions.

Bazsaid for skin-to-skin contact treatments the therapists are instructed to avoid inflamed areas in order to not cause potentialfurther harm to skin.

This includesthe possibility of bleeding or increased inflammationafterwards.

READ MORE:Rowers take on 24-hour challenge for world record attempt

Our therapist was trying to politely explain to the lady why she could not perform thetreatment, but the lady was not ready to listen to the reasoning, and kept insisting that massage must be performed, he said.

Baz explained in the case of severe conditions they may not be able to offer treatment for the safety of the client.

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Woman with psoriasis refused massage at Thy Spa Windsor - Slough and Windsor Observer

An array of agents exist for the symptomatic treatment of psoriasis. Patients with mild-to-moderate psoriasis typically receive topical treatments that modulate gene transcription, promote keratinocyte differentiation, and inhibit cell proliferation.

A number of innovative and advanced therapies for the treatment and management of psoriasis are under development, many of which have novel targets and mechanisms of action. Psoriasis is linked with a number of medical conditions inclusive of psoriatic arthritis, depression, and cardio metabolic syndrome. The most commonly occurring form of psoriasis is chronic plaque.

Common treatment methods of psoriasis include topical administration of vitamin D analogues, glucocorticoids, and phototherapy. Moderate to severe psoriasis often calls for systemic treatment.

Prevalence of psoriasis has displayed a growing trend over the past decade. Rising awareness initiatives regarding psoriasis disease and its management & treatment options, increasing reimbursement support, and growing research & development with the adoption of biologics and biosimilars are some of the factors responsible for impacting the psoriasis drugs market and aiding sales growth.

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"Growing adoption of combination therapy and favourable reimbursement support for psoriasis to drive market growth," says an analyst of Persistence Market Research.

Market Competition

Companies such as Amgen and Sun Pharma have been strongly working toward the development of an extensive clinical pipeline and manufacturing of new product lines for the treatment of psoriasis.

Similarly, other psoriasis drug manufacturers are also trying to maintain and strengthen their portfolios through collaborations with local players or distribution partners. All such recent developments related to companies manufacturing psoriasis drugs have been tracked by the team at Persistence Market Research, which are available in the full report.

Key companies operating in the psoriasis drugs market include Janssen Biotech Inc, Novartis International Ltd., Amgen Inc, Pfizer Inc., Takeda Pharmaceutical Company Ltd. Merck & Co, Inc., Abb Vie Inc., Eli Lilly and Company, Boehringer Ingelheim GmbH, and Sun Pharmaceutical Industries Ltd.

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What Does the Report Cover?

Persistence Market Research offers a unique perspective and actionable insights on the psoriasis drugs market in its latest study, presenting historical demand assessment of 2016 2021 and projections for 2022 2031.

The research study is based on the product (topical, oral, and injectable), drug class (interleukin inhibitors, corticosteroids, anti-inflammatory, and tumor necrosis factor inhibitor), distribution channel (hospital pharmacies, retail pharmacies, and e-Commerce), and indication (guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, and plaque psoriasis), across seven key regions of the world.

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Psoriasis Drugs Market is predicted to progress at a CAGR of 6.5% to reach a valuation of US$ 21.48 Bn by 2031 - PR Newswire UK

While there are a number of skin conditions that can cause inflamed, itchy and painful patches, two, in particular, stand out thanks to their similarities: ringworm and psoriasis. With overlapping symptoms, it can be hard to tell which is which.

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But if you know what to look for, there are a few differences, including how each condition is treated. To get a better understanding of both psoriasis and ringworm, and how to tell them apart, we spoke to dermatologist Sean McGregor, DO.

The biggest difference between psoriasis and ringworm, says Dr. McGregor, is the origins of each. Psoriasis is an autoimmune condition, while ringworm is a fungal infection. While a persons autoimmune issues trigger psoriasis, you can acquire the ringworm fungus in a number of different ways, he adds, from soil, other humans or even pets.

Additionally, psoriasis is a chronic condition, meaning it never goes away. Ringworm, conversely, will go away with treatment since its simply an infection.

For treatment purposes, of course, its important to differentiate between the two conditions and know which one you have. No matter which you think you have, though, its always important to contact your healthcare provider so you can get proper treatment.

Ringworm and psoriasis have several overlapping symptoms, which is where confusion can sometimes set in, including:

But there are signs that can help you figure out which condition you may be dealing with.

Dr. McGregor says theres one symptom in particular that can help you figure it out. Ringworm gets its name from a worm-like shape around the edges of the rashes, he says.

One other thing to look for, he advises, is a bit of clearing in the middle of a rash. Ringworm tends to have a little clearing in the center of the rash with more of the inflammation or irritation around that border.

While psoriasis doesnt have symptoms that are as clear cut as those of ringworm, there are a few other ways you might be able to tell that its psoriasis and not something else.

First, if the symptoms are recurring and lack that ring-like feature, it may be psoriasis. Since psoriasis is a chronic condition, it doesnt really go away over a few days with treatment like ringworm will.

Second, about 30% of people with psoriasis develop psoriatic arthritis, a type of arthritis closely associated with psoriasis.

As mentioned, the big difference in treatment is that ringworm can be cured, while the chronic condition of psoriasis is managed. No matter which condition you may have, its best to start by talking to your healthcare provider.

For treating ringworm, Dr. McGregor says, The antifungal cream terbinafine 1% is the best over-the-counter treatment available. Lamisil is the most prominent version of this medicine. If you wind up with ringworm on your scalp, though, your doctor will prescribe you an oral version instead of the topical cream.

There are many home remedies you can try for temporary relief for psoriasis, including:

When it comes to more long-term treatment, though, Dr. McGregor says your doctor will recommend topical steroids or Vitamin D ointment.

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Is It Psoriasis or Ringworm? - Health Essentials from Cleveland Clinic

More patients with moderate-to-severe psoriasis were found to be early responders to ixekizumab vs ustekinumab; all those who achieved early response were associated with stable skin clearance long-term.

Early response to the biologics ixekizumab and ustekinumab was associated with positive long-term efficacy outcomes in the treatment of moderate-to-severe psoriasis, according to study findings published in the Journal of Drugs in Dermatology.

In the management of patients with psoriasis presenting with more severe disease, researchers noted that defining and predicting high levels of clinical response, as well as identifying which patients are at risk of not having such levels, is key in tailoring treatment plans.

Although baseline Psoriasis Area Severity Index (PASI) and body mass index scores have served as modifiable predictors of response, use of these metrics has not consistently determined response to biologic therapies.

Preliminary data have shown early response to treatment is predictive of subsequent clinical improvement in patients with psoriasis, they said.

During ixekizumab treatment, patients who achieve at least a 40% improvement in PASI score (PASI 40) to at least a 50% improvement in PASI score (PASI 50) at weeks 4 and 6 often reach at least a 75% improvement in PASI score (PASI 75) at week 12 with a 90% predictability.

Seeking to further assess how early response rates to biologic therapy may predict long-term response, researchers conducted a post-hoc analysis of the IXORA-S study that compared the safety and efficacy of the interleukin (IL)-17A inhibitor ixekizumab with the IL-12/23 inhibitor ustekinumab in patients with moderate-to-severe psoriasis.

In the analysis, early treatment response rates to ixekizumab and ustekinumab were evaluated by the percentage of patients treated who achieved PASI 50 at week 2 or 4. Early response rates to these therapies were then examined for stable long-term response, as measured by associations with maintaining complete (PASI 100) or almost complete (PASI 90) skin clearance at 80% of monthly visits during weeks 16-52 of treatment.

Nonresponder imputation was used for missing PASI response status, added the study authors.

In their findings, a numerically greater number of patients given ixekizumab achieved early response vs those treated with ustekinumab; these patients were significantly more likely to achieve a stable PASI 90 response (P < .0001) or PASI 100 response (P < .0001) than the ustekinumab group.

Moreover, all patients treated with either ixekizumab or ustekinumab who were identified as early responders were more likely to achieve a stable response of PASI 90 or 100 (Odds Ratio > 1).

In patients with moderate-to-severe psoriasis treated with ixekizumab or ustekinumab, early response was a significant factor in maintaining stable complete or almost complete skin clearance, concluded the study authors. Therefore, rapid response is a clinically relevant factor to consider when optimizing individual therapeutic strategies.

Reference

Augustin M, Gallo G, See K, et al. Early response is associated with stable long-term response in psoriasis patients receiving ixekizumab or ustekinumab. J Drugs Dermatol. 2022;21(2):122-126. doi: 10.36849/jdd.6063

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Early Response to Biologics Linked With Stable Long-term Efficacy in Psoriasis - AJMC.com Managed Markets Network

In an interview with HCPLive, Vibeke Strand, MD, MACR, FACP, Division of Immunology and Rheumatology, Stanford University, discussed her study on the effect of secukinumab in patients with active psoriatic arthritis (PsA).

The Phase 3 data displayed clinical and radiographical efficacy. Patients reported significantly sustained improvements across all dose levels compared with placebo.

This study included patients who were naive to tumor necrosis factor (TNF) inhibitor, as well as patients who were TNF-inadequate or TNF-incomplete responders.

Strand explained that patients who have been heavily treated, who are TNF-incomplete responders, might appear less improved because their scores were lower at baseline compared to patients who were TNF-naive. However, they actually reported very similar amounts of improvement.

"If you account for the fact that they're starting with lower scores because they've had the disease for longer, and they've had more failed treatments, what you can see is that actually, they're able to respond as well as a naive population," Strand said. "It's just that the baseline scores are lower."

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Vibeke Strand, MD, on the Success of Secukinumab for Psoriatic Arthritis - MD Magazine

The research study on the Psoriatic Arthritis Therapeutics market is a detailed analysis of this industry vertical and includes substantial information like the present status of the market over the projected timeline. The basic development trends that the Psoriatic Arthritis Therapeutics market is characterized by over the forecast timeframe is provided in the report, in tandem with the vital pointers such as geographical industry layout characteristics as well as the various industry policies.

The report also includes several valuable information on the Psoriatic Arthritis Therapeutics market size, derived from various industrial sources. The report studies the competitive environment of the Psoriatic Arthritis Therapeutics industry share is based on company profiles and their efforts on increasing product value and production.

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Global Psoriatic Arthritis Therapeutics market forecast 2020-2026 report presents a pin-point breakdown of Industry based on type, applications, and research regions. Growth strategies adopted by these companies are studied in detail in the report. The market size section gives the Psoriatic Arthritis Therapeutics market revenues, covering both the historic growth of the market and forecasting the future.

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Research Report and Overview on Psoriatic Arthritis Therapeutics Market, 2021-2026 - Get News Alert

This article was originally published here

Immunotherapy. 2022 Feb 14. doi: 10.2217/imt-2021-0128. Online ahead of print.

ABSTRACT

Background/aim: Multiple sclerosis (MS) is a demyelinating central nervous system disorder with few cases reported to have concomitant spondyloarthritis (SpA) spectrum disorders such as ankylosing spondylitis and psoriatic arthritis. The aim of this study is to evaluate the effectiveness of secukinumab in the treatment of MS and accompanying ankylosing spondylitis or psoriatic arthritis. Materials & methods: In addition to four cases of their own, the authors conducted a systematic literature search. Demographics, comorbidities, symptoms of MS and SpA, medical treatments and changes in clinical and laboratory findings with treatment were recorded. Results & conclusions: After secukinumab therapy, all patients were found to have treatment response regarding axial involvement, without any progression of MS observed. For both SpA spectrum diseases and MS, secukinumab may be an appropriate choice.

PMID:35152720 | DOI:10.2217/imt-2021-0128

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Secukinumab in the treatment of psoriatic arthritis or ankylosing spondyloarthritis with multiple sclerosis: a case series with literature review -...

SINGAPORE A retired general practitioner was fined S$1,500 on Thursday (Feb 10) for his negligence in prescribing medication for a construction worker's psoriasis without running pre-prescription tests on the patient first.

Haridass Ramdass, 77, pleaded guilty to a single charge of endangering Savarimuthu Arul Xaviers personal safety by a negligent act. He was handed the maximum fine.

Savarimuthu died in 2014 aged 28. Haridass was originally charged with causing Savarimuthus death by a rash act, but the charge was later reduced by the prosecution.

The medication that Haridass prescribed, methotrexate, is often used in the treatment of cancer and severe psoriasis a skin disease that causes itchy and scaly patches. Methotrexate can also lead to serious and life-threatening toxic reactions.

Haridass ran Tekka Clinic Surgery on his own in the Little India area at the time, the court heard.

Around Oct 20 in 2014, Savarimuthu developed rashes over his body, face and upper and lower limbs. This prompted him to visit three different doctors to seek treatment.

At Healthway Medical Clinic in Chua Chu Kang, he was prescribed an antiseptic solution, some antihistamines and steroid cream. He went back about two weeks when he noticed his skin rashes had worsened.

He was diagnosed with psoriasis and was prescribed largely the same medication.

He then visited Bless Medical Centre in Boon Lay five days later with skin lesions on his body and limbs, which he said he had been having for months with no improvement.

He was again diagnosed with psoriasis and prescribed medication such as psoriasis oil.

On Nov 24 in 2014, he went to Haridass clinic. The doctor noted that he had extensive reddish and round lesions all over his body, including his scalp.

Savarimuthu said that his skin condition had persisted for 20 days, after which Haridass diagnosed him with psoriasis and administered an injection of Dexamethasone, which is an anti-inflammatory steroid.

Haridass also prescribed 10 tablets of methotrexate, 10 tablets of prednisolone similarly used to treat inflammation and 10 tablets of chlorpheniramine, an antihistamine.

The court heard that Haridass was negligent in failing to arrange for or ensure that Savarimuthu underwent the relevant pre-prescription tests for renal function, liver function and full blood count.

As a result, Haridass failed to discover the patients pre-existing renal impairment and was not conscious of the potentially increased toxic side effects of methotrexate.

Past court documents stated thatSavarimuthu later developed neutropenia and mucositis, leading to a fatal invasive fungal infection.

Neutropenia occurs when a person lacks a certain type of white blood cell, which helps to fight infections.Mucositis happens when a persons mouth or gut becomes sore and inflamed a common side effect of chemotherapy for cancer.

Deputy Public Prosecutors (DPPs) Timotheus Koh and Grace Chua said that methotrexate use in patients with impaired renal function should be undertaken with extreme caution as the impairment will decrease the bodys ability to eliminate the drug.

While the prosecutors noted that deaths have been reported following the use of methotrexate in the treatment of psoriasis, they also agreed with the defence not to make reference on whether Savarimuthu had suffered any adverse effect resulting from its consumption.

'GENUINELY REMORSEFUL'The prosecution sought the maximum fine, noting that the sentence must adequately deter negligence by medical professionals.

Doctors are vested with enormous responsibility and influence by their patients who, in entrusting their health and well-being to them, often accept their professional judgements unquestioningly.

This dynamic is even more pronounced in the case of foreign workers like the patient, who lack the knowledge and language ability to effectively interrogate their doctors recommendations, the prosecution added.

The risk to Savarimuthu was also of significant danger, the DPPs said. Methotrexate toxicity has been reported to cause fatal opportunistic infections, such as by fungi, which can be aggravated in patients with impaired renal function such as Savarimuthu.

In mitigation, Haridass lawyer, Senior Counsel Davinder Singh from Davinder Singh Chambers, said that there was no risk of the doctor committing the offence again as he has retired and not renewed his practising certificate.

Haridass is genuinely remorseful and accepts he was wrong, Mr Singh added in agreeing for a fine of S$1,500 to be imposed.

District Judge Eddy Tham noted that the doctor had been charged only with endangering Savarimuthus personal safety.

I will assume that none of the grave consequences (mentioned in court) had come to pass If any significant harm had resulted to the patient, in fact, I would have had no hesitation in imposing a custodial sentence, he told the court.

Those convicted can be jailed for up to three months or fined up to S$1,500, or punished with both.

CORRECTION: An earlier version of the headline implied that the patient had died because of the medication prescribed to him by the doctor. However, the prosecution and defence had agreed his death was not directly linked to the doctor's prescription. We are sorry for the error.

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GP fined S$1500 for negligence after giving medication to patient without pre-prescription tests - TODAY