Long-term efficacy, safety, and drug survival of secukinumab in patients with psoriasis in Turkey: a retrospective analysis of real-world experience.

Introduction: Secukinumab (SEC) has been shown to be highly effective and safe in the treatment of moderate to severe plaque psoriasis (PsO), but data on SEC's long-term drug survival are limited. Aim: To analyse the survival rate of SEC and its predictive factors of survival, together with the drug safety and efficacy. Material and methods: Data of 268 patients who received SEC between May 2018 and April 2022 with moderate to severe psoriasis and/or psoriatic arthritis were analysed retrospectively. Psoriasis Area Severity Index (PASI) was used to define effectiveness. Drug survival was examined using the Kaplan-Meier analysis and Cox regression analysis was used to analyse predictive factors. Results: PASI 75/90/100 responses achieved at week 16 (89.5%, 78%, and 16.2%, respectively) were well maintained at week 52 (96.3%, 90.7%, and 15.4%, respectively). The drug survival probability rates for SEC were 94.4% at 12 months, 88.4% at 24 months, 78.6% after 3 years, 52.7% after 4 years. Concomitant treatments, dose escalation and family history of psoriasis were associated with a higher risk for SEC withdrawal. Conclusions: Close monitoring may improve SEC survival in psoriasis patients who require dose escalation and concomitant drugs.

Efficacy and Safety of Omalizumab Updosing in Chronic Urticaria: A Retrospective Study.

Omalizumab is an effective and safe treatment option with licensed doses in patients with chronic spontaneous urticaria (CSU); however, some patients are not responsive to licensed doses and require updosing. As studies concerning updosing were insufficient, the present study evaluated the effectiveness and safety of omalizumab updosing (300 mg every 2 weeks) in CSU patients. Data of CSU patients treated with omalizumab were analyzed retrospectively. As an outcome measure, physician assessment of treatment response (complete response [CR], partial response, and unresponsiveness) was used. In all, 49 patients depicting CR to omalizumab 300 mg every 4 weeks and 54 patients treated with omalizumab 300 mg every 2 weeks were included in the study. Mean duration of the disease in updosing group was significantly lengthier than the CR group. The mean percentage level of eosinophils and basophils was significantly higher in the CR group. The history of systemic corticosteroid and oral cyclosporine treatment was significantly more frequent in the updosing group. Treatment with omalizumab 300 mg every 2 weeks for 12 weeks led to CR in 41 patients (75.9%). Our results confirmed the efficacy and safety of omalizumab updosing. Low baso-phil and eosinophil levels could also be important factors in defining the need for updosing.

Clinical efficacy and safety of secukinumab for psoriasis in a real-world setting in Turkey.

OBJECTIVES: The aim of this study was to examine the real-life efficacy and safety of secukinumab for psoriasis (PsO) along with the factors that could have an effect on clinical response. METHODS: Data in the charts of 121 patients with chronic PsO who were initiated secukinumab treatment between May-2018 and April-2020 with an observation period of up to 52 weeks were retrospectively analyzed. Demographic and clinical characteristics of patients, Psoriasis Area and Severity Index (PASI) scores and side effects were evaluated. RESULTS: A 75%, 90%, and 100% reduction in the baseline PASI score was observed in 84.3%, 68.6%, and 18.2% of patients at week 16, respectively. Obesity and previous biologic experience were important predictive factors for PASI 75 response at week 16. CRP levels, previous biological experience and age at PsO onset are found to be important factors in defining the need for updosing. Side-effect rates (9.7%) were not higher among patients with concomitant medications (13.6%) and dose escalation (13.3%). CONCLUSION: Our results are in line with the efficacy and safety profiles of secukinumab in PsO reported previously. Dose escalation and the addition of concomitant medications may increase response rates.

Remodeling of Cornea With Isotretinoin Treatment.

OBJECTIVES: To evaluate the change of corneal epithelial thickness (ET) in subjects using isotretinoin with spectral-domain optical coherence tomography and further to explore reflection of changes on corneal topography. METHODS: Forty eyes of 40 subjects with acne vulgaris scheduled for oral isotretinoin were included in this prospective study. Subjects were examined with RTVue-XR and Pentacam at baseline, 1th, 3rd, and 6th months of treatment, and 3rd month of isotretinoin cessation. RESULTS: A statistically significant increase was detected in each sector of ET map except inferonasal 7 to 9 mm between baseline and following visits (P<0.05, for all visits). The increase in superior (2-7 mm), inferior (2-7 mm), and maximum values in epithelium statistics and the decrease in superior (2-7 mm), inferior (2-7 mm), minimum, and maximum values in stroma statistics at follow-up visits were significant (P<0.05, for all visits). Central corneal thickness, maximum Ambrosio-relational thickness, average pachymetric-progression index at 1th, 3rd, and 6th months, and thinnest pachymetry, index of surface variance (ISV) at 3rd, and 6th months differed significantly (P<0.05, for specified visits). The regression in parameters was observed at 3rd month of isotretinoin cessation. CONCLUSIONS: Isotretinoin treatment induces epithelial thickening and stromal thinning. Remodeling of corneal layers causes statistical differences in ISV and pachymetry-related parameters of Pentacam. The pachymetry changes in cornea return to baseline at the 3rd month of discontinuation of treatment.

Evaluation of Social Anxiety Levels and Related Factors in Psoriasis Patients: A Controlled, Cross-Sectional Study.

INTRODUCTION: Psoriasis patients usually feel shame over their appearance and suffer from poor self-esteem, social anxiety, and avoidance. However, little is known about factors affecting social anxiety levels in these patients. We sought to examine the psychological, as well as disease-related factors which may affect social anxiety levels in psoriasis patients. METHODS: Our study consisted of 50 psoriasis outpatients and a corresponding 50 age and sex-matched healthy control volunteers who filled out the Liebowitz Social Anxiety Scale (LSAS), the Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS), Ways of coping questionnaire (WCQ) and Eysenck Personality Questionnaire Revised: abbreviated form (EPQR-A). The patients also completed the Dermatology Life Quality Index (DLQI). The extensiveness and severity of the disease were examined by employing the Psoriasis Area and Severity Index (PASI). RESULTS: Compared with our controls, psoriasis patients displayed significantly higher degrees of social anxiety. Both social fear/avoidance subscale scores of LSAS showed a significant correlation to impairment in quality of life (r: 0.373, p: 0.008, r: 0.336, p: 0.018). No appreciable correlation was observable among the PASI and LSAS scores. Regression analysis showed that EPQR-A-extraversion and neuroticism subscale scores had significant influence on LSAS-Social Anxiety scores, accounting for 41.5% of the variance. EPQR-A-extraversion was found to have significant influence on LSAS-Social avoidance scores, accounting for 26.8% of the variance. CONCLUSION: Our results indicate that psoriasis causes increased levels of social anxiety which is closely related to impaired quality of life. Personality characteristics might contribute considerably in expressing psychosocial morbidity among individuals living with psoriasis.

Differentiation of skin biopsies by light scattering spectroscopy.

INTRODUCTION: Spectroscopic systems are medical tools that are used for the detection of cancerous tissues ex vivo and in vivo. AIM: To differentiate inflammatory and benign skin lesions of excised biopsy samples via a combination of multivariate statistical analysis. MATERIAL AND METHODS: Spectral data were obtained from a total of 22 inflammatory and ten benign skin biopsy samples from 30 patients in the visible wavelength (450-750 nm) regions. Spectral data were compared with the dermatopathology results. Spectral data analyses of biopsy samples were performed via principal component analysis (PCA), followed by linear discriminant analysis (LDA). The differentiation performance was calculated with the receiver operating characteristic (ROC) curve analysis. RESULTS: The classification based on the discriminant function score provided a sensitivity of 90.9% and a specificity of 80% in discriminating benign from inflammatory lesions with an accuracy of 87.5%. CONCLUSIONS: Our study revealed that light scattering spectroscopy could discriminate between inflammatory and benign skin lesions of excised biopsy samples with high sensitivity by using multivariate statistical analysis. It can be concluded that the high diagnostic accuracy of the optical spectroscopy method has the potential to use as a supplementary system to distinguish inflammatory skin lesions from benign during the pathological examination.

CD26/dipeptidyl-peptidase IV and adenosine deaminase serum levels in psoriatic patients treated with cyclosporine, etanercept, and psoralen plus ultraviolet A phototherapy.

OBJECTIVE: The aim of this study is to determine serum levels of soluble forms of CD26/dipeptidyl-peptidase IV (DPP-IV) and adenosine deaminase (ADA), thought to be markers of T-cell activation, and changes in their levels in response to cyclosporine, etanercept, and psoralen plus ultraviolet A (PUVA) treatments with respect to disease activity. METHODS: This study is designed as a prospective clinical study with a control group and three months of follow-up. The study included 41 patients with psoriasis and 41 healthy controls that were older than 18years of age. There were three different treatment groups: PUVA (n=15), cyclosporine (n=15), and etanercept (n=11). To determine disease severity of patients with psoriasis, psoriasis area and severity index (PASI) scores were calculated. RESULTS: Only mean serum ADA levels were different between patients with psoriasis [mean1±standard deviation (SD)=13.9±3.3U/ml] and control group (mean±SD=12±3.5U/ml). Mean serum ADA levels were significantly higher before treatment than after treatment (mean±SD=12.4±3.4U/ml). Contrarily, following three months of therapy, mean serum CD26 levels increased significantly from 777.7±214.6 to 835.3±203ng/ml (P<0.05) and mean serum DPP-IV activity increased significantly from 12.1±4 to 15.9±4.2nmol/min (P<0.05). There was no correlation between ADA and CD 26/DPP-IV with PASI values. CONCLUSIONS: The results show that ADA might be a useful marker indicating disease activity and T-cell activation. As significant changes were observed in serum CD26/DPP-IV before and after treatment, we think CD26/DPP-IV might play a role in psoriasis pathogenesis, which should be clarified by further studies.

Symmetrical primary cutaneous marginal zone lymphoma associated with rheumatoid arthritis.

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is an indolent low grade B cell lymphoma of the skin, with lack of extracutaneous involvement at the time of diagnosis. Herein we report the case of a patient with rheumatoid arthritis (RA) who developed symmetrical PCMZL lesions on both ear lobes. Lesions occurring symmetrically on ear lobes are more specific for cutaneous lymphoid hyperplasia (CLH) and this kind of symmetrical localization hasn't been reported for PCMZL before. PCMZL is considered to arise from a background of reactive lymphoid hyperplasia and this case point out the concept of CLH and PCMZL spectrum. Association of marginal zone lymphoma with rheumatoid arthritis and resolution of lesions together with the resolution of symptoms due to rheumatoid arthritis after rituximab therapy is another interesting point for this case. To the best of our knowledge PCMZL associated with RA has not been reported previously.