Psoriasis

Introduction

  • Psoriasis (PsO) affects approximately 2% of the population in Europe and the USA, with prevalence ranging from 0.73% (Scotland) to 2.90% (Italy)1,2
  • This condition has a significant negative impact on physical, emotional and psychosocial well-being;3 the reduction in mental and physical functioning may be comparable to those with cancer, diabetes and depression1
  • Treatment is individualised in PsO, starting with topical therapies first, followed by phototherapy, and then oral systemics or infusion therapies; when these measures fail, biologics may be considered4
  • Treatment of PsO can cost upwards of €7,000 per patient, per year5

Burden of PsO

Burden of PsO

Impact

Disease severity

  • Disease severity assessment is based on:11–13
    • Skin symptoms (assessed by BSA or PASI)
    • Effect on global health (as reflected by PGA)
    • Areas involved (palmar-plantar, facial or genital involvement)
    • Effect on quality of life (assessed by e.g. DLQI)
  • Other factors that may influence severity include:13
    • Other signs and symptoms
    • Previous hospitalisation
    • Chronicity
  • Approximately 30% of patients have severe disease,10 as defined by ‘the Rule of Tens’:3
    • BSA >10 or PASI >10 or DLQI >10

Treatment

Treatment options in PsO

Comorbidities may need to be considered when selecting the right treatment:

Adapted from Meffert15 and Augustin et al.14 *Synthetic small molecules; agents marked in grey are not used very widely. Vitamin D analogs include agents such as calcipotriene and calcitriol; retinoids incude azarotene. **PUVA: combination of psoralen (bath or systemic) and UVA phototherapy.

Besides disease severity, other factors also inform the choice of therapy:

  • Type and localization of psoriasis14
  • The person’s age and medical history14
  • Impact of disease on patient’s QoL14
  • Local guidelines/algorithms

Biologics in PsO

Adapted from Ainsworth.16

Guidelines

Guidance on the use of biologic therapy in PsO

European guidelines present the level of evidence for the efficacy of the available treatments, but do not provide treatment algorithms17

TNFinhibitors: Adalimumab, etanercept and infliximab are all ‘Recommended as 2nd line medication* for induction and long-term treatment’, based on strong consensus17

*If phototherapy and conventional systemic agents were inadequate in response or if they are contraindicated or not tolerated.

IL-12/23 inhibitor: Ustekinumab is ‘Recommended as 2nd line medication† for induction and long-term treatment’, based on strong consensus17

If phototherapy and conventional systemic agents were inadequate in response or if they are contraindicated or not tolerated. (The label currently states: if PUVA or other systemic therapies including ciclosporin, methotrexate were inadequate in response or if they are contraindicated or not tolerated.)

IL-17 inhibitors: Secukinumab has been granted market authorisation by EMA, as well as ixekizumab; an update to the guidance is under preparation17,18

PsO treatment goals

An improved understanding of the marked impairment of patients' QoL, and the recognition of PsO as a systemic disease associated with major morbidity and increased mortality, have led to a reconsideration of the treatment goals19

Adapted from Mrowietz et al.12

Support

Additional information

You can find additional information about PsO by following these links:

NHS Choices:
https://www.nhs.uk/Conditions/Psoriasis/Pages/Introduction.aspx

Psoriasis Association:
https://www.psoriasis-association.org.uk/

Psoriasis and Psoriatic Arthritis Alliance:
http://www.papaa.org/resources/about-psoriasis

1. Camisa C. Handbook of Psoriasis. 2004:1-6.
2. Parisi R, et al. J Invest Dermatol. 2013;133:377–385.
3. Langley RGB, et al. Ann Rheum Dis. 2005;64(Suppl II):ii18–ii23.
4. Menter A, and Griffiths CEM. Lancet. 2007;370:272–284.
5. Steinke SIB, et al. PLoS ONE. 2013;8:e78152.
6. Dalgard F, et al. J Investi Dermatol. 2015;135:984–991.
7. Armstrong A, et al. PLoS ONE. 2012;7(12):e52935.
8. Feldman S, et al. Arthritis Care Res. 2015;67(5):708-717.
9. Wan J, et al. BMJ. 2013;347(October):f5961.
10. Horn EJ, et al. J Am Acad Dermatol. 2007;57:963–971.
11. Menter A et al. J Am Acad Dermatol. 2011;65:137–174.
12. Mrowietz U et al. Arch Dermatol Res. 2011;303:1–10.
13. Finlay AY. Br J Dermatol. 2005;152:861–867.
14. Augustin M, et al. JEADV. 2012;26(Suppl. 4):1-16.
15. Meffert J. Psoriasis medication. Medscape;2016. http://tinyurl.com/hhkg3bf [last accessed 22 June 2016].
16. Ainsworth C. Nature. 2012;492:S52–S54.
17. Nast A, et al. J Eur Acad Dermatol Venereol. 2015;29:2277–2294.
18. European Medicines Agency. Taltz. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/003943/WC500205807.pdf. Last accessed July 2016.
19. Mrowietz U, Reich K. Dtsch Arztebl Int. 2009;106:11-19.

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