Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S13 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement outcome. in clinical trials, the nnt is the number of patients who are treated to get one patient to beneft when compared to a control patient. 17 fortunately, based on prescribing information provided in product labeling and clinical trials, it is possible to know the nnt scores for a variety of psoriasis drugs for various outcomes (table 2). the old treatment paradigm for psoriasis modeled a stepwise progression starting with over-the-counter (otc) products, such as emollients, and advancing to prescription topicals (including topical steroids, vitamin D analogs, retinoids), phototherapy options, and fnally systemic therapy. in this traditional treatment scheme, patients had to move step by step through the system and could not advance to the next step until they had failed the current step. in other words, patients could not get phototherapy until they had failed prescription topicals. this has given way to our emerging psoriasis treatment model, which commences with topical therapy; if a patient fails topical therapy (otc or prescription products), the patient may be advanced to phototherapy, traditional systemic agents (such as apremilast, acitretin, methotrexate), or biologics, based on the individual patient's preferences and condition. PsOrIAtIC ArthrItIs UPdAtE the societal costs of psoriatic arthritis (Psa) have been and remain enormous. in a nationwide cohort study from Denmark using data from January 1998 through December 2014, 10,525 Psa patients were matched with 20,777 comparators from the general population. 18 at baseline, compared to the general population, Psa patients had more comorbid conditions: cardiovascular disease (odds ratio [or] 1.70, 95% ci: 1.54–1.6), respiratory disease (or 1.73, 95% ci: 1.54–1.96), and infectious diseases (or 2.03, 95% ci: 1.69–2.42). Psa patients had higher total healthcare costs and signifcantly lower income than people in the general population. Perhaps most concerning is the fact that fve years prior to Psa diagnosis, Psa patients were at greater risk of being on disability (risk ratio [rr] 1.36, 95% ci: 1.24–1.4) than individuals in the general population, but that risk increased to 1.60 (95% ci: 1.49–1.72) at the time of diagnosis, and then increased to rr 2.69 (95% ci: 2.40–3.02) 10 years after diagnosis. in fact, a decade after the Psa diagnosis, 22 percent of Psa patients were on disability insurance. 18 about 2 to 3 percent of the population has cutaneous psoriasis, and, of that population, about 30 percent will develop Psa. 19 thus, it becomes important to the healthcare system to better identify those psoriasis patients who are most at risk of developing Psa, to allow for earlier and potentially more edective intervention. the question remains unanswered as to why some patients with psoriatic skin disease do not develop Psa. it has been speculated that Psa may exist in all patients with cutaneous psoriasis but it remains subclinical in most. Better understanding of this so-called "occult Psa" and the transition from psoriatic skin disease to Psa will allow for development of better therapeutic targets. in a study of 85 subjects (55 psoriasis patients and 30 healthy control subjects), high-feld magnetic resonance imaging (Mri) scans were used to evaluate patients with psoriasis for synovitis, osteitis, tenosynovitis, and periarticular ingammation based on the Psa Mri scoring (PsaMris) criteria. 10 at least 47 percent of these patients had at least one ingammatory lesion visible on Mri. the frequencies of the observed lesions were 38 percent ingammatory, 11 percent osteitis, four percent tenosynovitis, and four percent periarticular ingammation. in psoriasis patients with subclinical synovitis and arthralgia- associated symptoms, the risk for developing Psa was as high as 55.5 percent, but was 15.3 percent for those patients with normal Mri scans and no reported arthralgia symptoms. 20 c-c-x motif ligand (cxcl) 10 is a chemokine which is secreted by a variety of cells, including tAblE 2. the number-needed-to-treat (nnt) for various psoriasis drugs and specifc outcomes* drUg dOsE WEEKs nnt COMMEnts PAsI 75 PAsI 90 PAsI 100 apremilast esteeM1 16 3.6 n/a n/a none Methotrexate MetoP 16 3.2 5.6 25 none etanercept 50mg BiW 12 2.2 4.8 25.3 none adalimumab 40mg eoW 16 1.6 2.3 5.3 none ustekinumab 90mg 12 1.6 2.9 9.2 none Brodalumab 210mg 12 1.3 1.5 2.4 Pasi 90 score at 16 weeks secukinumab 300mg 12 1.3 1.7 3.6 none ixekizumab uncover2 12 1.1 1.4 none ingiximab 5mg/kg 10 2.2 4.1 none nnt: number needed to treat; Pasi: Psoriasis area and severity index ; esteeM1: study to evaluate safety and edectiveness of oral apremilast (cc-10004) in Patients With Moderate to severe Plaque Psoriasis nct01194219; MetoP: trial in Patients With Psoriasis treated With Methotrexate using an optimized treatment schedule nct02902861; BiW: twice weekly; eoW: every other week; uncover2: a Phase 3 study in Participants With Moderate to severe Psoriasis nct01597245 *based on package inserts and clinical trial results (results stated as primary endpoints of treatment). note: not all data available

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