Psoriasis Review

A review of recent news, research, and treatment related to psoriasis.

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Psoriasis Therapy Improves Joint and Skin Symptoms of PsA  

Ixekizumab (Taltz) may be effective to treat patients with psoriatic arthritis (PsA) who are not be able to receive antitumor necrosis factor (anti-TNF) inhibitors, according to a recent study presented at the British Society for Rheumatology Annual Conference, which was held from May 1-3 in Liverpool, England. 

In the double-blind, placebo-controlled trial, 363 participants with PsA unresponsive to 1 or 2 anti-TNF inhibitors or those who were TNF-intolerant were randomized to 80 mg of subcutaneous ixekizumab every 2 or 4 weeks or placebo after an initial 160-mg dose at baseline. Participants who showed inadequate response at week 16 received rescue therapy. The primary endpoint was improvement in American College of Rheumatology (ACR) score by 20% or more at week 24. In addition, the researchers assessed skin outcomes, patient-reported outcomes, and safety. Overall, 87% of participants completed the study.

Compared with participants who received placebo, those treated with ixekizumab were significantly more likely to have achieved ACR20, ACR50, ACR70, minimal disease activity, and reductions in functional disability by week 24. Likewise, a significantly higher proportion of participants who received ixekimuab every 4 weeks achieved complete resolution of dactylitis compared with placebo. Ixekizumab was associated with improved enthesitis, significantly more participants achieving an itch numeric rating scale of 0, itch resolution or Dermatology Life Quality Index (DLQI) score of 0 or 1, improvements in body surface area by 3% or more on the Psoriasis Area Severity Index, and significantly greater improvements in patient-reported outcomes compared with placebo.

While there was a higher incidence of injection site reactions among participants who received ixekizumab, the majority were mild. Otherwise, the incidence of treatment-emergent adverse events was similar across groups. 

“Ixekizumab improved arthritis, physical function, psoriasis, and DLQI compared to placebo with no unexpected safety findings in patients with active PsA who had inadequate response or intolerance with prior TNF-inhibitors,” the researchers concluded. 

Reference

Marzo-Ortega H, Meroni P, Galindez-Agirregoikoa E, et al. Efficacy and safety of ixekizumab at week 24 in biologic experienced patients with active psoriatic arthritis summary results. Presented at: British Society for Rheumatology Annual Conference; May 1-3, 2018; Liverpool, England.

Effectiveness of Biologics for Psoriasis in Difficult to Treat Areas

Guselkumab (Tremfya) was associated with significant improvements in psoriasis on the scalp, palms, and soles of the feet compared with adalimumab (Humira), according to the findings of a recent study. 

In their post-hoc analysis, the researchers examined data from VOYAGE 1 and VOYAGE 2, which were double-blind, placebo- and adalimumab-controlled studies of guselkumab conducted at 101 and 115 global sites, respectively. Participants in both trials had moderate to severe plaque psoriasis (N=1829) and were randomized to 100 mg of guselkumab, which was administered at week 0 and 4 followed by every 8 weeks, or placebo followed by 100 mg of guselkumab starting at week 16, or adalimumab at a dose of 80 mg at baseline followed by a dose of 40 mg at week 1, then administered every 2 weeks. 

The main outcomes included the number of participants who achieved scores of 0 or 1 (clear or almost clear) or 0 (clear) on the scalp specific Investigator’s Global Assessment (ss-IGA), Physician’s Global Assessment of the hands and feet (hf-PGA), and fingernail PGA (f-PGA), as well as the percentage of participants who experienced improvements in the target Nail Psoriasis Severity Index score. All assessments were conducted through week 24.

At week 16, a greater proportion of participants who received guselkumab achieved a ss-IGA score of 0 or 1 compared with placebo (560 [81.8%] vs 43 [12.4%]). A greater proportion of participants who received guselkumab achieved a ss-IGA score of 0 or 1 compared with adalimumab at week 24 (582 [85%] vs 329 [68.5%]). Additionally, 479 participants (69.9%) who received guselkumab achieved a ss-IGA score of 0 compared with 270 participants who received adalimumab.

Guselkumab was found to be superior for achieving hf-PGA score of 0 or 1 compared with placebo at week 16 (154 [75.5%] vs 15 [14.2%]) and adalimumab at week 24 (164 [80.4% vs 91 [60.3%]). A score of 0 on the hf-PGA was achieved by 153 participants (75%) in the guselkumab group compared with 76 (50.3%) in the adalimumab group.

In addition, 196 participants (46.7%) in the guselkumab group achieved an f-PGA score of 0 or 1 compared with 32 participants (15.2%) in the placebo group at week 16. A total of 252 participants (60%) in the guselkumab group achieved f-PGA score of 0 or 1 compared with 191 (64.3%) in the adalimumab group at week 24. A f-PGA score of 0 was achieved by 115 participants (27.4%) in the guselkumab group compared with 83 (27.9%) in the adalimumab group.

“These results may help dermatologists make treatment decisions for patients with psoriasis in difficult-to-treat body regions,” the researchers concluded. 

Reference

Foley P, Gordon K, Griffiths CEM, et al. Efficacy of guselkumab compared with adalimumab and placebo for psoriasis in specific body regions: a secondary analysis of 2 randomized clinical trials [published online May 16, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.0793

Biologic Does Not Reduce Vascular Inflammation

Adalimumab (Humira) was not associated with reduced vascular inflammation in patients with psoriasis, according to a recent study by Joel M. Gelfand, MD, and colleagues. The study findings were published in Circulation: Cardiovascular Imaging

In the trial, 97 participants with moderate to severe psoriasis were randomized to adalimumab, phototherapy, or placebo for 12 weeks. A total of 92 participants completed the first phase of the study, of whom 81 went on to the 52-week extension period and received adalimumab. Sixty-one participants completed the entire study. The primary outcomes included changes in vascular inflammation, assessed using 18F-fluorodeoxyglucose positron emission tomography and computed tomography, and biomarkers of inflammation, insulin resistance, and lipoproteins.

The researchers did not observe any differences in vascular inflammation between adalimumab, placebo, and phototherapy groups at week 12, and found no differences in vascular inflammation after 52 weeks of treatment with adalimumab.

While adalimumab and phototherapy decreased inflammation by serum C-reactive protein and IL-6, only adalimumab reduced tumor necrosis factor and glycoprotein at weeks 12 and 52. In addition, adalimumab and phototherapy did not impact metabolic markers, including insulin, adiponectin, and leptin. Phototherapy was also associated with increases in high-density lipoprotein-p at week 12. At week 52, adalimumab treatment was associated with reduced cholesterol efflux and high-density lipoprotein-p.

“Adalimumab reduced key markers of inflammation including glycoprotein acetylation compared with phototherapy with no effect on glucose metabolism and vascular inflammation, and potential adverse effects on high-density lipoprotein,” the researchers concluded. “Glycoprotein acetylation improvement may partially explain the beneficial effects of adalimumab seen in observational studies. Larger studies with more detailed phenotyping of vascular disease should assess the comparative differences in the effects of adalimumab and phototherapy seen in our study.” 

Reference

Mehta NN, Shin DB, Joshi AA, et al. Effect of 2 psoriasis treatments on vascular inflammation and novel inflammatory cardiovascular biomarkers: a randomized placebo-controlled trial. Circ Cardiovasc Imaging. 2018;11(6):e007394. doi:10.1161/CIRCIMAGING.117.007394

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