Serial Quantiferon-TB Gold test results in 279 patients with psoriasis receiving biologic therapy.

The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon-TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow-up, along with chest radiography alterations. This retrospective study included 279 patients with plaque-type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow-up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X-ray abnormality was noted during the follow-up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow-up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.

Long-term effects of biologic therapies on peripheral blood eosinophils in patients with psoriasis: a 3-year single-center study.

Background: Biologic therapies (BTs), etanercept, infliximab, adalimumab, and ustekinumab, are generally well-tolerated and safe agents in psoriasis management.Objectives: To determine the overall effect of BTs on peripheral blood eosinophil count (PBEc) and percentage (PBEp), peripheral blood basophil count (PBBc) and percentage (PBBp), white blood cell count (WBCc), erythrocyte sedimentation rate (ESR), and serum C-reactive protein (s-CRP) level during a 3-year follow-up in patients with psoriasis.Methods: This retrospective cohort study included 200 patients (116 men; 84 women) treated continuously with BTs for 3 years for plaque-type, pustular, or nail psoriasis. Patient data were reviewed from medical charts. During routine laboratory investigation at baseline and every 3 months thereafter up to 3 years, the PBEp, PBEc, PBBp, PBBc, WBCc, ESR, and s-CRP level were monitored. Generalized estimating equations were used to compare consecutive data.Results: Seventy patients received infliximab (35%); 34 (17%), etanercept; 44 (22%), adalimumab; and 52 (26%), ustekinumab. The mean PBEp and PBEc significantly increased starting from 3 months after BT (both p<.001). The mean PBEp and PBEc significantly increased during follow-up compared with the baseline values (PBEp (%): 1.49 ± 0.1 (1st month) vs. 2.29 ± 0.14 (3rd month), p<.001 and 1.49 ± 0.1 (1st month) vs. 2.17 ± 0.18 (36th month), p=.004; PBEc (×103/µL): 115.80 ± 6.32 (1st month) vs. 174.9 ± 10.08 (3rd month), p<.001 and 115.80 ± 6.32 (1st month) vs. 162.9 ± 12.86 (36th month), p<.001). However, the mean PBBp, PBBc, WBCc, ESR, and s-CRP level did not change significantly.Conclusions: The PBEc and PBEp increase with BTs up to 3 years in patients with psoriasis. This increase is observed at as early as 3 months of BT and maintained thereafter.

TUR-PSO: A cross-sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey.

Psoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76 million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross-sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol-5 dimension (EQ-5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, ≥10). Mean DLQI was 7.03 ± 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ-5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.

Long-term follow-up of early mycosis fungoides patients treated with narrowband ultraviolet B phototherapy.

BACKGROUND: Narrowband ultraviolet B (UVB) provides complete response (CR) in 54-91% of early mycosis fungoides (MF) patients. Data concerning relapse rate and relapse-free interval after discontinuation of therapy need clarification. The purpose of this study was to evaluate the relapse rate and the relapse-free intervals of early MF patients after achieving complete response with narrowband UVB phototherapy. METHODS: Retrospective evaluation of data, which belong to early MF patients treated with narrowband UVB phototherapy between May 2000 and July 2010, and followed-up until May 2012 in a single institution, for the occurrence of relapse and the time to relapse. RESULTS: Of 31 patients, who were followed-up for a mean of 56.5 ± 30.2 months (median 55 months, range 20-120 months), relapse was observed in 11 (35.5%) patients, within a mean of 28.8 ± 18.2 months (median 33 months, range 4-59 months), whereas 20 (64.5%) patients stayed relapse-free for a mean of 54.2 ± 28.8 months (median 55.5 months, range 20-119 months). Patients received maintenance phototherapy with a median duration of 12 months (range 1-30 months) after achieving complete response. CONCLUSION: Results indicate that narrowband UVB phototherapy may induce low relapse rates and long relapse-free intervals for early MF.

In search of an optimum dose escalation for narrowband UVB phototherapy: is it time to quit 20% increments?

OBJECTIVES: Our aim was to compare 20% with 10% to 5% incremental regimens in narrowband UVB phototherapy. STUDY PATIENTS: The study included patients with psoriasis (N = 191) with Fitzpatrick skin phototypes II and III. RESULTS: Occurrence of erythema as well as maximum and cumulative doses were higher with 20% escalations, whereas response rates and time to response did not significantly differ. LIMITATIONS: The study was limited by its retrospective nature. CONCLUSION: A 5% or 10% incremental regimen may have similar therapeutic efficacy.