SUMMARY

Corticosteroid therapy is regarded as first-line therapy for treating mild psoriasis and recalcitrant lesions. Members of the IPC Topical Therapies Working Group reviewed available international topical corticosteroids guidelines in order to understand current information and to identify areas that would benefit from greater practical guidance for dermatologists. The results of their review were published online by the Journal of Dermatological Treatment in May. The researchers reviewed corticosteroid guidelines from 10 countries: New Zealand, Norway, Malaysia, United Kingdom, the Netherlands, Scotland, Canada, the United States, Germany, and South Africa. In their article, the authors revealed that a broad consensus exists across guidelines regarding the choice of steroid potency for specific body sites and the duration of steroid use in the short term. However, the review demonstrated that there are gaps in the recommendations for long-term treatment, as well as in the utility of tapering of topical corticosteroids and breaks in treatment. The authors call for an international collaboration to develop a consensus opinion that would outline effective and safe real-world practice in the use of topical corticosteroids. Such a consensus would maximize the appropriate use of steroids for the benefit of patients with psoriasis.

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Abstract

Psoriasis in children can be a challenging diagnosis: the clinical presentation is often more subtle, may occur in covered sites and can be an unexpected diagnosis as psoriasis if often thought to occur at older ages. Poor recognition and delayed diagnosis of psoriasis in children can lead to inadequate treatment and lack of monitoring for comorbidities including juvenile psoriatic arthritis. Diagnostic criteria would help both clinical practice and clinical research, but to date none are available.

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ABSTRACT

Purpose of Review

Over the last several years, major changes have occurred in Europe regarding the use of biosimilars. Some countries such as Norway, Denmark, and the United Kingdom (UK) have a relatively high market penetration of biosimilars, whereas in other European countries, biosimilar uptake is low. The objectives of this review are to describe the use of biosimilars in selected European countries, using “real-life” information from members of the International Psoriasis Council (IPC) who are key opinion leaders in dermatology. The use of biosimilars for patients with psoriasis is continuously discussed and reviewed by the IPC, through in-person meetings by members of the Biosimilar Working Group (BSWG).

Recent Findings

In preparation for this paper, we surveyed the use of biosimilars for patients with psoriasis through European BSWG members, who were asked to describe the situation in their countries. The survey collected information from each IPC councilor regarding the use of biosimilars currently on the market, guidelines for interchangeability, traceability, and naming of these agents. In addition, information regarding pricing, access, and physician/patient education was obtained. The status of biosimilars was discussed at an IPC biosimilar working group roundtable event which was held in Stockholm on June 28th, 2018.

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ABSTRACT

Engaging global key opinion leaders, the International Psoriasis Council (IPC) held a day-long roundtable discussion with the primary purpose to discuss the treatment goals of psoriasis patients and worldwide barriers to optimal care. Setting clear expectations might ultimately encourage undertreated psoriasis patients to seek care in an era in which great gains in therapeutic efficacy have been achieved. Here, we discuss the option for early treatment of all categories of psoriasis to alleviate disease impact while emphasizing the need for more focused attention for psoriasis patients with mild and moderate forms of this autoimmune disease. In addition, we encourage policy changes to keep pace with the innovative therapies and clinical science and highlight the demand for greater understanding of treatment barriers in resource poor countries.

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Abstract

Background:
Topical treatment of mild to moderate psoriasis is first-line treatment and exhibits varying degrees of success across patient groups. Key factors influencing treatment success are physician topical treatment choice (high efficacy, low adverse events) and strict patient adherence. Currently, no formalized, international consensus guidelines exist to direct optimal topical treatment, although many countries have national guidelines.

Objective:
To describe and analyse cross-regional variations in the use and access of psoriasis topical therapies.

Methods:
The study was conducted as an observational cross-sectional study. A survey was distributed to dermatologists from the International Psoriasis Council (IPC) to assess topical therapy accessibility in 26 countries and to understand how body surface area (BSA) categories guide clinical decisions on topical use.

Results:
Variation in the availability of tars, topical retinoids, dithranol and balneotherapy was reported. The vast majority of respondents (100% and 88.4%) used topical therapy as first-line monotherapy in situations with BSA < 3% and BSA between 3% and 10%, respectively. However, with disease severity increasing to BSA > 10%, the number of respondents who prescribe topical therapy decreased considerably. In addition, combination therapy of a topical drug and a systemic drug was frequently reported when BSA measured >10%.

Conclusion:
This physician survey provides new evidence on topical access and the influence of disease severity on topical usage in an effort to improve treatment strategies on a global level.

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Abstract

The International Psoriasis Council, a global nonprofit organization dedicated to innovation across the full spectrum of psoriasis, led a symposium to discuss the current state of psoriasis epidemiology and to introduce the vision and development of a Global Psoriasis Atlas. The symposium was held on 9 September 2015 at the 45th annual meeting of the European Society for Dermatological Research, Rotterdam, the Netherlands. Collectively, these presentations highlighted challenges associated with assessing psoriasis epidemiology and emphasized the urgent need for an authoritative resource to clarify psoriasis disease burden on a global scale.

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Abstract

Importance:
Use of systemic therapies for moderate to severe psoriasis in children is increasing, but comparative data on their use and toxicities are limited.

Objective:
To assess patterns of use and relative risks of systemic agents for moderate to severe psoriasis in children.

Design, setting, and participants:
A retrospective review was conducted at 20 centers in North America and Europe, and included all consecutive children with moderate to severe psoriasis who used systemic medications or phototherapy for at least 3 months from December 1, 1990, to September 16, 2014.

Main outcomes and measures:
The minimal core data set included age, sex, severity of psoriasis, systemic interventions, monitoring, adverse events (AEs), and reason for discontinuation.

Results:
For 390 children (203 girls and 187 boys; mean [SD] age at diagnosis, 8.4 [3.7] years) with psoriasis who used 1 or more systemic medications, the mean interval between diagnosis and starting systemic therapy was 3.0 years. Methotrexate was used by 270 patients (69.2%), biologic agents (primarily etanercept) by 106 (27.2%), acitretin by 57 (14.6%), cyclosporine by 30 (7.7%), fumaric acid esters by 19 (4.9%), and more than 1 medication was used by 73 (18.7%). Of 270 children taking methotrexate, 130 (48.1%) reported 1 or more AEs associated with methotrexate, primarily gastrointestinal (67 [24.8%]). Folic acid 6 days per week (odds ratio, 0.16; 95% CI, 0.06-0.41; P < .001) or 7 days per week (OR, 0.21; 95% CI, 0.08-0.58; P = .003) protected against gastrointestinal AEs more than once-weekly folic acid, regardless of the total weekly dosage. Methotrexate-associated hepatic transaminase elevations were associated with obesity (35 of 270 patients [13.0%]), but a folic acid regimen was not. Injection site reactions occurred in 20 of 106 patients (18.9%) treated with tumor necrosis factor inhibitors, but did not lead to discontinuation of treatment. Having 1 or more AEs related to medication, gastrointestinal AE, laboratory abnormality, or AE leading to discontinuation of the drug was more likely with methotrexate than tumor necrosis factor inhibitors, but having 1 or more infections related to medication (predominantly upper airway) was less likely. Six patients developed a serious treatment-related AE (methotrexate, 3; fumaric acid esters, 2; and adalimumab, 1), but methotrexate and biologic agents were taken for a mean duration that was 2-fold greater than the mean duration for cyclosporine or fumaric acid esters. No patient developed tuberculosis or a malignant neoplasm.

Conclusions and relevance:
Medication-related AEs occur less often with tumor necrosis factor inhibitors than with methotrexate. Folic acid administration 6 or 7 times per week protected more against methotrexate-induced gastrointestinal AEs than did weekly administration. A prospective registry is needed to track the long-term risks of systemic agents for pediatric psoriasis.

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Abstract

 Psoriasis is a common inflammatory skin disorder for which multiple genetic susceptibility loci have been identified, but few resolved to specific functional variants. In this study, we sought to identify common and rare psoriasis-associated gene-centric variation. Using exome arrays we genotyped four independent cohorts, totalling 11 861 psoriasis cases and 28 610 controls, aggregating the dataset through statistical meta-analysis. Single variant analysis detected a previously unreported risk locus at TNFSF15 (rs6478108; P = 1.50 × 10-8, OR = 1.10), and association of common protein-altering variants at 11 loci previously implicated in psoriasis susceptibility. We validate previous reports of protective low-frequency protein-altering variants within IFIH1 (encoding an innate antiviral receptor) and TYK2 (encoding a Janus kinase), in each case establishing a further series of protective rare variants (minor allele frequency < 0.01) via gene-wide aggregation testing (IFIH1: pburden = 2.53 × 10-7, OR = 0.707; TYK2: pburden = 6.17 × 10-4, OR = 0.744). Both genes play significant roles in type I interferon (IFN) production and signalling. Several of the protective rare and low-frequency variants in IFIH1 and TYK2 disrupt conserved protein domains, highlighting potential mechanisms through which their effect may be exerted.

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