Psoriasis

Introduction

  • Psoriasis (PsO) affects 1.5% to 5% of the population in most developed countries, and some reports suggest that prevalence is increasing1
  • PsO has a significant negative impact on physical, emotional, and psychosocial well-being;3 in some studies the reduction in mental and physical functioning has been found to be comparable to those with cancer, diabetes, and depression2
  • Treatment of PsO starts with topical therapies, followed by phototherapy, and then oral systemics or infusion therapies; when these measures fail, biologics may be considered2
  • Treatment of PsO can cost over EUR 5 000 per patient, per year3

Burden of PsO

Burden of PsO

 

Impact

Disease severity

  • Disease severity assessment is based on:7–9
    • Skin symptoms (assessed by body surface area [BSA] involvement or Psoriasis Area and Severity Index [PASI])
    • Effect on global health (as reflected by Physician’s Global Assessment)
    • Areas involved (palmoplantar, facial, or genital involvement)
    • Effect on quality of life (assessed by e.g. Dermatology Life Quality Index [DLQI])
  • Other factors that may influence severity include:9
    • Other signs and symptoms
    • Previous hospitalization
    • Chronicity
  • Approximately 20% of patients have moderate-to-severe disease7
  • Disease severity can be defined by ‘the Rule of Tens’:2
    • BSA >10 or PASI >10 or DLQI >10

Treatment

Treatment options in PsO

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

IL, interleukin; PUVA, psoralen and ultraviolet A; TNF, tumor necrosis factor; UVB, ultraviolet B. Vitamin D analogs include agents such as calcipotriene and calcitriol; retinoids include azarotene. *PUVA: combination of psoralen (bath or systemic) and UVA phototherapy. **Synthetic small molecules.

Adapted from Augustin et al, 2012,2 Nast et al, 2015,10 and Nast et al, 2017.11  

 

Besides disease severity, other factors also inform the choice of therapy:2

  • Type and localization of PsO
  • The person’s age and medical history
  • Impact of disease on patient’s quality of life (QoL)
  • Local guidelines/algorithms

Biologics in PsO

IL, interleukin; Th, helper T cell; TNF-α, tumor necrosis factor alpha.

Adapted from Ainsworth, 201212 and Veilleux and Shear, 2017.13

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 algorithms.10

TNF-α inhibitors: Adalimumab, etanercept, and infliximab are ‘recommended as 2nd line medication* for induction and long-term treatment’, based on strong consensus.10

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

Interleukin (IL)-12/23 inhibitor: Ustekinumab is ‘recommended as 2nd line medication for induction and long-term treatment’, based on strong consensus.10

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

IL-17 inhibitors: Ixekizumab and secukinumab have been granted market authorization by the European Medicines Agency.14,15 Secukinumab has been added to the European S3 guidelines for induction and long-term treatment, and ixekizumab is scheduled to be discussed in a further update.11

IL-23 inhibitors: Guselkumab and tildrakizumab have shown promising results in clinical studies and are approved by the European Medicines Agency for the treatment of moderate-to-severe PsO.13,16,17

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 goals.10,12

DLQI, Dermatology Life Quality Index; PASI, Psoriasis Area and Severity Index.

Adapted from Mrowietz et al, 2011.8

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. World Health Organization. Global report on psoriasis (2016). Available at: http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf?ua=1 [accessed 27 Nov, 2018]  

2. Augustin M, et al. J Eur Acad Dermatol Venereol. 2012;26(Suppl. 4):1–16. 

3. Steinke SIB, et al. PLoS ONE. 2013;8:e78152.

4. Armstrong A, et al. PLoS ONE. 2012;7(12):e52935.

5. Dalgard F, et al. J Invest Dermatol. 2015;135:984–91.

6. Mrowietz U, et al. Exp Dermatol. 2014;23:705–9.

7. Menter A, et al. J Am Acad Dermatol. 2011;65:137–74.

8. Mrowietz U, et al. Arch Dermatol Res. 2011;303:1–10.

9. Finlay AY. Br J Dermatol. 2005;152:861–7.

10. Nast A, et al. J Eur Acad Dermatol Venereol. 2015;29:2277–94.

11. Nast A, et al. J Eur Acad Dermatol Venereol. 2017;31:1951–63.

12. Ainsworth C. Nature. 2012;492:S52–S54.

13. Veilleux MS and Shear NH. J Allergy Clin Immunol. 2017;139:1423-30.

14. European Medicines Agency. Taltz SmPC. https://www.ema.europa.eu/documents/product-information/taltz-epar-product-information_en.pdf [accessed 02 January 2019]

15. European Medicines Agency. Cosentyx SmPC. https://www.ema.europa.eu/documents/product-information/cosentyx-epar-product-information_en.pdf [accessed 02 January 2019]

16. European Medicines Agency. Tremfya SmPC. https://www.ema.europa.eu/documents/product-information/tremfya-epar-product-information_en.pdf [accessed 02 January 2019]

17. European Medicines Agency. Ilumetri SmPC. https://www.ema.europa.eu/documents/product-information/ilumetri-epar-product-information_en.pdf [accessed 02 January 2019]

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