Long-term drug survival of risankizumab in psoriasis: insights from a real-life multicenter study on hard-to-treat areas.

Psoriasis, a chronic inflammatory condition, often presents challenges in treatment, particularly in areas such as nails, palms/soles, scalp/face, and genitalia. Monoclonal antibodies (mAb) like risankizumab targeting interleukin-23 (IL-23) have emerged as promising treatments, yet data on long-term efficacy remain limited. This multicenter retrospective study aimed to evaluate the drug survival at 12 and 36 months of 191 psoriasis patients treated with risankizumab, focusing on critical areas. Patients, previously unresponsive to first-line therapies, were treated according to Italian Guidelines. Survival analysis revealed a 97.6% one-year and 95% three-year drug survival rate. Secondary ineffectiveness was the primary reason for discontinuation, particularly in palmoplantar involvement cases. Factors such as BMI, gender, age, disease duration, baseline severity, and previous biologic exposure did not significantly impact drug survival, except for palmoplantar psoriasis (HR 4.72). Risankizumab demonstrated prolonged response with low treatment switch requirements, especially notable in challenging areas. Understanding such factors can aid in optimizing therapeutic approaches for improved patient care and long-term outcomes in managing psoriasis. Further research is warranted to refine treatment strategies in difficult-to-treat areas.

Tuscan consensus on the diagnosis and treatment of hidradenitis suppurativa.

BACKGROUND: A rationalized model of clinical and therapeutic management of hidradenitis suppurativa (HS) should place the patients at the heart of the process, facilitating their access to diagnostic tests and treatments, providing the appropriate care for each grade of disease severity and optimizing the use of healthcare resources, both in economic and human terms. MATERIAL AND METHODS: This paper reports the results of a Consensus of the Tuscany HS working group for a rationalized model of diagnosis and management of HS. RESULTS: The diagnostic and therapeutic protocols, the available technological equipments and the management models, are presented in the light of today's scientific evidence. CONCLUSION: The goal of the Consensus is to bring the issue of HS management to the attention of the Tuscan regional government, in order to create unanimously accepted diagnostic and therapeutic protocols.

Clinical experience with the etanercept biosimilar SB4 in psoriatic patients.

Background After the expiry of the patent of reference etanercept, several biosimilars have been developed, including SB4. Objective To study safety and efficacy of SB4 in psoriatic patients previously treated with etanercept and in the etanercept naive ones. Method Patients affected by moderate to severe psoriasis and/or psoriatic arthritis attending the Psoriasis Center of Florence University, treated with SB4 were enrolled in the study. Patients were divided in two cohorts. Cohort 1 included 32 patients who were switched from previous etanercept, cohort 2 included 12 patients who were naive to etanercept. Results Evaluation of the efficacy of SB4 in cohort 1 patients revealed rates of clinical remission (defined as both PASI and/or DAS28 increase < 10%) of 92% and 64% for psoriasis and psoriatic arthritis respectively. In cohort 2 at week 24 PASI 75 was observed in 75% of patients. Conclusion In our experience switching from originator to SB4 in psoriatic patients seems not to influence efficacy, especially cutaneous manifestations, over a median observational period of 24 weeks.

Induced Preference Improves Offspring Fitness in a Phytopathogen Vector.

In the Asian citrus psyllid (Diaphorina citri Kuwayama), learning facilitates host recognition and mate preference; however, it is unclear whether induced female oviposition preference occurs in this species. We investigated the influence of natal host experience on adult oviposition preference when reared on either 'Valencia' orange (Citrus x sinesis) or orange jasmine (Murraya paniculata). Psyllids reared on 'Valencia' orange preferred 'Valencia' orange as an oviposition host compared with orange jasmine, whereas there was no difference in oviposition between the two hosts in orange jasmine reared psyllids. Nymphs transferred from 'Valencia' orange to orange jasmine were smaller in adult size and required more time for development. These findings were reversed in orange jasmine reared psyllids, which increased in size and displayed shorter development times when transferred from orange jasmine to 'Valencia' orange. However, mortality increased in nymphs transferred to the non-natal host species in both treatment groups compared with nymphs transferred to the same host. These results indicate an association between host plant preference and performance in this species. Maternal host experience appeared to influence the oviposition preference in this species. Juvenile psyllid performance appeared negatively affected by orange jasmine plants such that fitness was reduced, suggesting benefits for maternal host fidelity in those insects not acclimated to feeding on orange jasmine. Induced oviposition preference may provide an important mechanism of adaptive plasticity in D. citri reproductive strategies, allowing females to discriminate among potential host species in favor of those to which her offspring are best adapted.

Treatment of severe nail psoriasis with acitretin: an impressive therapeutic result.

Nail psoriasis is common in adult psoriatic patients. Although several new drugs have recently been introduced for the treatment of skin psoriasis, treatment of nail psoriasis still remains a challenge. Topical treatments (e.g., corticosteroids, tazarotene, 5-fluorouracil, calcipotriol) are the first line in the management of skin psoriasis. The efficacy of these drugs in nail disease, however, is limited, mainly due to the difficulty in penetrating the nail bed and nail matrix. In cases of nail disease resistant to topical treatment, methotrexate, ciclosporin, acitretin, or biological agents can be used. The present authors introduce a 73-year-old patient affected by impressive psoriatic nail disease involving all her fingernails and toenails treated by acitretin, a traditional systemic treatment. After 2 months of treatment there was a marked improvement. The clinical improvement of the nails was progressive and 6 months later it was stable and satisfactory. The remarkable response to treatment in this case suggests that oral acitretin, in association to urea nail lacquer, might be useful in the management of disabling severe nail psoriasis even in absence of severe cutaneous involvement.

Development of MGUS in psoriatic patients: a possible undiagnosed event during anti-TNF-α-treatment.

BACKGROUND: Monoclonal gammopathies are haematological conditions characterized by the clonal proliferation of plasma cells which produce a monoclonal immunoglobulin that accumulates in the blood. They have already been reported during treatment with a range of drugs but never before during treatment with the anti-TNF-α treatments: adalimumab, etanercept and infliximab currently used in the therapy of moderate-severe psoriasis and psoriatic arthritis. OBJECTIVE: This is a case series describing the development of MGUS in psoriatic patients treated with anti-TNF-α. METHODS: Three hundred patients receiving an anti-TNF-α treatment for chronic plaque psoriasis or psoriatic arthritis in a clinical setting in Italy, These patients were screened through serum protein electrophoresis to investigate the possible development of MGUS. RESULTS: Eight patients were found to have developed monoclonal gammopathy of undetermined significance. The median treatment duration for the eight patients was 1 year with excessive IgG present in five patients, IgM accumulation in one patient and a double monoclonal component in two patients. CONCLUSION: Our data suggest that there may be an association between anti-TNF-α therapy and development of MGUS.

Tumour necrosis factor-α antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C: a retrospective analysis of 17 patients.

INTRODUCTION: Tumour necrosis factor (TNF)-α antagonists are effective for the treatment of plaque-type psoriasis and psoriatic arthritis, but concerns remain about the safety of these agents in the presence of chronic infections, including past hepatitis B (HBV) and chronic hepatitis C virus (HCV) infections. OBJECTIVE: To assess the safety of TNF-α therapy in patients with plaque-type psoriasis and concurrent past HBV or chronic HCV. METHODS: Data were collected retrospectively from patients in the PsoCare Centre, Division of Dermatology II, Florence University. Patients with plaque-type psoriasis who were receiving anti-TNF-α therapy were retrospectively reviewed for the presence of HBV or HCV by a serological evaluation. RESULTS: Seventeen patients (13 men and four women, age 36-74 years) with plaque-type psoriasis associated with hepatitis infections (11 with past HBV infection, five with chronic HCV infection and one affected by both HBV and HCV) were identified. Fourteen patients had received etanercept, two adalimumab and one adalimumab as a second biologic treatment after an unsuccessful trial of etanercept. In none of the cases were changes in serum aminotransferases or viral load reported. CONCLUSIONS: In our analysis, the use of anti-TNF-α therapy appears to be safe as it did not affect serum aminotransferases or viral load. However, repeated monitoring is necessary throughout the treatment period. Systematic, large-scale studies are also needed to assess the risks and benefits of TNF-α antagonists in these patients.

A global approach to psoriatic patients through PASI score and Skindex-29.

AIM: Psoriasis is a chronic immune-mediated inflammatory skin disorder affecting approximately 2% of the population worldwide. Because of its visible manifestations and symptoms, psoriasis has profound effects on quality of life (QoL). Our objective is to determine the clinical severity of psoriasis and its impact on QoL in patients treated with phototherapy, traditional systemic therapy and biological therapy. METHODS: Patients with plaque-type psoriasis and psoriatic arthritis were recruited at a PsoCare centre and followed up for 6 months. Psoriasis severity was assessed based on the Psoriasis Area and Severity Index (PASI) score and QoL using the SKINDEX-29 questionnaire. RESULTS: PASI score improved significantly in all patients after 6 months of therapy. The greatest improvement was observed in patients receiving biological treatments. PASI-75 was obtained by 46.9% of patients on phototherapy and 43.1% on biological therapies. Skindex-29 results did not significantly differ among the three treatment groups. CONCLUSION: Effective management of patients with psoriasis depends on the appropriate assessment of both the physical and psychosocial impact of the disease.

Retrospective analysis of systemic treatments for psoriasis patients attending a Psocare center in Florence. Relevance of biological drugs use and comorbidities.

BACKGROUND: Psoriasis is a chronic inflammatory skin condition associated with several risk factors and comorbidities. METHODS: The present study outlines patient and therapy profiles emerging from the analysis of 471 patients affected by plaque psoriasis or psoriatic arthritis (PsA). RESULTS: In our sample, the age of onset and first diagnosis of PsA is significantly higher than plaque psoriasis and about 65% of the patients are either smoker or ex-smokers, while 79% are not drinkers. We also report a different distribution in the use of systemic treatments compared to the Psocare report 2007, with a tendency for a larger use of biologics over classical systemic drugs and in particular etanercept is the main treatment for PsA, and efalizumab for plaque psoriasis. All biological treatments used in the study significantly reduced PASI score. The main comorbidity associated both with plaque psoriasis and with PsA was hypertension, while hyperlipidaemia was frequently present in patients under biologics treatment. Finally, a strong association between type II diabetes and PsA was also reported. CONCLUSIONS: Current treatments have to consider general health conditions and patients habits. In this picture, biological drugs are emerging as the therapy of choice for their good efficacy in the long term management of psoriasis.

Comparison of body weight and clinical-parameter changes following the treatment of plaque psoriasis with biological therapies.

OBJECTIVE: This study is a retrospective analysis evaluating the presence of comorbidities, as well as the changes in body weight and clinical parameters in psoriasis patients following treatment with anti-TNF-alpha agents and with the anti-CD11a agent efalizumab. RESEARCH DESIGN AND METHODS: A total of 268 patients affected by chronic plaque psoriasis, and receiving systemic monotherapy with efalizumab, etanercept, or infliximab, were included. The follow-up period was 2, 4 and 6 months. MAIN OUTCOME MEASURES: Clinical data including age, gender, weight, type and severity of psoriasis and age of onset were collected. Severity of psoriasis was assessed according to the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). RESULTS: Hypertension and hyperlipidaemia were the comorbidities present with the higher frequency in our group of patients. PASI score was reduced by between 43.8 and 52% in all treatment groups. No relevant blood chemistry changes were observed following therapy, with the exception of a decrease in neutrophils and an increase in leukocyte numbers reported in the efalizumab and etanercept groups. Interestingly, after 6 months of therapy, the weight of the patients remained unvaried in those taking efalizumab (-0.05%) but was moderately increased in the etanercept (+0.72%) and in infliximab groups (+0.3%). CONCLUSIONS: The present study shows that there were clinically significant differences in weight gain effects between efalizumab and anti-TNF-alpha agents in psoriatic patients. The changes in body weight gain increase did not reach statistical significance, although there is a trend towards this, and this may be due to the relatively small number of patient studied.

Itch in psoriasis: epidemiology, clinical aspects and treatment options.

BACKGROUND: Pruritus is an important symptom in psoriasis vulgaris, may be severe and seriously affect the quality of life of patients, but published data on its frequency and characteristics are limited. OBJECTIVE: The study objective was to characterize the prevalence of itch in psoriatic patients and the effect of treatment modalities by using a comprehensive itch questionnaire of own design. METHODS: A structured itch questionnaire was given to 90 patients with moderate to severe chronic-plaque psoriasis selected consecutively from the patients visiting the Department of Dermatology of the University of Florence. The questionnaire concerned the areas involved psoriasis and pruritus, the pruritus characteristics, the worsening and relieving factors and treatment modalities. Itch intensity was reflected by a 10 point visual analog scale (VAS) and the degree of symptoms discriminated between mild (1-3), moderate (4-7) and severe (8-10). RESULTS: Almost 85% of psoriatic patients suffered from itching; the frequency of pruritus was daily and mean intensity by VAS scale was moderate. Presence and intensity of pruritus and body mass index (BMI) were correlated. 40% of patients with pruritus were overweight (BMI > 25 < 30) and 10% obese (BMI > 30). Almost all patients appeared unsatisfied with the available treatment modalities for pruritus in psoriasis. Emollients, topical steroids and calcipotriol cream could relieve pruritus but their effect was temporary. Among the antipsoriatic therapies, phototherapy with narrow band ultraviolet B (nb-UVB) was the most effective treatment in reducing pruritus. Biological therapies, mainly etanercept and efalizumab, proved useful in its control. CONCLUSIONS: The questionnaire was a useful tool to characterize itch, and the results might help us to better understand pruritus in psoriasis. The results confirmed the need for a global study of psoriasis with regard to both the cutaneous manifestations and the itch symptom.