HLA-C*06:02 genotype is a predictive biomarker of biologic treatment response in psoriasis.

BACKGROUND: Biologic therapies can be highly effective for the treatment of severe psoriasis, but response for individual patients can vary according to drug. Predictive biomarkers to guide treatment selection could improve patient outcomes and treatment cost-effectiveness. OBJECTIVE: We sought to test whether HLA-C*06:02, the primary genetic susceptibility allele for psoriasis, predisposes patients to respond differently to the 2 most commonly prescribed biologics for psoriasis: adalimumab (anti-TNF-α) and ustekinumab (anti-IL-12/23). METHODS: This study uses a national psoriasis registry that includes longitudinal treatment and response observations and detailed clinical data. HLA alleles were imputed from genome-wide genotype data for 1326 patients for whom 90% reduction in Psoriasis Area and Severity Index score (PASI90) response status was observed after 3, 6, or 12 months of treatment. We developed regression models of PASI90 response, examining the interaction between HLA-C*06:02 and drug type (adalimumab or ustekinumab) while accounting for potentially confounding clinical variables. RESULTS: HLA-C*06:02-negative patients were significantly more likely to respond to adalimumab than ustekinumab at all time points (most strongly at 6 months: odds ratio [OR], 2.95; P = 5.85 × 10-7), and the difference was greater in HLA-C*06:02-negative patients with psoriatic arthritis (OR, 5.98; P = 6.89 × 10-5). Biologic-naive patients who were HLA-C*06:02 positive and psoriatic arthritis negative demonstrated significantly poorer response to adalimumab at 12 months (OR, 0.31; P = 3.42 × 10-4). Results from HLA-wide analyses were consistent with HLA-C*06:02 itself being the primary effect allele. We found no evidence for genetic interaction between HLA-C*06:02 and ERAP1. CONCLUSION: This large observational study suggests that reference to HLA-C*06:02 status could offer substantial clinical benefit when selecting treatments for severe psoriasis.

Use of complementary medicine among outpatients with dermatologic conditions within Yorkshire and South Wales, United Kingdom.

BACKGROUND: The use of complementary and alternative medicine (CAM) is increasing throughout the Western world, particularly by patients with chronic disease. In 1999, 20% of the United Kingdom population reported that they had used CAM in the preceding 12 months. OBJECTIVES: We sought to investigate the use of CAM by outpatients with general dermatologic conditions in 3 United Kingdom cities: Leeds (North England), and Cardiff and Swansea (South Wales). METHODS: Independently constructed, anonymous, self-directed questionnaires were designed and distributed to 400 consecutive outpatients with dermatologic conditions in Leeds and 637 consecutive outpatients with dermatologic conditions in Cardiff and Swansea. RESULTS: In Leeds 302/400 questionnaires were fully completed with 39% patients having used CAM. In South Wales 415/637 questionnaires were fully completed with 34% having used CAM. Of these, 45% of patients in Leeds and 50% of patients in South Wales were using CAM to treat their dermatologic condition. The most popular treatments in Leeds, Cardiff, and Swansea were herbal medicine and homeopathy. LIMITATIONS: These results were obtained from outpatients with dermatologic conditions in the United Kingdom and may not be applicable to other populations. CONCLUSIONS: More than one third of outpatients with general dermatologic conditions in two geographically distant regions are using CAM. More than 45% of these patients used CAM to treat their dermatologic condition.