Case author Danna Calder, MMSc, PA-C presents a case of a 34-year-old male with severe, recalcitrant psoriasis achieving remarkable improvement after decades of treatment challenges.

A Remarkable Result after a Lifetime of Disappointment in the Treatment of Severe, Recalcitrant Psoriasis 

Case author Brad Glick, DO, MPH, FAAD, presents the case of a 57-year-old female with worsening plaque psoriasis of the elbow who experienced limited responses to multiple therapies.

Tapinarof 1% Cream Effectively Clears Plaques of the Boney Prominences

Ron Vender, MD, FRCPC, presents the case of a 31-year-old male with an 8-year history of severe psoriasis who was frustrated with the lack of effective treatment options.

Rapid and sustained clearance of severe psoriasis with dual inhibition of IL-17A and IL-17F

5 Tips in 5 Minutes: Co-Managing Psoriasis and Obesity With GLP-1 Receptor Agonists 

Summarize the role of glucagon-like peptide 1 (GLP-1) receptor agonists in the management of psoriasis 

Recognize opportunities to promote appropriate administration of GLP-1 receptor agonists in patients with psoriasis 

5 Tips in 5 Minutes: Co-Managing Psoriasis and Obesity With GLP-1 Receptor Agonists: An Online Activity

Setting Sights Higher With New and Emerging TYK2 Inhibitors for Psoriasis

Outline the role of new and emerging tyrosine kinase 2 (TYK2) inhibitors in optimizing psoriasis management 


Review the latest clinical data for new and emerging TYK2 inhibitors in the treatment of psoriasis 


Discuss strategies to incorporate more stringent efficacy targets to optimize treatment plans for psoriasis

FC25: Setting Sights Higher With New and Emerging TYK2 Inhibitors for Psoriasis: An Online Activity

​Encapsulating Progress With New and Emerging TYK2 Inhibitors for Psoriasis

Differentiate tyrosine kinase 2 (TYK2) inhibitors from Janus kinase (JAK) inhibitors 

Identify patients with moderate to severe psoriasis who may benefit from oral small molecule treatment 

FC25: ​Encapsulating Progress With New and Emerging TYK2 Inhibitors for Psoriasis: An Online Activity

Clear Skin, Clarity in Care: Emerging IL-23 Data Highlights for Psoriasis 

Evaluate severity of psoriatic disease to identify patients who meet International Psoriasis Council (IPC) eligibility criteria for systemic therapies 

Describe the emerging long-term clinical evidence for interleukin (IL)-23 inhibitors in psoriasis management 

Select the optimal therapy for patients with psoriasis who are eligible for systemic therapy

FC25: Clear Skin, Clarity in Care: Emerging IL-23 Data Highlights for Psoriasis: An Online Activity 

Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management

Review emerging oral therapies in the context of the current treatment landscape for psoriasis (PsO) 

Discuss considerations for PsO treatment selection, including patient preferences and treatment targets

Evaluate the safety and efficacy of oral IL-23 inhibitors to improve outcomes for patients with psoriasis 

FC25: Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management: An Online Activity

Fall Clinical 2025 Wrap-up: Key Takeaways on GLP-1’s in Psoriatic Disease Instagram 

Identify strategies for integrating GLP-1 receptor agonists into dermatology practice, considering patient support programs to improve access and adherence

Fall Clinical 2025 Wrap-up: Key Takeaways on GLP-1’s in Psoriatic Disease: An Online Activity

Fall Clinical 2025 Wrap-up: Key Takeaways on GLP-1’s in Psoriatic Disease: Instagram Live

Identify strategies for integrating GLP-1 receptor agonists into dermatology practice, considering patient support programs to improve access and adherence.  

Fall Clinical 2025 Wrap-up: Key Takeaways on GLP-1’s in Psoriatic Disease

Pediatric Psoriasis: Emerging Oral Options

Evaluate emerging clinical data for targeted oral therapies for the treatment of pediatric psoriasis 

Recognize the role of emerging targeted oral treatment options in individualizing treatment plans for pediatric psoriasis

PEDS25: Pediatric Psoriasis: Emerging Oral Options: An Online Activity

Crack That Case: Individualizing Care in Psoriasis

Discuss the role of available targeted systemic therapies in individualizing the management of psoriasis. 

Identify targeted systemic therapies that may be better suited for specific patient populations based on demographics, comorbidities, and medical history. 

Recognize patient characteristics that may make the use of certain targeted systemic therapies less favorable. 

PANP25: Crack That Case: Individualizing Care in Psoriasis: An Online Activity

'HowTo' Use GLP-1 Receptor Agonists for Psoriatic Disease Management

Identify strategies for integrating GLP-1 receptor agonists into dermatology practice, considering patient support programs to improve access and adherence.

'HowTo' Use GLP-1 Receptor Agonists for Psoriatic Disease Management: Microlearning CME Activity

The ABC’s of GLP’s and Psoriatic Disease Instagram 

Discuss the mechanistic rationale of combining interleukin (IL)-17 biologics and glucagon-like peptide (GLP)-1 receptor agonists in psoriatic disease management for patients with obesity, including disease control and weight loss.

The ABC’s of GLP’s and Psoriatic Disease: An Online Activity

The ABC’s of GLP’s and Psoriatic Disease Instagram Live

The ABC’s of GLP’s and Psoriatic Disease

DermInsider - VGR Session 2

Recognize the importance of timely access to biologic therapy to optimize psoriasis outcomes, especially among Medicare patients 

Discuss emerging data for biologic therapies for the treatment of psoriasis 

Identify strategies to increase timely access to biologic therapy for patients with psoriasis covered through Medicare

Mastering Psoriasis Management With Medicare

DermInsider - A Virtual Grand Rounds Series - Session 2: Mastering Psoriasis Management With Medicare

Review the immunopathologic mechanism of psoriatic disease and associated comorbidities 

List key therapies to manage psoriatic disease and associated comorbidities

Select optimal therapies for psoriasis patients based on demographics, comorbidities, and medical history

Describe effective strategies for multidisciplinary care of patients with psoriasis and related co-morbidities

FC24: The Comorbidities of Psoriasis: What Clinicians Need to Know to Optimize Care: An Online Activity

List the barriers of early diagnosis of psoriasis in skin of color and how to overcome them

Describe strategies for multidisciplinary collaboration to more promptly diagnose psoriatic disease in patients with skin of color

Review the role of systemic therapies for the management of psoriatic disease in skin of color patients

FC24: Practical Insights and Pitfalls for Psoriatic Disease in Skin of Color: Early Diagnosis for Effective Treatment: An Online Activity

Define the impact of palmoplantar pustulosis on patient quality of life (QoL) 

Describe strategies for effectively diagnosing palmoplantar pustulosis 

Review the latest clinical data pertaining to emerging therapeutics for palmoplantar pustulosis 

FC24: Palmoplantar Pustulosis: Looking Ahead to New Treatment Options: An Online Activity

CMEswiper: Swiping Away Comorbidities Through the Lens of Psoriatic Disease: An Online Activity

Identify non-steroidal topical agents for the treatment of atopic dermatitis and psoriasis

Discuss strategies to individualize care with topical non-steroidal therapies for the management of atopic dermatitis and psoriasis

Non-Steroidal Topical Therapies in Psoriasis and Atopic Dermatitis: The Paradigm Shift: Online CME Activity 

Overview the key data on the IL-17 and IL-23 classes of biologics 

Compare and contrast IL-17 and IL-23 biologic therapies based on clinical trial and real-world data

Categorize which biologic agents may be more appropriate for specific patient populations based on demographics, co-morbidities and medical history 

IL-17 vs. IL-23 Inhibitors for Psoriasis: The Great Debate

Highlight the key different clinical presentations of plaque psoriasis in skin of color (SOC) 

Review the unique treatment goals in patients with SOC that have psoriasis 

Classify the role of novel targeted agents for the management of plaque psoriasis in SOC

The Many Shades of Plaque Psoriasis: Considerations for Treating Skin of Color

Differentiate between the IL-17 inhibitors and IL-23 inhibitors for the management of chronic inflammatory dermatologic disorders such as psoriasis, psoriatic arthritis, and hidradenitis suppurativa

Overview the role of IL-17 inhibitors for the management of psoriasis, psoriatic arthritis, and hidradenitis suppurativa

Describe how to manage patients with IL-17 inhibitors over the continuum of care with particular attention to the ease of dealing with side effects

Tips in the Use of IL-17 Inhibitors in Dermatology

Now, we're going to go into our next session where we're going to learn about tips on the use of IL 17 inhibitors in dermatology. And who better to do this than two of my dear and esteemed colleagues, Dr. Bruce Strover and Dr. Joseph Morola. And with that, I won't take any more of their time. All right, folks, we are so excited to be with you. We packed a little more than we probably should have into this session, so Bruce and I are going to be doing lightning round here. Bear with us if we go quickly, but the tips are going to be coming fast and furious. This is us. I think we had an intro. I'm Joe Morola. I'm a dermatologist and rheumatologist. And as of Monday, in fact, big change for me. I went from Boston to Dallas. I'm thrilled to be the chair at UT southwestern as of Monday, happy to meet with any Dallas folks. Give me some tips later. And Bruce. Bruce Strober. And if you liked Mona, you'll like me, because we practice in the same practice and nothing more. Connecticut. That's it. Yeah, I can't tell them apart with that. I'm going to turn it over to my colleague and we will go from there. Right. Well, I like to say if you utilize IL 17 inhibitors, you're really covering most of the relevant bases when it comes to treating patients with psoriatic disease. Disease. And that's because, as you can see in this slide, the IL 17 isoforms and they combine up with each other in various combinations, mediate inflammation, not only in the skin, but also in the bones and joints and the ligaments. And this also can be either part of the adaptive immunity or the innate immunity. So blocking IL 17 is going to be very fruitful across various disease states and actually subsets within those disease states, too. That's an important point. Aspects of those diseases that need to be controlled differentially. So for psoriasis, we now have four IL 17 inhibitor pathway inhibitors. Secukinumab, ixicismab being IL 17 a blockers, rodalumab being receptor for il 17 blocker. And bimikizumab, just approved on Tuesday of this week, is an IL 17 a and f blocker. And I'm not going to go through the dosing. You can look it up. Bimikismab, actually, uniquely of this class of drugs, actually has tailored dosing based on weight. So patients weighing more than 120 kg get more frequent injections in the maintenance phase. I ask you to look that up now. All of these drugs have the feature of being rapid with regard to achievements of posey 75 and 9100. Ultimately, if you go out to a year, roughly eight out of ten patients have a posey 75. Seven out of ten have a posey 90, and a half of the patients have a posey 100. So deep responses, rapid responses, if you remember anything about these drugs, deep and rapid and long term response, too. A unique aspect of the study program for ixicismab was the evaluation of efficacy in genital psoriasis, the achievement of PGA zero or zero one. Three out of four patients with genital psoriasis get a genital PGA of zero. One half of them, approximately get a full clearance. So a unique study and definitely a specific use in a special area. I like to always call out one of the safety features of IL 17 inhibitors. There's really no malignancy signal at all. And you can see that's kind of a flat line. And more importantly, I use IL 17 inhibitors in patients with a history of malignancy, where you're really backed into a corner and you have a patient with severe psoriasis and in any really stage of their malignancies. I've been using erythrodermic patients with active lung cancer, really changing the lives. So think about these drugs with a history of malignancy. I really advocate it. And so the oncologists actually approve of this as well. Palmoplanner psoriasis. This is just an example of how sacukinumab achieves PGA one. You certainly could get this level of efficacy with all of the IL 17 inhibitors in palma planner. And just extending that, the ability to use an IL 17 inhibitor, brodaliumab, that's the receptor blocker for patients who have failed other classes. And even within the class, you can get rescue, so to speak, with brodaliumab. So don't forget about brodymab, because it may work. When, for example, an IL 23 doesn't work or a TNF doesn't work. And these data show it clearly how they can achieve PoSI 90 and posey 100. Half of the patients, for the most part or better, maybe two thirds get to posey 100, even though they failed a prior drug, palm implant or postular psoriasis. This was done in Japan. But if you really want to tackle one of the toughest aspects of psoriasis, postural psoriasis of the palms and soles, think about an IL 17 inhibitor. This is brodaliumab. Probably does it as well or better than the others in the class. But I don't know how bimikismab will function, but I actually predict it'll be like this as well, given its broader approach to IL 17 inhibition. And this is bimikizumab's data. Just so you know, it really has remarkably effective ability to achieve Posey 90. There's nine out of ten patients get to posey 90, and they get there very rapidly. So this might be the most rapid and deepest response we've ever seen in a biologic. And notice, they keep that response out a year. And the posey 100 response rates in bimikizumab are in about two thirds of the patients. Two thirds of the patients get Posey 101. Issue you should be aware of with bibikizumab is about 10% to 15% have oral candidiasis. So you'll have to be familiar with treatment of that issue. Usually very mild and treatable. But you should be aware that some patients might have that occurred during the course of treatment. And then there's nail psoriasis. I always say this, I'm a broken record, but if you really want to normalize nails, use an IL 17 inhibitor. These are the data of a head to head between bimikizumab and secukinumab. The ability to clear nails, fully napsy zero at 48 weeks, and you can see 80% of the bimikismab patients have clear nails. That's superlatively good data. But notice the comparator secukinumab. It's in the 60% to 70% range. So both drugs are really good. It takes a while, of course, to normalize a nail, but definitely can impart to patients who have psoriasis with nail disease or simply nail disease alone that they could use a 17 inhibitor and get there over the course of a year. So my psoriasis summary is rapidly acting. High efficacy, effective when other drugs fail. Ideal for nails. And I didn't say scalp, but scalp rates go with il 70 inhibits for scalp psoriasis, really high success rate. Genital palm oplanner. It's worth trying. Top line efficacy for psoriatic arthritis, and that's going to be covered by Joe in just a second. And then actually, don't forget about this one. Great choice for patients with a history of malignancy. It's the most common question I get, and I always say, try an il 17 inhibitor in these patients and you'll have a high rate of success and not create a risk of recurrence more than the baseline for that particular patient. All right, so we're going to move forward to Joe. He's going to talk about psoriatic arthritis. All right, thanks, Bruce. Great tips. We're going to move as quickly as possible. Again, we're watching the clock against us up here. We covered psoriasis. I'll do PSA. We have a little bit on HS, and then we'll sort of wrap up for you. So what about IL 17 in psoriatic arthritis? And I'll say two things to sort of bookend this. On the one hand, really, in the current era for putting my rheumatology hat on, TNF inhibition has been king for a very long time among rheumatologists and psoriatic arthritis. And really, IL 17 has proven itself first line therapy in PSA. And I'll show you why. Similar to what Bruce showed, we have secinumab, ixicasumab approved in the US for psoriatic arthritis. Brodiamab, the receptor blocker approved in Japan for psoriatic arthritis. So we do have some data to look at. And bimicasumab, quite exciting, particularly at this meeting, as you mentioned. Now, approved for psoriasis, not yet for psoriatic arthritis in the US, but it is approved for psoriach arthritis outside the US. And so we have data there to look at as well. So when we think about. People ask me all the time, well, how do you decide in this huge landscape of options for csoric arthritis? If you want to know, you're checking all the boxes here. I'm going to focus. This is my cheat sheet for psoriatic disease treatment by mechanisms in the interest of time, just to focus on the mechanism here of IL 17. What you see is we check all the boxes for psoriatic disease, peripheral arthritis, skin and nail disease, some of the most robust skin and nail disease data that we just saw from Bruce a moment ago, axial disease. And this is not a minor point, jackalitis and endocitis. The highlights I have here are two other points for you, really. It distinguishes itself from other mechanisms. In that coverage of axial disease, we have only TNF inhibitors, IL 17 and jack inhibitors in that space. And also this differentiation point of inhibition of radiographic progression, meaning we know that we are getting an insurance policy for protecting joints and eroding joints with those studies. We have that only for TNF, IL 17, Jack so really have become mainstay for me. IL 17 has really moved to the forefront of first line therapy for psoriatic arthritis. And we don't have nearly the amount of head to head data in rheumatology that we have in dermatology in the psoriatic disease space. Again, TNF has been king. I would argue that TNF has been dethroned as king by IL 17. I think increasingly so by my rheumatology colleagues. And let me show you some of that data. So one key element is the spirit head to head data. This was a look at ixicasumab versus adlimumumab. Right. IL 17 a versus TNF inhibition. What's the take home message? Two points. Number one, that ixicasumab did as well as our gold standard tnf inhibitor across all the metrics in psoriatic arthritis, but did better and was superior to tnf in skin clearance. I think we've seen that repeatedly. The second study similar to that was the exceed study looking at sekicinumab versus adolemab. Same two take home points as good as gold standard TNF in joint outcomes, better skin efficacy. So, bimicationab, we have to talk about. Right, super hot topic, particularly at this meeting, and this is the be complete study. So what you see on the left hand side is the ACR 50. You may be used to looking at ACR 20 data, which is the usual regulatory primary endpoint for psoriatic arthritis. Here we see ACR 50, which is arguably a more clinically meaningful endpoint, higher bar. And we see an impressive 40% ACR 50 with IL 17 AF inhibition in this population. That is tnf inadequate response. So really important. And it's important for us to see that. Right, Bruce, given the current state of where a lot of patients will be coming from in their therapy, heading towards potentially a drug like bimbakizumab in the current era. And Bruce array touched on the robust skin efficacy that was seen as well in the psoriatic arthritis programs here with bimakizumab. Be complete. And I want to point these out to you as well if you want the next level version of the data. I'm a big fan of this MDA measure, minimal disease activity. It's just a low disease activity state, and it really speaks deeply to both the breadth and depth of efficacy in psoriatic arthritis because it covers all the domains of disease and psoriatic arthritis, and it's a low disease activity metric. So it's really very robust, very meaningful to patients. What you see here is some of the highest MDA data that we've seen to date, over 40% meeting that bar as early as week 16. So it's a metric I really like to look at. When I'm looking at drugs for psoriatic arthritis, who are the patients that I think about? So these are two real brief cases recently that I utilized Nile 17 inhibition. In the first one, a 45 year old woman with psoriasis cerric arthritis referred by a rheumatologist to our combined skin clinic in Boston for residual skin disease despite well controlled joints on a limumab. This was a clear patient for an IL 17 inhibitor and a 30 year old man with a history of psorias circulis who had back pain symptoms. We worked it up, had normal x rays, but was B 27 positive. Subsequently had an MRI with sacralitis. The point of this is whether or not you did that workup. This is a patient very much facing an IL 17 because of those back symptoms in the context of psoriasis, psoriarthritis. So my tips IL 17 A has shown efficacy as high as our gold standard PNF inhibitor data in psoriatic arthritis with better skin outcomes. So for me, this is a no brainer first line, putting the rheumatology hat on. I do avoid this when the patient has a personal history of IBD in favor of some of our other agents. However, I will say similar to MS and PNF and others, if they have a first degree relative with IBD, I'm not worried. Inhibition of radiographic progression is a major checkbox for me. And axial disease considerations. Major checkbox distinguishing from other agents in psoriatic arthritis. I'll turn it to Bruce, so we'll wrap up with an HS discussion. Basically, if you block IL 17, you can treat HS. It's going to come down to the potency and the isoforms you hit. These are data from the secukinumab clinical trials for HS. And basically, you see that it beats a placebo and two different studies that beats a placebo. So therefore, you're going to have the ability to use secukinumab dosing yet to be determined when the approval comes out. And in general, dosing for all drugs for HS, as you know, is greater and maybe more frequent. But look for secukinimab for the treatment of HS. This is bimikizumab. We just talked about that. For PSA and psoriasis, IL 17 af blocker. What I would see is even better data. These are high score 75, achievement rates, high score 75. And that's a higher bar. And you're seeing 40% of patients getting to that when on bimikizumab, regardless of the study you look at. So this might be next level bimikizumab. And then finally a drug I would doubt any of you have likely heard a lot about. But it's sonalocumab, which is a nano body, a smaller biologic molecule that blocks ANF as well, like bimikizumab. And recently they portrayed their data at the EADV just last week, and maybe even a little better than bimikismab. It's hard to say because they're different studies, but 43 versus 14% placebo at the high score 75 metric. So here we have two different AF blockers, which are going to be really extremely good, not only treating the inflammatory component of HS, but also the draining tunnels. So if you can cover all the bases with HS with one drug, you're going to really make a difference for patients. Huge unmet need. And FYI, just the enormous pipeline of drugs being developed for HS across the moas we have. So look for a lot of activity in the next five years. So tips for HS and IL 17 variable but convincing efficacy. I'm going to say I think the bimikismab sonolocumab data af blockade is a little better than the a blockade. I think you got to touch f to get even better efficacy for HS safety comparable to that seen in psoriasis. There is candidiasis variably again, across the agents. Bimikismab has higher candidiasis rates, ten to 15% depending on the study you look at. And this is the next frontier for HS beyond TnF inhibition, which makes me wonder, are you going to need to fail a TnF blocker before you get to an Il 17? And how will a patient do who fails a TNF who has moved to an IL 17? Those are interesting questions to answer with future studies. Just to review, some of the AES we can commonly see in patients on IL 17 inhibition, nasopharyngitis, URis, headaches, tinia Canada. All right, tinia in Canada would be. I would warn patients about there's no evidence of tb risk with IL 17, though we have to get quantifier on golds before we start these drugs. And I talked about no evidence of malignancy. There's the Canada risks. Depending on drug, you have higher risk. Bimikizumab topping that rare instances of IBD. I don't like IBD being portrayed as a common issue with IL 17. We've seen that. I don't think that's the issue. It's a rare issue. It's about a one in 500 to one in thousand rate in all the studies. And then Bridalumab has a REMS program for suicidal ideation behavior, but I think it's very soft. I think the whole issue of suicidal ideation behavior with IL 17 blockers is questionable. I'm just going to say in my opinion. I'll be happy to second that. Yeah, and then you're going to see warnings variably in various drug labels, not all of them for that issue, as well as a liver precaution in patients getting bimikismab, which I also think is very soft. I'm not going to file a liver function test based on my knowledge of the data. So while there might be language in the label, you have to sort of gauge it in the context of the true data and not necessarily what is stated. Thank you for your attention. I hope you found the tips and tricks in this section helpful. I would like to remind you just to again bookend our comments that this was the best session that you saw today. Thank you all so much for your attention. And we'll take questions in the back. We can hang around. Thank you so much.

Explain the role of the IL-17 pathway in the pathophysiology of chronic inflammatory dermatologic disorders

Review data for IL-17 inhibitors for the management of inflammatory dermatologic disorders

Discuss strategies to educate patients about IL-17 inhibitors and incorporate these agents into clinical care

2023 Virtual Grand Rounds Session 11: September 13, 2023 - The Role of the IL17 Inhibitors in Targeted Management of Inflammatory Dermatologic Disorders

Therapeutic Hotline: Expert Perspectives on IL17 Inhibitors in Targeted Management of Inflammatory Skin Disorders

Therapeutic Hotline: Expert Perspectives on IL17 Inhibitors in Targeted Management of Inflammatory Skin Disorders: An Online Activity

Hi, I'm Mark Lebwall, and I am pleased to be giving this talk on the therapeutic hotline on IL 17 inhibitors. This session is supported by an educational grant from UCB. I am the dean for clinical therapeutics at Mount Sinai in New York City, have been chairman of the Department of Dermatology for the 25 years before that, and I'm very pleased to be doing this talk with my friend Ron vendor. Ron, please introduce yourself. I am Ron vendor from Canada. I am part of McMaster University here in Hamilton, the home of evidence based medicine. And this program is approved for one quarter point 25 AMA CME credits. So, Ron, let's start out and tell us what's new in IL 17 inhibition. What are the new developments? Well, we've had three very stable anti IL 17s on the market for quite some time, sachicinumab, ixicizumab, and brodalumab. And the newest, antiil 17 is vimicizumab. That was approved about 18 months ago in Canada and Australia around the same time, February of 2022. And this is a different anti il 17. It affects the a and AF as well as the f part. And this allows a different type of efficacy, as well as an extended type of frequency in terms of injection. So instead of the usual frequent every two to four week injection of the other anti Il seventeen s, the mechizumab allows every four to every eight weeks. Yeah. Interesting. We've always known il 17 a is important because secuchinumab works so well and ixicizumab works so well, and 17 a clearly plays a major role. But it turns out 17 f is more prevalent in the skin of psoriatics, and that may explain why blocking the two together gives an added benefit. One of the things that we know about il 17 blockade is that these are the fastest drugs we have, and we've actually published data on this, where the three fastest drugs, until bimikizumab came out, were indeed bridalumab, ixicizumab, and sechiniumab, in that order, very fast, all three of them. And now, of course, we have this data on bimicizumab, which shows that at week four, over 75% achieved passy 75. So a very fast therapeutic outcome. What about the degree of efficacy, Ron? Well, at the Pasi 100, which is our target that we're trying to get to all the time, by week 16, we're seeing the majority of patients, almost 60%, are Pazi 100. Now, when we have the ixicizumab and psychicinumab and verdeliumab. And we look at them all at four weeks. It's hard to clinically tell the difference at that point. But by week 16, when you're having 58% with bimikizumab that are Pazi 100, that's extremely impressive. Ron, now that you have experience with bimikizumab in the real world, what can you tell us about the fungal infections which we know were reported in the clinical trials? Well, the good news is that my real world evidence that I'm seeing in my practice is mimicking what was reported in the clinical trials where the fungal infections that I see with bimikizumab is oral candidiasis. That's very easily manageable, does not recur often whatsoever. Most of the patients have one or two episodes, responds to either oral nystatin or oral diflucan, which is available by prescription here in Canada. And the patients are doing so well with it that they really don't want to stop the mcKizumab because of one or two yeast infections. And we're not seeing extensive yeast infections. No one had to stop it in my practice, because of oral thrush. It occurs less than 25% of the time in the first four months, and then when the dose is extended to every eight weeks, we see it half of that. So maybe 9% of the time, and that's maybe where they're getting their second episode. Yeah, you show a picture also of tinia versicolor, which I'm glad you're showing. It was not reported in the clinical trials, but we also have seen with other IL 17 blockers. Tinia corporus developed when I, years ago, took care of a patient with chronic mucocutaneous candiditis, which is an IL 17 deficiency. That patient had horrific tinia infections. But in the clinical trial, what we saw really was limited to infrequent, mild to moderate monilial infections that were easy to treat. And as you see here, that in the first year, 9% of patients had one episode, another 4.1% had two episodes, and almost nobody had more than that in that year. Over two years, those numbers hardly changed. A small fraction of a percent more had one or two episodes during the two years, and very few patients had more than two episodes. So, infrequent, mild or moderate, and easy to treat. Agreed. So my next question to you is, how, why, and when do you switch from one biologic to another if the patients are doing well? I'm not switching anything, even if they say, oh, I'd like to have something that's less frequent, leave well enough alone. Very rare nowadays to have a primary non response. This lack of initial efficacy, we just don't see that with the power of these biologics anymore. The secondary non response, again, is very uncommon. It may occur 1015 percent of the time. And we know that the more biologics that we use to treat these patients, the tougher it is and the more secondary response. Of course, if there's an adverse event, we're going to switch the biologic, and occasionally the patient is not that satisfied. So we may do a switch, but generally, if they're doing well, we don't do a switch. If they're not doing well, we'll switch. Now, if they had secondary response, I will switch within class. If they had an adverse event in that class, then I usually switch out of class. Okay. And this is called treatment sharing. I believe there's a word for it. But basically you're sharing with the patient the decision of what to do, and if they're not doing well enough, you switch. And unfortunately, we do have another option. Now, do we know anything else about long term safety? We do know a lot from the clinical trials. Do you know anything from real world safety? Do we have to worry about anything else? The good thing is that these biologics are super targeted, very focused molecules. And in the 18 months of using bimikizumab, there's no signals that have come up. There's very little data from real world registries like coravitus, still a bit too early for that. With other anti IL 17s like secucinomab or ixicizumab, we're not seeing any safety signals long term. We're not seeing malignancy or increase in Canada infections or mace. It just doesn't occur. And we're not seeing a reactivation of tuberculosis, especially in those areas and countries where tuberculosis is more prevalent. We're not seeing that. So short term safety equals long term safety and comfort for the patients especially. And allows the dermatologist or prescribing physician to sleep at night. Right. I will say that when we ask our gastroenterologist, because secucinum was tested for Crohn's disease and did not work, and there were a few patients who even had a little exacerbation, they will not allow us to use 17 blockers in patients with psoriasis and Crohn's disease. The last thing I want to touch on is what other indications are IL 17 blockers used for and I will say that we have a little bit of experience using them off label for hydratinitis separativa. And now, of course, secuchiniumab has been approved. And as you can see, there is very good efficacy data comparing that to placebo. Bimakizumab, I know, is in trials for hydratnitis. So hopefully that will be another future indication. And of course, the 17 blockers are great for psoriatic arthritis. And what you see here is that secuchemab and executionumab are approved in the US for psoriatic arthritis. Burdeliumab is approved for psoriasis along with the other two IL 17 blockers in the US. And we're waiting for approval of vimicizumab for psoriatic arthritis. Bridalimab is approved Xus as is vimakizumab. But secuchenab isa kizumab are available for psoriatic arthritis. The only one approved to date for hydronitis suprativa is indeed secukenumab. And hopefully we'll be getting more for hydratinitis as well. So with that, I want to thank everyone for participating. Thank you, Ron, for that excellent discussion. And we are delighted to have this expanding armamentarium of, of treatments for psoriasis. Thank you. Thank you very much. Thank.

Identify the relationship between psoriasis, psoriatic arthritis and biologics 

Describe the role of IL-17 inhibitors for the management of moderate-to-severe plaque psoriasis in challenging body areas such as, nails, scalp, genitals, palms, and soles of the feet 

Recognize patients who would benefit from IL-17 inhibitors for the management of moderate-to-severe plaque psoriasis in challenging body areas 

Discuss how PAs and NPs can work in a multidisciplinary team to manage patients with moderate-to-severe plaque psoriasis in challenging body areas 


Take the Challenge to Manage Moderate-to-Severe Psoriasis From Head-to-Toe: CME Satellite Symposium - Online CME Activity

Identify the role of IL-17A and IL-17F inhibitors across multiple disease pathways and how therapies target this pathway 

Discuss the benefit-risk profiles of IL-17 inhibitors for the management of psoriasis 

Describe strategies on how to work as a multidisciplinary team to individualize patient care with IL-17 inhibitors 

Taking a Deep Dive Into the Role of IL-17 Inhibitors for Psoriasis: What do PAs and NPs Need to Know? Seminar-in-Depth Online CME Activity

Taking it around. And hopefully we'll be able to incite some knowledge about the aisle seventeen s and psoriasis. There we go. Okay, so the clicker is right here. Excuse me. Thank you. And April and I will. I'm actually very honored to be on the same stage with April, who is an expert in this condition. These are objectives here. We want to talk about the aisle seventeen s and about the mechanism action of il 17 a and 17 f inhibitors. Talk about the risk benefit profiles, and talk about how to work in a multidisciplinary way to individualize patient care. So April is going to start off by talking about the role of il 17 in inflammatory diseases, and then we'll go from there. Great. We ask a lot of you, take the quiz, and then also absorb the information at the same time, but really appreciate your energy and attention. So we're going to dive a little bit into the science for the first section, and then Dr. Paris is going to talk about some of the clinical data, and then we're going to bring together with regards to the clinical relevance. So why do we care about il 17? So, IL 17 has been implicated by in a number of different inflammatory conditions, not only in the skin, but also, importantly, in the joints. And the three conditions that are relevant to what we practice is psoriasis, psoriatic arthritis and hydranitis separativa. And I'm going to show you a little bit with regards to where il 17 acts and how that matters. So, when we look at the psoriasis pathogenesis, for example, we have il 23, which is important for the differentiation of the adaptive th 17 cells. So the blue cells on the top. And then we also, however, have contributions from the red cells, which are those innate lymphocytes. So they both produce il 17. They produce il 17 a as well as il 17 f, which then lead to the skin inflammation that we see clinically. So, not only is this seen in the skin of patients with psoriasis, the same process is also seen in the joints, as well, with bone remodeling, as well as cinovitis, typical findings that we can find in psoriatic arthritis. So what we've noted over time is that IL 17 A as well as IL 17 f, they share some overlapping biology. They're cousins of one another. In fact, they share about 50% similar homology. And both adaptive as well as immune system as well as the innate system, can be responsible for their production. So you can get AA homodimers, FF homodimers, or AF heterodimers, and they can signal through a number of different receptors. So here, the AAF and FF, they signal through one set of receptor. Now, the IL 17 family also has other members as well. We have IL 17 e and its role is still being elucidated. And then we have IL 17 c, and then IL 17 c is very important for the amplification of the cascade. Now, this is important. So what we're looking at on the left hand side are psoriasis, lesions, and the expression of IL 17 A and IL 17 f compared to non lesional psoriasis. And what we see is that we know a is very important. We already have segukinumab and execismab against a, and then the a level is actually relatively, compared to f is less abundant. So we actually have more abundant levels of IL 17 f in psoriasis. Skin on the right hand side, what we see is a level of IL 17 f in HS lesions. And this is something I think we've really come to appreciate, something novel, that IL 17 f is present at high levels in HS lesions as well. And here is a summary of the biologics that target IL 17 axis with regards to what has been approved and as well as what is emerging. So, as you can see here, sekukinumab and ixicismab have the same mechanism action focusing on inhibiting IL 17 A. Bimikizumab, which is an emerging agent. It targets both a and F. Brodalamab, which is also approved for psoriasis, it's a receptor inhibitor. It inhibits IL 17 receptor alpha, and by doing so, it inhibits the actions of signaling pathways of AFC. So with that bit of science as a background, I'm going to turn the podium to Dr. Parasar. Okay, so, real good review of the biology of the drugs that are out there now. I want to talk to you about the clinical safety and efficacy data, and I'm going to do it in a little different way than you're used to seeing. These are the four agents that I'm going to speak about. I want to emphasize that vimakismab is not FDA approved at this point. It's under review. Brodalumab, ixicismab and psychicinimab are all approved. You know, we don't like to compare clinical trials, one clinical trial against another clinical trial, when they weren't a head to head comparison within the same trial, but yet we all kind of do that. And I'm going to take the liberty to sort of do that in this presentation, because all of these il 17, inhibitors for psoriasis had very, very similar clinical trials. They all enrolled adults, some also enrolled children, but all adults, the patients had passes a BSA of 10% or more and a passy of twelve or more. And they all had an IGA of moderate or severe. In that respect, they were pretty similar. So let's talk about these in alphabetical order. Bimikizumab first, because it's the first. In alphabetical order, it is. Again, I'll just emphasize for the last time, this is not an FDA approved. The BLA has been submitted, it's undergoing review. We don't really even know what the approved dose is going to be, but we do have some ideas about that. So there were several studies, and I'm going to throw together the results of different studies, but I'm going to try to make a point. The BIMIC hasemabs start off with this comparative study, double blind study, between the active drug and the placebo, and eustachinumab as another active control with a 16 week primary endpoint, and then continuation for week 52. And so this one we can say, yes, there's a valid, statistically significant difference between the efficacy, the passing 90 and the IGA one clear, or almost clear, in the patients who use bimachizumab versus eustachinumab. And this was because it's the same study, randomized control, good statistical significance. If you look at the passy 75, there's also the same spread. First was passy 75 was on the left side. On the right side is passy 100. And look at that, 58% passy 100. We haven't seen that before, really, in anything, in any of the psoriasis drugs. Secondary endpoint of bimikismab 90, Pazi 90, and the IGA one over a year, basically a very slight decrease in the efficacy. But I want to make a point with this one. If you look at week four already, the Bimachismam group is having a 43% improvement reach, passing 90, 49% IJ of zero one works very, very quickly and it stays effective over a 52 week study. In a long term side effects on biblicismab that we want to look at, I could show you this same slide and tell you it was from any of the biologics, because it really would be any of the Il 17s, rather. And these are all nonspecific ones. If we look at the common ones that are important, we're going to see down near the bottom, candida and candida. The presence of candid infections, mostly mild, some moderate, no real severe candidate infections in any of the biologics. But that's the IL 17 adverse event of interest. Now, they also did in head to head studies not only the eustachinumab that I showed you, but also adelimumab and secukinimab, and showed in a blinded study, increased efficacy in terms of looking at the passing 90 at week 16, which, remember, wheat 16 was not the primary endpoint for the other biologically other IL 17s that we're talking about. Okay, Bimacam is again looking at adelinemab, secukinimabs, igA, one at wheat 16, and for long term three years, it seems to not lose very much effectiveness. The people who achieved apacia 100, still 60, some percent all the way out to week 152 adverse events. Again, this is one of the other studies. And there's Candida again, as the one was the one of significance. All right, let's talk about the others. Bridalumab, the other one, that's another one that's currently on the market. There were two primary studies, placebo controlled registration studies, and again, compared to eustachinumab. Everybody wants to beat up on that, on that one. And you can see that the bridalumab people achieved passive 75 at a rate of 85% with the higher dose at week twelve compared to eustachinumab. And the lower dose, bridalumab, which didn't do quite as well. Long term extensions out to week 52 and beyond seemed to maintain most of its efficacy in both the higher and the lower dosage. Just so very briefly, there were in the phase two study some exacerbating based on existing Crohn's disease. And we know that that's one of the issues with il 17s, inflammatory bowel disease. Candida again, but no neutropenia, some neutropenia, no mace. Bedalliumab has a boxed warning for suicidal ideation and behavior. We can argue whether that is justified or not, but it's there. And there is a REMS program for bridalumab that you have to sign up for exechismab, another currently market drug. Complicated study, but I'm really focused on the induction period. That first twelve weeks were the primary endpoint of two doses of ixicismab versus placebo. And both of those doses showed obviously significant improvement over the placebo in results of passing 75 9100. And the SPGA just focusing on the passing hundred for a minute. A third of the patients, a little more than the third got the passing hundred. That's what we want to see. Nowadays, passing hundred is a realistic goal for most patients and slight decrease of efficacy over time, but not much. Again, the people who were clear through week 60 longer term studies, it stayed about the same as it was at the primary endpoint. So it did not lose a whole lot of efficacy over time. Here's the adverse events from one of the exechismab studies. And where is it? Again, it's Candida. There is the one that shows up as something of significant importance. All right, long term exechismab out to week 60 and in a different study. Again, just to make the point that the pasi 75 rate maintained itself all the way through till the end of the study in week 60, as did the passy 90, and as is the PGA, zero or one. So good improvement. The primary endpoint, long lasting improvement with ixacizumab. Finally secidumab, the other last one, very complicated slide. Don't even look at this except I want to make the point that this was studied in double blind fashion against itself and against the tannercept and in two different doses of secukinimab. Looking at the iga of zero one, passing 90 and passy hundred responses, you can see that again at passy hundred, which is what I always focus on now, is passing 145% with secukinimab. Passing 90, 76% Iga clear. Almost clear. 78. Week 52 pretty much maintained efficacy over that amount of time. Passing 90 results in the passing hundred and iga one. Again pretty much response over time and again, long term result. This was a DLQi which I didn't report on the other ones, but that remained as well about the same as it was at the primary endpoint. Adverse events. I could show you the same table again and look at the bottom last one, candida. That is the major adverse event of the aisle 17s in general. And looking at the rest of them, looking at the other serious the mace events and the inflammatory bowel disease, some one case actually of inflammatory bowel disease, mace events were not much. So this is a slide on the approved dosing. Now for the vimicismab. We don't have an FDA approved dose. What I've listed here for you is the dose which is approved in the EU where it has been approved for a while and this data is available on the handout that you get, but not for bimbikism because that's not approved in the US later. Until later, maybe later this year. We hope so. I will turn it over to April to bring it home about the real world use. So I'm going to talk a little bit about real world applications. This is a slide that I kind of put together, really think about some of the common shared characteristics among IL 17 inhibitors. So they are overall great in terms of the skin psoriasis efficacy, as David has shown, they also have very good efficacy in psoriatic arthritis. So this is one of their key strengths, not only peripheral psoriatic arthritis affecting the hands and the feet, but also axial spine psoriatic arthritis. They have pediatric dosing for secucunumab and ixicismab for six years and older for psoriasis. Where you want to avoid IL 17 inhibitors are those with a personal family history, a personal history of inflammatory bowel disease, and also there's low rates of oral candidiasis, as David has pointed out. In general, I will say that oral candidiasis is not prohibitive. Most of them can continue their il 17 with oral candidates treated with a few days of oral fluconazole. And also one thing that's interesting, based on the literature, is that you can actually switch from one IL 17 inhibitor to another IL 17 inhibitor. So this is a study by Dr. Lebwell's group that looked at people who have failed ixicizumab and failed psychicinumab. And if you put them on brodalamab, as you can see, that patients, about 76% of the patients would still achieve posey 75. Could it be because brodalamab is a receptor inhibitor and therefore is inhibiting other pathways? Possibly, but something to consider, and I'm just going to show some of the strength of IL 17 inhibitors is really inhibiting radiographic progression. And just for 1 minute, I'm going to pretend, have you pretend you're radiologists. So if you look at the left hand side is a normal hand, and on the right hand side is a patient with psoriatic arthritis. So you'll see the joint space is narrowed and joint space narrowing is a bad thing. And they can be quite progressive in our PSA patients. The other finding in PSA is hand. So this is the same picture of someone with PSA. And so what you see, radiology calls these mouse ear signs, where you get erosions, or maybe in Orlando we'll call them Mickey Mouse signs. So you get these erosions that can progress over time. And that's what we try to avoid as well. And what IL 17 inhibitors do, and all of them both approved as well as emerging, what they do is that they are best in terms of halting these radiographic progression, in terms of what I showed you, also, we have data showing that this is with secuchinumab. This is the only trial currently that's showing IL 17 inhibitors being very effective in terms of treating axial psoriatic arthritis. And those are the patients who wake up with a stiff back as their primary manifestation of their PSA in the morning, and it takes them a while to move. All right, what's exciting in the horizon is our IL 17 inhibitors for hydranita separativa. I know tomorrow you're going to hear a talk on HS, but what we see is that this is secukinumab with regards to treatment of patients with HS, as you can see, effective in terms of achieving high score of 50, so at least 50% improvement. So something we are looking to see coming down the pipelines. So secicinumab actually has already been approved in Europe for the treatment of HS not yet approved in America. I feel like usually we get approved in the US, always first. And then recently we've seen this kind of reversal of it being approved elsewhere than in the US, but very exciting. Also, I showed you earlier about IL 17 F and its role in terms of HS. And here we're looking at bimakismab, not yet approved in the US for any indication currently. But this is bimikizumab data in HS as well, showing really great efficacy in this area, too. So very exciting. So now we're going to have, in addition to adelemumab, hopefully very soon, both sekikinumab and bimikizumab for our patients with moderate to severe HS. And just to echo what Dr. Paraser have said, taking a multidisciplinary approach to care. Talk to your rheumatologist when you see a patient with psoriasis and psoriatic arthritis, which I'm sure you are doing already, the trouble is figuring out when you have a mutually agreeable time to talk. But I think having a multidisciplinary approach would be very helpful. And here's conclusion of what we talked about. Il 17 family of cytokines, important in inflammatory skin and joint disease, IL 17 F. We are gaining appreciation for its role in psoriasis, psoriatic arthritis, as well as HS. And we talked about the multiplinary approach. We want to thank you so much for your attention. Thank you. April and Dave bed.

Overview how IL-17 inhibitors target the inflammatory disease pathway

Summarize the clinical trial data for IL-17 inhibitors for psoriasis and psoriatic arthritis

Illustrate how to individualize care with IL-17 inhibitors for the management of psoriasis and psoriatic arthritis

Managing Psoriasis and Psoriatic Arthritis with IL-17 Inhibitors: What do we Know Today?: Online CME Activity

Is everybody having fun yet? Having a good time learning anything? Well, you're about to learn more from Dr. April Armstrong and Dr. Mark Lebwall, two of the codirectors. And they're going to be talking about managing psoriasis and psoriatic arthritis with IL 17 inhibitors. What you need to know, I thank you, Jim. All right, so in this session, we're going to take a deep dive into IL 17 inhibitors for psoriasis. And I'm very excited to share the podium with Dr. Lovewell, who is dean of clinical therapeutics and chairman emeritus at ICANN School of Medicine at Mount Sinai. And we're going to go right into it. So today, there are several learning objectives. Number one is we're going to look at the science of IL 17 family and why they're important in psoriasis pathogenesis. We're then going to talk about the mechanism of action of the various IL 17 inhibitors. And importantly, we're going to summarize some of the clinical trial data for you, and that Dr. Lebo is going to take you through this wonderful case, looking at the real world application of IL 17 inhibitors in patients with psoriasis and psoriatic arthritis. This is accredited. And to earn this extra CME credit, you can go to the special sessions agenda icon, which is right next to the regular agenda icon on your app, and your CME certificate will be emailed to you. All right, so let's first talk about the importance of IL 23 and IL 17 accessing psoriasis, right? This is like the evil accessing psoriasis. And when we think about this, and if you look at the left hand side of the graph, first, you have your myeloidic dendritic cells with these tentacles, and they secrete IL 23. So this IL 23 is this master regulator, and it really signals your naive t cells differentiating into different types of cells. So upon the stimulation of IL 23, your naive T cells can differentiate into th 17 cells, which is a blue ball, on the left hand side, and that th 17 cells then secrete downstream cytokines, principally IL 17. And this is really important because, predominantly, it's the IL 17 from the Th 17 cell type that's responsible for psoriasis. Now, there is a contribution through some of the innate immune system as well. So IL 17 is not only secreted through the Th 17 cells, but also by a number of innate immune cells as well. So ultimately, you get skin inflammation on the right hand side in terms of the clinical manifestation. But what we also learn is that in addition to that IL 17 is important in terms of when you have dysregulated, excessive IL 17 cytokines, you also get psoriatic arthritis. So you see abnormal bone remodeling. This is where you see the erosions on x rays in patients with psoriatic arthritis. They have cinovitis as well. And that's the reason why IL 17 inhibitors are also. Many of them are also approved for psoriatic arthritis. Okay, now let's think about the f word. So when we think about a and f, IL 17 family actually has a number of different members. The two key members that we care a lot about is IL 17 a and IL 17 f. In fact, those two members are related. They have about 50% homology between IL 17 A and IL 17 f. Importantly, they also exist in dimers. So if you look at the right side of the slide, you'll see these dimers, sort of these hamburger appearing graphics. So you can get Il 17 AA exists as a homo dimer or Il 17, or you can get the Il 17 AF heterodimer and also, notably, ilcenting Aaff or Af. They bind to the same receptor. Now, we didn't talk about the other members of the family, which is notable and relevant to us. We have IL 17 e, which we're trying to still understand and study as a field. And then on the right hand side, we have IL 17 C, which is actually secreted mostly by keratinocytes to perpetuate this cycle. All right, so where do our current therapies target? So, this slide, looking at the biologic agents that target IL 17, summarizes where they work. So you'll see that seguchinumab and ixicizumab, they're IL 17 A inhibitors, and therefore they inhibit IL 17 Aa homodimer and AF heterodymer. When you look at the Guring bimachizumab, which is an emerging therapy, it inhibits both the AAF as well as FF. Brodalamab is a receptor inhibitor. Therefore it affects the signaling of AFC and E. All right, so one kind of summarizing approach that I oftentimes think about when I think about the IL 17 inhibitors is that they, as a class, have robust efficacy in psoriasis. There are some differences among the agents. They have also robust efficacy, very important in psoriatic arthritis in terms of both peripheral as well as axial psoriatic arthritis. They have pediatric indication with secukinumab and ixacizumab in kids six years and older. You do want to avoid il 17 inhibitors in those with inflammatory bowel disease and other considerations is that there are low rates of mucocutaneous candidiasis that may be associated with IL 17 inhibitors. So we as a field have learned a lot about IL 17 inhibitors and IL 23 inhibitors over the years. And the type of study that I personally like a lot is head to head comparison. Much like the recent Super bowl. Who is a winner depends on which quarter that you're looking at. So the timing and how the study is designed and at what time point that endpoint is evaluated is very important. I'll highlight two very important studies to our field. So number one, this is our first, IL 23 versus IL 17 inhibitor, comparing Gasell cumab and secukinumab. Gasell cumab is the green line, segukinumab is a red line. So if you are looking at the end of the first quarter, you will see by week 16 they're very similar. However, when you're looking at at the end of one year, what you'll notice is that gaselchumab is superior to segukinumab with a Posi 75 as the comparator. If you look at a head to head exechismab versus gaselchumab study now we're looking at another IL 17 versus gaselchumab. Also, depending on where you look at, is important. This is looking at PoSi 100, right, highest bar. And what we see is that at week twelve, execismab is superior to gaselchumab. However, at week 24, they are pretty much equivalent. And this is secukinumab. Over the years, we learned that every two week dosing for people who are obese are more helpful than every four week dosing. So if you have obese patients who are not responding to every four weeks, consider dose escalating. And you'll see, when we were looking at the various metaanalysis out there, the IL 17 inhibitors tend to rank pretty high. So bimikizumab, as I talked about before, inhibits both IL 17 a as well as f. And then what you'll notice is that the IL 17 a and f expression, if you look at the middle column here, we actually have a lot of IL 17 f expression in the lesional skin of psoriasis. We also see that in the lesions of psoriatic, in the lesions of HS. And that's why it's being studied in both indications and whether it's comparing it to eustachinumab or adolemumab or IL 17. Another comparator, psychicinumab you'll see that bimikismab is superior to that. So seven out of ten patients will be completely clear by week 16 with a bimakismab, which is a tremendous efficacy that we haven't seen before. This efficacy is sustained at one year. And also what we see is that it's also sustained over three years period of time. And with that, I'm going to give the podium to Dr. Levwall. Thanks, April. So we are going to do some interesting cases, and I'm going to start out with this patient. A 36 year old patient with severe psoriasis is on an IL 17 blocker. And this is something that we see all the time. Skin does great, but the joints are still severe. The patient had already failed TNF blocker for both the skin and the joints and failed methotrexate for skin and joints. So what are our options? Should we switch to eustachinumab, switch to a 23 blocker? A few other options. Let's go through these. Eustachinumab is approved for psoriatic arthritis. It is only modestly effective. The delta in ACR 20 scores between placebo and the higher arm is not that great. Uselchumab, an IL 23 blocker, actually has some fairly good data on psoriatic arthritis. It is approved for psoriatic arthritis. So is resent kejumab, the other 23 blocker. Again, the data is not quite as different, as good as it is for the 17 blockers or for the TNF blockers, although here you see statistically significant, really good data for ACR 2050 and 70. When you look for Vonderhide scores, which are a measure of radiographic progression of joint disease, what you see is the q four, which is shown all the way over on the right, is statistically significant. But the drug, of course, is approved only at q eight weeks. So there is a benefit, but it's not statistically significant at the approved dose. So that's the story for use to kinium Evan 23 blockers. What about another IL 17 blocker? Why don't you switch from one to another, or a TnF blocker? And here there is a good option coming. Bimicizumab will be here in June, hopefully. And what you see here is they're not looking at ACR 20s, but actually at ACR 50 as the primary endpoint. So very high bar. And you see the kind of difference that we see with the other drugs for ACR 20, we are seeing ACR 50 changes, so very effective for psoriatic arthritis. And here you see as you go out to week 48, that improvement continues. Now, I will say they just published a phase three trial and compared bimikizumab to adolemumumab, which is the equivalent of many of the 17 blockers. Those are probably the most effective treatments we have for psoriatic arthritis, and it looked like the two were similar, bimikizumab and adolemumumab. We were hoping it would be much more effective. In fact, when you break the data out and you look at monotherapy, bimikizumab was much more effective than adolemab. So hopefully, we do have a better drug coming, hopefully in the near future. And here's even very impressive. Again, phase two data, ACR 70 scores. So a really effective drug for psoriatic arthritis. This is the study that was published which showed equivalence to adolemab, but that's including adolemab with methotrexate. Again, when you do monotherapy, the differences are actually substantially better for bimichizumab. Okay, what about adding a premilaster to creviceitinib? Decreasetinib is not yet approved for psoriatic arthritis. We actually have tried it in combination with biologics, and there may be some added efficacy for ducravacitinib. A premolast is approved for psoriatic arthritis, and we actually use that a fair amount, although as monotherapy, it is only modestly effective for psoriatic arthritis. Okay, what about methotrexate? Methotrexate is interesting. It's been around for decades, and I will say we often use it in combination with other biologic agents to get better improvement in psoriatic arthritis. So it would be a good option. I will point out that as monotherapy, it does not prevent radiographic progression of joint disease. So it's not as good as the TNF blockers and the 17 blockers. Okay, let's go to our next case. I've actually seen several of these, at least two, and we've published, I think two. I get a call from a really good dermatologist on Long island saying, I gave my patient secucinumab, and it's supposed to be two shots a week for the first five weeks, and then you go to once a month. The patient calls me up on Friday. She took the first two shots on Monday, second two shots on Tuesday, Wednesday, Thursday, Friday, and calls me up and says, what do I do? I'm all out of injections. After he cleaned the urine up off his floor, he called me up and I said, don't worry, be happy. The patient will get better very quickly. And the drug is very benign. You cannot overdose on 17 blockers. So it turns out there have been over 100 patients who have done just what that patient did. And here's what happens in their blood. The correct way of doing it is the blue line. You get a little increase in secuchinumab levels each week for the first five weeks. If you take them all over one week, you get that red line. So you get a massive increase in psychicinumab levels, which clears psoriasis very quickly. So the patients do well. And in fact, if you go to the package insert, what you'll see is that they've given ten times the dose to patients with no ill effects. So it's a pretty benign treatment. And you wouldn't expect a lot of side effect here because IL 17 blockade is very benign. There's a human model and also a mouse model of IL 17 blockade. People with chronic mucocutaneous candidiasis are IL 17 deficient, and all they get is yeast infections. They don't get more cancers, they don't get more heart attacks. They get yeast infections. So it was actually kind of calming to us to see. When we did the clinical trials, all we expected were yeast infections. That's all we got. April did mention a very uncommon worsening of inflammatory bowel disease, which occurs again. Okay, let's go to the next patient. And this is one we published a few years ago. We published a series of patients, patient who has a new onset of gutted psoriasis. The patient's hypertensive and alcoholic. So what are your options? This patient's got dots everywhere. Topical therapy is not practical. You're not going to give the patient cyclosporin because of the hypertension. You're not going to give a methotrexate because of the alcoholism. Aprimolast is okay, but it's very slow and modestly effective. So you start a biologic. Now, many patients with gutted psoriasis have it go away and it doesn't come back. And I'm sure you've all seen that phototherapy used to be the gold standard for this. That has changed in my practice. The gold standard is now an IL 17 blocker. Why? And I will say you could use a 23 blocker as well, and it will work. But in general, the IL 17 blockers are fast, which April showed you in the head to head trials. They work right away. And these are patients who actually are not used to having anything wrong with them, and they come in very upset because they're covered with psoriasis. And what we reported were patients who were treated between three and six months, and we then stopped the 17 blockers. At this point, I've probably treated more than 20 patients with this. The first one to recur were some patients I treated in the last few weeks, last few months who came in after the first three month course of a 17 block and recurred. But the vast majority of patients, three to six months of therapy clears of psoriasis completely, and in several years, they have not recurred. Okay, and why do we pick a 17 blocker? Because they're fast. And this is a study in which you looked at passage 75 and 90, and the brown, purple and green bars are the 17 blockers. Bridalumab is actually the fastest, followed very closely behind by ixakisumab and a little bit behind by secukinumab. So all very effective and very rapidly effective treatments for psoriasis. This is actually a patient who came to our office covered head to toe with severe psoriasis, and he was so debilitated by his psoriatic arthritis. Look at how swollen those hands are. He couldn't walk and he couldn't use his hands. And we actually hospitalized him on a Friday. Here he is a week later. The resident on call called me on Sunday and said, he's almost completely better. Can we send him home? And we did. And he came back a week later. There he is. Before and after. In one week on sekikinumab. Why did we pick sekikinumab? That's the one we had samples of in the office. Here's his hands a week later. Look at that dramatic reduction. So this is a study we did with ixicizumab. Look at that difference. At just one week with ixicizumab, this is two weeks, four weeks, eight weeks. I mean, you can't see anything. This is so rapidly effective. I'm going to close with a slide on oral thrush, which is the one side effect that we do indeed see with 17 blockers. So for vaginal candidiasis, a single 150 milligram dose of fluconazole clears it. That, by the way, is over the counter in Canada and the UK if you have oral thrush. April wrote a beautiful review of how that can be treated. I used to treat it with three days of fluconazole, and then I saw her guidelines, so I actually went to 100 to 200 milligrams a day for seven days, usually. And I've never had a patient not respond to that. And this is a slide in which bimikizumab, which is coming, is more effective than the other 17 blockers. It also has more oral thrush. But the number of cases which, by the way, are all mild to moderate and easy to treat was the vast majority of patients gets one, some get two. Very few patients get more than two cases of oral thrush. So very effective treatment. So, in conclusion, we have very useful drugs in IL 17 blockers. If you want to receive your credit, find that on the app. And if you have any questions, you won't find them in the journal of irreproducible results. Thank you very much.

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2023 Virtual Grand Rounds Session 3: March 8, 2023 - WCM: Your Questions Answered

Illustrate strategies to manage dermatologic conditions effectively in clinical practice

Discuss the treatment of psoriasis and related disorders with evolving therapies

Describe the modalities for diagnosing and managing skin cancer

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2023 Virtual Grand Rounds Session 1: February 1, 2023 - WCH23 Your Questions Answered

Overview of key data for emerging topical therapies to manage plaque psoriasis

Describe how to individualize care with emerging topical therapies to optimize patient outcomes

Compare between the various topical therapies for the management of plaque psoriasis


Plaque Psoriasis: Itching for New Topical Options: Online CME Activity

Overview IL-17 inhibitors for the management of moderate-to-severe psoriasis

Describe how to prevent and manage side effects associated with IL-17 inhibitors

Discuss strategies to individualize care for patients with moderate-to-severe psoriasis 

Matching the Right Patient with the Right Therapy: The Role of IL-17 Inhibitors for Psoriasis: Online CME Activity

Our next speakers are going to talk about matching the right patient with the right therapy, the role of IL 17 inhibitors and psoriasis. Dr. April Armstrong, one of the program directors, and Dr. Bruce Strover, thank you very much. I first of all want to thank you for staying late today. And also I want to say it's just an honor to cop present this with Dr. Schrober, who's the clinical professor of dermatology at Yale. So today we're going to talk about matching the right patient with the right therapy and specifically looking at the role of IL 17 inhibitors. This is accredited, and we're going to have three learning objectives. First, we're going to go over, give an overview of the currently approved IL 17 inhibitors, as well as emerging IL 17 inhibitor. And we're also going to talk about how we are going to manage some of the side effects that you may see with IL 17 inhibitors, and then finally discuss strategies for individualized care. So when I think about care of a patient with a psoriatic disease, I think about three different aspects. The skin and then the joints, and then specifically for the joints, focusing, looking at both the peripheral arthritis, peripheral psoriatic arthritis, as well as axial psoriatic arthritis. And when we think about our approved therapies for psoriasis in the realm of IL 17 inhibitors, we have our psychicinumab, ixechizumab and brodalamab. So, first of all, in my opinion, that I think they are great in terms of both strong, robust skin efficacy in terms of psoriasis, but also very strong and robust peripheral as well as axial efficacy. They also have pediatric dosing available for psychicenumab as well as ixicizumab down to six years of age. I avoid IL 17 inhibitors in those with a personal history of inflammatory bowel disease. And also other considerations we'll talk about are the low rates of mucocutaneous candidiasis. So when we look at the three approved medications, and I'll start with secukinumab, it's an IL 17 A inhibitor, so it binds to the IL 17, a cytokine. And in adults, it's approved as 300 milligrams every four weeks. Now, in those patients who may be a little bit larger, specifically greater than 90 kg, there's a studies that have been done looking at Q two week dosing versus the approved q four week dosing. And what they found is that in those patients who may be more obese, that q two week dosing tends to be more effective in terms of treating those patients. So for those patients, if you're not finding the efficacy that you need for secuchinumab, then consider dose escalating them, giving them more frequent dosing at Q two weeks. In terms of peripheral joint disease. Here we're looking at the ability of psychicenumab to inhibit radiographic progression in terms of joint narrowing or inhibiting joint erosions. And here, the higher the bar, meaning more radiographic progression. And we see that at two years, 84% of the patients on psychicenumab did not have radiographic progression. And then finally, this is one of the studies, few studies that we have axial data in this particular IL 17 inhibitors, showing the amelioration of axial signs and symptoms for secuchinumab. And moving on to ixicizumab, also IL 17 a inhibitor. It's approved as every four weeks for maintenance. And here is a long term ixicismab data. Look at response through five years, and specifically looking at either clear or almost clear, which is the top two set of lines, or clear. As we can see, overall, depending on the method of analysis that we use, between 72% to 80% of the patients over five years will maintain clear, almost clear. So pretty good response when we are thinking about this particular IL 17 inhibitor. And now this is a comparative effectiveness study using network bed analysis. And what it showed is that over one year period of time, when we look at cumulative benefit, we see that our IL 17 inhibitors are among the top medications that have come up in this particular analysis. For example, specifically, execismab and brodalamab have shown quite good efficacy. And then what about the inhibition of radiographic progression? What we see here, as you can see, is that for executionab, which is the orange bar, there's very little radiographic progression in terms of peripheral joint disease. And then finally to brodalamab, which is different in mechanism, action, it's not a cytokine inhibitor, but rather it is a receptor inhibitor. So it affects the actions of Il 17 AF as well as C Enc. And then probably you didn't know, is a fast onset of action. Quite fast. 60% of the people achieve posey 75 by week four. So this is quite fast. And if you compare that with other biologics, what we see is that in the meantime, for 50% of patients to achieve posey 90, as you can see, numerically shorter time compared to the other biologics here. And also, if you're wondering if you failed, if you have patient failing exechismab or secuchinumab, can the patient respond to brodalamab this is a study looking at that they can. So you can get about 60% of the patients still achieve clear or almost clear, even though they have failed ixicizumab or secicinumab. And with that, I'm going to turn the podium to Dr. Strover. Okay, thank you, Dr. Armstrong. So we're going to move forward with a medication that currently is not approved in the US, bimikizumab. It is approved around the world, though, and we'll probably see this drug approved sometime next year, in the middle of the year. So bimikizamab, an il 17 a and f inhibitor, that makes it somewhat novel. Brodalumab, you saw, has the ability to block multiple il 17 isoforms. But this is a solitary monoclonal antibody that actually blocks a and f together, which is relevant, as you'll see, because as I highlight here, you'll see efficacy, which, in my opinion, we haven't seen before. Nine out of ten patients at week 16 are at posey 90. So essentially, you can tell almost every patient you start on this drug, they're going to get at least 90% improvement. And if you go out over a year on the right side of that graph, similar data. In fact, the Q four and q eight week dosing interval in the maintenance appear very similar. So this will be a novel IL 17 inhibitor given at an eight week interval after an initial 16 weeks every four weeks. I'll talk about the Canada infections in a few slides. And this also speaks to long term efficacy. If you get a patient to posey 102, out of three patients on this medication get to posey 100 by week 16. Well, if you follow those patients another three years, four out of five of them, approximately 80%, keep that positive 100 for three years. And this is a pretty conservative analysis. And note, the Q four and Q eight week intervals are roughly the same in terms of efficacy. So a Q eight week dosing for an IL 17 inhibitor that gets two thirds of its patients to posey 100. And most of those patients keep the POSI 100 over time, as shown here. Now, in case you were wondering, secukinumab April just discussed it. It was put to a head to head with bimikizumab. And the red line is the secukinumab arm with the blue line, the bimikismab arm. And through 48 weeks, whether you're looking at PosI less than or equal to two, that would be the solid lines or the dashed lines, PoSI 100, bimikizumab is more effective and if you switch the people on secukinumab to bimikizumab over here, you get similar efficacy over time. So you can clearly see that bimikizumab does better than sacukinumab. Blocking f in addition to a, gets you to higher efficacy in this instance. Now, April appropriately discussed IL 17 inhibition as a PSA psoriatic arthritis control approach. And there will be no difference here with bimikismab, where ACR 50 scores are right where they need to be compared to a placebo. And then you have ACR 20 and 70 scores, and this is compared to adolemab in the study, roughly comparable. So if you like TNF inhibitors for ACR 2050 and 70, you're going to like bimikizumab. Additionally, you see control of tender and swollen joints, and you will see that bimikizumab controls axial disease as well, which we have to keep thinking about. Axial disease in addition to peripheral psoriatic arthritis. From a safety standpoint, really, there's only one thing that we need to discuss. We don't have to talk about serious infections. They're where they should be with regard to a biologic. Similarly, tb is not even on the radar. There were no cases over three years of tb. There is oral candidiasis, and it's oral candidiasis that seems to be biased towards patients getting vimicismab. It's roughly ten to 18% of patients, depending on dose. The higher rate is for the Q four week maintenance patients, and Q eight week is going to get the 10% rate. So ten to 18%, not really an IBD signal. There are some people who believe the signal is basically background. I'm one of those who believe that the signal is not there. But nevertheless, you could imagine that the label will warn you against using this medication in someone with preexisting IBD. No mace, no malignancy signal. So pretty good. You just have to think about oral candidiasis. Just again to frame that issue. Secukinumab, ixicismab, and brodalumab showing their rates somewhere between two and 5% depending on study. And then you have the bimicizumab rates, ten to 18% depending on dose. And April is about to get into the way we approach that issue with therapy. To conclude, as I write here, rapid response, probably bimikismab is going to be the most rapid drug. It's even going to probably edge out brodaliumab in terms of how quickly it gets people to pose 75 and 90 every eight week dosing. That's unique. Great efficacy for psoriatic arthritis inhibits radiographic progression, as April just pointed out, much like IL 17s typically do low signal for malignancy and serious infections. I didn't mention this, but nail psoriasis will be effectively controlled over time with this medication. There's no doubt IL 17 inhibition gives you the best nail psoriasis efficacy. No. Laboratory monitoring candidiasis a little higher than the other IL 17 inhibitors, usually treatable. Most patients stayed in the study when they had oral candidiasis in the bimikizumab trials. And finally, you will probably see a contraindication with IBD, but clinical trials, to my eye, indicate a very low risk. So now we're going to turn it back over to April with regarding to managing candidiasis in patients on IL 17 inhibitors. So, as Dr. Strober spoke about, there can be oral candidiasis that have been seen. How many of you, just by show of hands, have seen oral candidiasis in patients, in your patients onto the current IL 17 inhibitors? Okay, so I see a few hands coming up. So few things. Is that most of the candidiasis that we see in the clinical trials, as well as real world data, tend to be oral candidiasis versus other types of candidiasis. I think that the management of oral candidiasis is definitely in the wheelhouse of us dermatologists. And the important part to note is that most cases of oral candidiasis that occur with IL 17 inhibitors do not necessitate discontinuation of IL 17 inhibitors. So I think we, as dermatologists, are pretty facile at recognizing oral candidiasis. Typically, this can appear as white, cheesy material in the buckle mucosa or on the tongue. Patients who are most at risk for developing oral candidiasis are patients with uncontrolled diabetes or those with dentures. There are a number of different approaches of treating oral candidiasis, and the table here is the recommendation by the Infectious Disease Society of America. So, if you're facing a patient with mild oral candidiasis, you can treat them topically, for example, with clotrimzole trochis or nystatin suspension. Typically, those would require you, however, to have the patient do it four times a day, for example, for about seven to 14 days. And this can be somewhat inconvenient if you imagine your patient has to go to the bathroom and do this a few times a day. For moderate to severe, they recommend the first line, oral fluconazole, 100 to 200 milligrams QD for seven to 14 days. So I personally like to use oral fluconosol because it's a little bit easier for patients. They can just take a pill. So 100 milligrams, you can do it for seven days. And typically they would then resolve and most of the cases did not require discontinuation. And now I'm going to turn the podium back to Dr. Strover. So I'm just going to bring us home a little bit about clinical perspective, how I think about IL 17s. Just first and foremost excellent psoriatic arthritis drugs in addition to be rapidly acting psoriasis drugs. And then one thing we were learning through corona, this used to be called corona. Now it's core evitas drug. Survival has been shown in biologic naive patients to be very good for ixicismab compared to non Ixi IL 17s, which is mostly sacukinumab, and then tnfs at the bottom there. So this is over 24 months in biologic naive patients in the corona. Now core Evitas study. And then this is biologic experience, which is basically a little lower efficacy over time. But still Ixi does well. So I think of ixicism as a very good long term efficacy medication. And that's where I'm biased in terms of choosing that particular IL 17. And also because of these data which show at week twelve weeks, not much going on with the NaPsI score in terms of normalizing nails. And this was head to head with etannercept. But over the course of time, you see up to 50% to 60% of patients are having fully normal nails who had nail disease at baseline on ixicism. This is why I think IL 17 inhibition probably is your best approach for normalizing psoriatic nail disease. Then you have peeds data. April mentioned this excellent posey 90 and posey 75 responses in peeds with ixicismab really as good or better than the adult data. Similarly, secukinumab posey 90s in the 70% range, and over time retention of that at posey 100. So you clear patients almost two thirds of the time when you give them secukinumab in the pediatric population down to the age of six. So think about IL 17 inhibition for pediatric psoriasis and then the low risk for serious infection. You can see all three of them are depicted here. 1.31.4 events per 100 patient years. That's very low in perspective with other biologics and very comparable to real world studies. And malignancy is similarly just background rates in my opinion, these are background rates of malignancy in patients on IL seventeen s to the point where both IL seventeen s and IL twenty three s I feel are really excellent medications for patients with prior history of malignancy who you really feel you need to have to treat. And I'm constantly now using both classes for patients with prior history of malignancy. I think these are inert medications with regard to malignancy. So to summarize, Il seventeen s I told you rapid response depending on which drug, some are more rapid than others, more frequent dosing than IL 23s. We'll see bimikismab somewhat edges now towards the IL 23s with the Q eight week maintenance comparable efficacy to adolemumumab for psoriatic arthritis. Really, we should be turning to IL 17s for people with significant psoriatic arthritis ahead of tnf blockers because you just get better skin response, low signal for malignancy and serious infections. I think background rates best efficacy for nail psoriasis no laboratory monitoring pediatric psoriasis for both secucanium Ab and ixicas. Your mab join Z ten or sepinyusticinumab in that department lower signal for candidiasis for those IL 17 A inhibitors that we've been discussing all along and the only issue you got to think about is querying for IBD. That's only really what you got to think about hard. When you start a patient on an IL 17, the presence of IBD in their history.

Psoriasis

WEDNESDAY, Jan. 14, 2026 (HealthDay News) -- Metabolic bariatric surgery (MBS) is associated with improved outcomes in patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, according to a review published online Jan. 12 in BMC Surgery.Dimitrios Kehagias, M.D., Ph.D., from the Hull University Teaching Hospitals NHS Trust in the United Kingdom, and colleagues reviewed the current evidence on psoriasis outcomes following MBS. Six studies with 447 patients were included; demographic data were available for 159.The researchers found the pooled body mass index reduction was 11.0 ± 3.3 kg/m2. Baseline therapies included systemic, topical, and phototherapy in 53, 44, and 5 percent of patients, respectively. Systemic therapy reduced to 34 percent after surgery, topical reduced to 39 percent, and no treatment was required by 29 percent. There was a decrease in the Dermatology Life Quality Index, from 14.9 to 5.0; the percentage of affected body surface area decreased from 5.7 to 1.7; the Psoriasis Area Severity Index decreased from 3.6 to 1.2; and there was a reduction in nail involvement from 43.8 to 21.9 percent. Improvement or remission of psoriasis was demonstrated by 69.5 percent of individuals, which was mainly defined by reduced or discontinued treatment. In 80 percent of gastric bypass cases and 10 percent after nonbypass surgery, there was improvement or remission. Greater excess weight loss, older age, Roux-en-Y gastric bypass, and absence of family history of psoriasis were factors related to improved clinical response."Preliminary findings suggest a positive association between MBS and psoriasis outcomes, supporting the need for well-designed, large, prospective, controlled studies to provide definitive evidence," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://link.springer.com/article/10.1186/s12893-026-03502-1">Abstract/Full Text</a>

69.5 percent of patients demonstrated improvement or remission of psoriasis after metabolic bariatric surgery for obesity

Metabolic Bariatric Surgery Tied to Improvement in Psoriasis Outcomes

MONDAY, Dec. 29, 2025 (HealthDay News) -- For patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> and active or recent cancer, biologics are safe and have no impact on cancer progression, according to a study published online Dec. 17 in the Journal of the American Academy of Dermatology.Danielle Bar, M.D., from Tel Aviv University in Israel, and colleagues examined the safety of biologic therapies in patients with psoriasis and active or recent (no more than five years) cancer in a surveillance study involving 333 cases. Comparators were patients treated with conventional systemic agents.The researchers found that progression/recurrence rates were 10.7 and 10.5 per 100 patient-years for biologics and conventional agents, respectively, during a median follow-up of six years. In both groups, the cumulative one-year progression- or recurrence-free survival was 86 percent. Biologics did not have an impact on cancer progression (hazard ratio, 1.02; 95 percent confidence interval, 0.59 to 1.77; P = 0.94). Impaired functional status, advanced cancer stage (hazard ratio per stage increment, 1.48; 95 percent confidence interval, 1.21 to 1.82; P &lt; 0.001), and higher comorbidity burden were predictors of progression."Our findings indicate that biologics exhibit a favorable safety profile in patients with cancer, and treatment choice may be guided more by psoriasis severity than by the presence of malignancy," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)03420-6/fulltext">Abstract/Full Text</a>

Biologics do not affect cancer progression, while predictors of progression include advanced cancer stage, higher comorbidity burden

Biologics Are Safe for Patients With Psoriasis, Cancer

MONDAY, Dec. 29, 2025 (HealthDay News) -- Weight-loss interventions seem to improve <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> severity and quality of life, according to a review published online Dec. 19 in the Journal of the European Academy of Dermatology and Venerology.Sarah Morrow, B.M., B.Ch., from the University of Oxford in the United Kingdom, and colleagues examined the impact of weight-loss interventions on psoriasis severity and quality of life. Five databases and two trial registries were systematically searched. Patient focus-group discussions informed outcomes. The review included randomized controlled trials (RCTs) in adults with psoriasis, comparing any weight-loss intervention to usual care or a lower-intensity weight-loss intervention; 13 RCTs (1,145 participants), with 14 comparisons, were reviewed.Eleven interventions advised dietary changes, and of these interventions, four included physical activity; three used weight-loss medications. The researchers found that weight-loss interventions produced a greater reduction in the Psoriasis Area and Severity Index (PASI) than control across 14 interventions (mean difference, −2.5). A significant effect of weight-loss interventions was seen on the likelihood of achieving a 75 percent reduction in baseline PASI (PASI75). The intervention had no significant effect on the likelihood of achieving PASI50 or PASI100; both analyses were limited by few studies. Weight-loss interventions were associated with a significant improvement in the Dermatology Life Quality Index compared with control across seven comparisons (mean difference, −5.0)."Clinicians should consider using these findings to counsel patients and refer them for weight-loss support when appropriate," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.70247">Abstract/Full Text</a>

Review of randomized controlled trials shows interventions improve psoriasis severity and quality of life

Weight-Loss Interventions Seem Beneficial in Psoriasis

WEDNESDAY, Nov. 26, 2025 (HealthDay News) -- There was a slight increase in the global burden of <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> from 1990 to 2021, according to a research letter published online Nov. 26 in JAMA Dermatology.Linli Liu, M.D., from Suining Central Hospital in China, and colleagues obtained psoriasis data from 1990 to 2021 from the Global Burden of Disease Study 2021 to examine the burden of psoriasis across 236 countries.The researchers found that from 1990 to 2021, there was a slight increase in global psoriasis burden. For males, the age-standardized incidence rate (ASIR) increased from 56.89 to 62.77 per 100,000 individuals, while for females, the increase was from 57.08 to 61.26 (10.3 and 7.3 percent, respectively). Based on data through 2021, forecasts projected a continued increase in ASIR to about 70 and 66 per 100,000 in males and females, respectively, by 2050. In sensitivity analyses excluding 2021 data, the projected increase for males was attenuated and nearly flat, while the projections for females were similar to the main analysis. Global variations were seen in psoriasis burden in a geographic analysis, with the highest crude incidence and crude prevalence rates in North America and Western Europe, while lower estimated burdens were seen in East Asia and sub-Saharan Africa. A positive correlation was observed between ASIR and sociodemographic index."This decision model analysis identified a slight increase in the global burden of psoriasis from 1990 to 2021, consistent with previous studies," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2841752">Abstract/Full Text</a>

Age-standardized incidence rate projected to continue increasing through 2050 in males and females based on data through 2021

Slight Increase in Global Burden of Psoriasis Seen Through 2021

WEDNESDAY, Nov. 12, 2025 (HealthDay News) -- For patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, antibiotic exposure is associated with an increased risk for biologic discontinuation, according to a study published online Nov. 12 in JAMA Dermatology.Raphaël Ouakrat, M.D., from the Université Paris-Est Créteil in France, and colleagues examined the association between antibiotic exposure and persistence of biologic therapies in patients with psoriasis in a retrospective cohort study. Adults initiating a biologic therapy for psoriasis were identified using data from the French National Health Insurance database between June 2011 and December 2022.A total of 36,129 patients were included: 25.9 percent were exposed to antibiotics at baseline and 60.6 percent were exposed during follow-up. The researchers found that β-lactams, macrolides, and fluoroquinolones were the most commonly prescribed antibiotic classes. There was an association seen for antibiotic exposure with a higher risk for biologic discontinuation (weighted hazard ratio, 1.12), with a stronger effect for multiple dispensations (weighted hazard ratio, 1.29), indicating a dose-response relationship."Clinically, these findings underscore the importance of careful antibiotic prescribing in patients receiving biologics," the authors write. "While causality is unproven, minimizing unnecessary antibiotic exposure may support better treatment persistence."Two authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2841456">Abstract/Full Text</a>

Stronger effect seen for multiple dispensations, suggesting dose-response relationship

Antibiotic Exposure Linked to Biologic Discontinuation in Psoriasis

WEDNESDAY, Nov. 12, 2025 (HealthDay News) -- For adults and adolescents with moderate-to-severe <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">plaque psoriasis</a>, selective blockade of the interleukin-23 receptor with the targeted oral peptide icotrokinra yields a significantly higher incidence of skin clearance at week 16 than placebo, according to a study published in the Nov. 6 issue of the New England Journal of Medicine.Robert Bissonnette, M.D., from Innovaderm Research in Montreal, and colleagues conducted a phase 3, randomized trial involving adults and adolescents (aged 12 years and older) with moderate-to-severe plaque psoriasis. Participants were randomly assigned to receive either icotrokinra (200 mg once daily through week 24) or placebo through week 16 followed by transition to icotrokinra (456 and 228 patients, respectively).The researchers found that 65 percent of the participants receiving icotrokinra and 8 percent of those receiving placebo had an Investigator's Global Assessment (IGA) score of 0 or 1 with ≥2-point reduction from baseline at week 16, and 50 and 4 percent, respectively, had a ≥90 percent reduction from baseline in the Psoriasis Area and Severity Index (PASI) score. At week 16, complete clearance of skin was significantly more likely with icotrokinra than placebo (IGA score 0: 33 versus 1 percent; 100 percent reduction from baseline in the PASI score: 27 versus 1 percent). In each group, 49 percent of patients had at least one adverse event through week 16."Once-daily icotrokinra, a systemic targeted oral peptide binding to the interleukin-23 receptor, was effective for treating plaque psoriasis in adults and in adolescents, an age group with limited systemic treatment options," the authors write.The study was funded by Johnson &amp; Johnson, the manufacturer of icotrokinra.<a target="_blank" rel="noopener noreferrer" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2504187">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://www.nejm.org/doi/full/10.1056/NEJMe2512027">Editorial</a>

Icotronkinra results in significantly higher incidence of complete skin clearance at week 16 than placebo

Icotrokinra Beneficial for Adults, Teens With Plaque Psoriasis

THURSDAY, Oct. 30, 2025 (HealthDay News) -- Changes in family structure in the first year of life are associated with increased risk for developing <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> later in life, according to a study published online Sept. 2 in the Journal of Investigative Dermatology.Debojyoti Das and Johnny Ludvigsson, M.D., Ph.D., from Linköping University in Sweden, examined whether early childhood stress contributes to development of psoriasis later in life. Parents of 16,145 children in the All Babies in Southeast Sweden prospective birth cohort completed questionnaires when the children were 1, 3, 5, and 8 years of age.The researchers found an association for the stress life factor "new family structure" (divorce/separation and/or new adult or new/step sibling) before age 1 year with an increased risk for developing psoriasis (odds ratio, 4.19) in a univariate model; after adjustment for confounders, the significant association persisted. New family structure increased the risk for psoriasis in the univariate model (odds ratio, 3.40) but not in an adjusted multivariable model when integrating data from follow-up at ages 1, 3, 5, and 8 years."Changes in family structure like divorce or separation of parents, death in the family, and/or new adult or new/step siblings leading to an acute sense of insecurity and fear for the young child, seems to make the child extra vulnerable when it happens in the first year of life. This fits with the knowledge that very young individuals seem to be more vulnerable to the immunomodulatory effects of stressful life factors than older children and adults," Ludvigsson said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(25)02400-5/fulltext">Abstract/Full Text</a>

Children experiencing the psychological stress of 'new family structure' in first year of life have increased psoriasis risk

Early Change in Family Structure May Increase Risk for Psoriasis

WEDNESDAY, Oct. 22, 2025 (HealthDay News) -- For patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> treated with biologics, ustekinumab may be associated with a lower five-year risk for any first <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cancer</a> than adalimumab, according to a research letter published online Oct. 22 in JAMA Dermatology.Christopher Willy Schwarz, M.D., from Copenhagen University Hospital-Herlev and Gentofte in Denmark, and colleagues examined the risk for developing any first cancer in patients with psoriasis treated with the biologics adalimumab, secukinumab, or ustekinumab. A total of 2,878 new users were included: 2,001, 286, and 591 initiated adalimumab, secukinumab, and ustekinumab, respectively. To account for cancer induction and latency periods, 12-month lag time after treatment initiation and 12-month lag time after discontinuation were applied. Twenty-four-month lag times were used in a secondary analysis.The researchers found that 36, five, and 10 first cancers were diagnosed in the adalimumab, secukinumab, and ustekinumab groups, respectively, using 12-month lag times. The five-year standardized cancer absolute risks were 0.040, 0.036, and 0.024 for adalimumab, secukinumab, and ustekinumab, respectively. Standardized estimates suggested cancer risks that were 41 and 12 percent lower with ustekinumab than adalimumab and with secukinumab than adalimumab (P = 0.06 and P = 0.77). The standardized estimates suggested a 56 percent lower five-year cancer risk with ustekinumab versus adalimumab using 24-month lag times (P &lt; 0.001)."We found a pattern suggesting that ustekinumab is associated with a lower five-year risk of any first cancer (excluding NMSC [nonmelanoma skin cancer]) than adalimumab," the authors write.Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2840410">Abstract/Full Text</a>

Five-year cancer risk 56 percent lower with ustekinumab using 24-month lag times after treatment initiation

Ustekinumab May Be Linked to Lower Cancer Risk Than Adalimumab in Psoriasis

THURSDAY, Oct. 2, 2025 (HealthDay News) -- The U.S. Food and Drug Administration has approved Tremfya (guselkumab) for the treatment of plaque psoriasis and active psoriatic arthritis in children 6 years of age and older.The approval is for pediatric patients living with either moderate-to-severe plaque psoriasis, who are candidates for systemic therapy or phototherapy, or active psoriatic arthritis. This approval expands indications of use beyond the initial adult population and is the first and only pediatric approval for an interleukin-23 inhibitor.The approval is based on results from the phase 3 PROTOSTAR study in which the coprimary end points of Psoriasis Area Severity Index (PASI) 90 and Investigator's Global Assessment (IGA) score of 0/1 were achieved at week 16. More than half of patients (56 percent) receiving Tremfya achieved PASI 90 versus 16 percent of patients receiving placebo. For IGA score, at week 16, two-thirds (66 percent) of patients receiving Tremfya achieved high levels of skin clearance (score 0/1) versus 16 percent of patients receiving placebo. Complete clearance (IGA 0) at week 16 was achieved by nearly 40 percent of pediatric patients receiving Tremfya versus 4 percent on placebo."Despite advancements in the treatment of pediatric plaque psoriasis and active psoriatic arthritis, there continues to be a significant gap in available therapies for these debilitating immune-mediated diseases that impact a child's physical and emotional well-being during critical years," study investigator Vimal Hasmukh Prajapati, M.D., from the University of Calgary in Alberta, Canada, said in a statement. "The approval of Tremfya offers physicians, as well as parents and care partners, an established treatment option with proven safety and demonstrated efficacy that can significantly improve the signs and symptoms in children living with these diseases."Approval of Tremfya was granted to Johnson &amp; Johnson.<a target="_blank" rel="noopener noreferrer" href="https://www.jnj.com/media-center/press-releases/u-s-fda-approves-tremfya-guselkumab-for-the-treatment-of-pediatric-plaque-psoriasis-and-active-psoriatic-arthritis-marking-a-first-and-only-approval-for-an-il-23-inhibitor">More Information</a>

40 percent of children achieved complete skin clearance at week 16 with Tremfya versus placebo

FDA Approves Tremfya for Pediatric Plaque Psoriasis, Active Psoriatic Arthritis

FRIDAY, Sept. 26, 2025 (HealthDay News) -- A 16-week Mediterranean diet intervention significantly improves psoriasis severity in patients with mild-to-moderate disease receiving stable topical therapy, according to a study published online Sept. 24 in JAMA Dermatology.Javier Perez-Bootello, M.D., from the Instituto Ramón y Cajal de Investigación Sanitaria in Madrid, and colleagues assessed whether a 16-week Mediterranean diet intervention would improve psoriasis severity in patients with mild-to-moderate disease. The analysis included 37 participants receiving stable topical therapy randomly assigned to a dietitian-guided Mediterranean diet program or standard low-fat dietary advice without dietitian supervision.The researchers found that the estimated marginal means change in the Psoriasis Area and Severity Index (PASI) at week 16 was −3.4 (95 percent confidence interval, −4.4 to −2.4) in the intervention group and 0.0 (95 percent confidence interval, −1.0 to 1.0) in the control group. In the Mediterranean diet group, 47.4 percent achieved a 75 percent reduction in PASI compared with 0 percent in the control group. There was also a significant reduction in glycated hemoglobin in the intervention group versus the control group (between-group estimated marginal means difference, −4.1 mmol/mol; 95 percent confidence interval, −6.9 to −1.3 mmol/mol; P = 0.01)."These findings suggest that incorporating dietary strategies may be beneficial as an adjunctive therapy in psoriasis management," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2839013">Abstract/Full Text</a>

Sixteen-week intervention showed significant improvement in Psoriasis Area and Severity Index

Mediterranean Diet Tied to Improvement in Psoriasis

TUESDAY, Sept. 30, 2025 (HealthDay News) -- Patients with psoriasis treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have better long-term outcomes compared with those taking other diabetes or weight-loss medications, according to a study presented at the European Academy of Dermatology and Venereology Congress 2025, held from Sept. 17 to 20 in Paris.Henning Olbrich, from the University of Lübeck in Germany, and colleagues conducted a retrospective population-based cohort study using real-world data from the global TriNetX database to identify patients with psoriasis who were treated for diabetes or obesity with GLP-1 RAs. Over two years, cardiovascular, inflammatory, and psychiatric outcomes were compared for individuals treated with GLP-1 RAs and those treated with other systemic antidiabetic or obesity drugs. The analysis included 3,048 propensity-matched participants (1:1) in each cohort.The researchers found that GLP-1 RA treatment was associated with significantly decreased all-cause mortality (hazard ratio [HR], 0.219) and a reduced risk for major adverse cardiac events (HR, 0.561). Additionally, GLP-1 RA-treated individuals had lower risks for alcohol (HR, 0.346) and substance abuse (HR, 0.510). The GLP-1 RA cohort did not experience more frequent typical adverse drug events. Risk reductions were even stronger in those with psoriasis versus persons with obesity or type 2 diabetes without psoriasis."Psoriasis management has traditionally focused on controlling skin symptoms, but these findings emphasize the need to consider the wider health risks faced by patients," lead author Ralf Ludwig, M.D., Ph.D., also from University of Lübeck, said in a statement. "GLP-1 RAs may offer a valuable dual benefit, improving both metabolic control and long-term health outcomes, representing an important step forward in holistic care for people living with psoriasis."<a target="_blank" rel="noopener noreferrer" href="https://eadv.org/wp-content/uploads/2025/09/EADV_Congress_2025_PR_GLP-1RA-drugs.pdf">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://eadv.org/congress/">More Information</a>

Risk reductions stronger in those with psoriasis versus those with obesity or type 2 diabetes without psoriasis

GLP-1 Receptor Agonists Tied to Reduced Mortality in Patients With Psoriasis

FRIDAY, Sept. 19, 2025 (HealthDay News) -- <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">Psoriasis</a> is associated with an increased risk for age-related macular degeneration (AMD), with increased risks seen for exudative and nonexudative AMD, according to a study presented at the European Academy of Dermatology and Venereology Congress 2025, held from Sept. 17 to 20 in Paris.Alison Treichel, M.D., from Case Western Reserve University School of Medicine in Cleveland, and colleagues conducted a 15-year retrospective cohort study within TriNetX. A total of 22,901 patients older than 55 years with psoriasis were compared to three propensity-matched control cohorts: melanocytic nevus (MN; 13,279), major depressive disorder (MDD; 14,055), and ophthalmologic exam. The 10-year incidence and risk ratios (RRs) of exudative, nonexudative, and unspecified AMD were analyzed.The researchers found that the risk for developing unspecified AMD at 10 years was significantly increased among patients with psoriasis compared with the MDD and MN cohorts at 10 years (RR, 1.561 [95 percent confidence interval (CI), 1.344 to 1.812] and RR, 1.209 [95 percent CI, 1.047 to 1.397], respectively). Psoriasis was also associated with a higher 10-year risk for exudative AMD and nonexudative AMD compared with the MDD cohort (RR, 1.404 [95 percent CI, 1.129 to 1.746] and RR, 1.13 [95 percent CI, 1.011 to 1.262], respectively). There was a lower risk for 10-year unspecified AMD for patients treated with biologics versus those receiving topical corticosteroids alone."Our findings support a connection between psoriasis and AMD, both exudative and nonexudative, which could be mediated by shared lipid dysregulation," Treichel said in a statement. "Patients with psoriasis should continue to follow standard eye exam guidelines and promptly report any changes in their vision to their health care providers. More research is needed before specific screening recommendations can be made."<a target="_blank" rel="noopener noreferrer" href="https://eadv.org/congress/">More Information</a>

Risk for unspecified AMD lower for those treated with biologics versus topical corticosteroids alone

AMD Risk Increases With Psoriasis

WEDNESDAY, Sept. 10, 2025 (HealthDay News) -- Poor cardiovascular-kidney-metabolic (CKM) health is associated with an increased risk for <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, especially for those with high genetic risk, according to a study published online July 18 in the Journal of the European Academy of Dermatology and Venereology.Gang Zheng, from China Medical University in Shenyang, and colleagues examined the associations among CKM status, genetic risk, and the risk for developing psoriasis in a prospective cohort study involving 392,454 participants free of psoriasis from the U.K. Biobank. The presence of metabolic risk factors, chronic kidney disease, and cardiovascular disease defined CKM syndrome, which was categorized into five stages.The researchers found that the multivariable-adjusted hazard ratios for developing psoriasis were 1.21, 1.38, 1.64, and 1.72 for individuals with CKM stages 1, 2, 3, and 4, respectively, compared with stage 0. Compared with those at stage 0 with low genetic risk, participants with CKM stage 4 and high genetic risk had the highest risk for psoriasis (hazard ratio, 2.82). In terms of development of psoriasis, a significant positive additive interaction was seen between advanced CKM stages and high genetic risk (relative excess risk due to interaction, 0.82). Advanced CKM stage (stage 4) was associated with a greater reduction in life expectancy (2.03 years) within the psoriasis population."Our findings highlight the critical importance of early detection and timely intervention during the initial CKM stages to mitigate the risk of psoriasis and enhance life expectancy," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.20852">Abstract/Full Text</a>

Significantly higher risk for psoriasis noted, especially among those with high genetic risk

Poor Cardiovascular-Kidney-Metabolic Health Increases Psoriasis Risk

WEDNESDAY, Aug. 27, 2025 (HealthDay News) -- Both the Nail Psoriasis Severity Index (NAPSI) and the Nijmegen-Nail Psoriasis Activity Index Tool (N-NAIL) provide accurate cutoffs for diagnosing nail <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, with better accuracy seen for the N-NAIL, according to a study published online Aug. 24 in the International Journal of Dermatology.Evi C.C. Rikken, M.D., from the Radboud University Medical Center in Nijmegen, Netherlands, and colleagues conducted a cohort study among patients with psoriasis and matching controls to examine the diagnostic performance of two severity scoring tools: the NAPSI and the N-NAIL, which were used to score fingernails. Cutoff values were established to determine their diagnostic properties. Receiver operating characteristic curves were constructed; for various cutoff points, sensitivity and specificity were calculated.A total of 104 patients with psoriasis were included, and of these patients, 68 were diagnosed with nail psoriasis. The researchers found that a cutoff value of 2 showed the best accuracy for N-NAIL in the psoriasis population (sensitivity, 83.8 percent; specificity, 83.3 percent) and in the general population (sensitivity, 83.8 percent; specificity, 67.3 percent). A cutoff value of 7 showed the best accuracy for the NAPSI in the psoriasis population (sensitivity, 80.9 percent; specificity, 69.4 percent), while in the general population, a cutoff of 10 was optimal (sensitivity, 72.1 percent; specificity, 70.2 percent)."This study shows better accuracy for the N-NAIL, with a cutoff value of 2, for the inclusion of nail psoriasis patients in a study from a pool of plaque psoriasis patients than the NAPSI," the authors write. "Another advantage of the use of the N-NAIL as a scoring tool is that it only has one version, so no confusion exists about the utilization of the exact scoring tool, and it is easier and faster to apply for dermatologists, researchers, and other specialists working with nail psoriasis compared to other scoring systems."Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/ijd.70024">Abstract/Full Text</a>

Both NAPSI and N-NAIL provide accurate cutoffs, but better accuracy seen with N-NAIL, with cutoff value of 2

N-NAIL Score More Accurate Than NAPSI for Diagnosing Nail Psoriasis

WEDNESDAY, Aug. 6, 2025 (HealthDay News) -- For patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, interclass biologic switching is effective, but may be associated with increased infection rates, according to a review published online Aug. 6 in JAMA Dermatology.Miao Zhang, M.D., from the Shanghai University of Traditional Chinese Medicine, and colleagues examined the effectiveness and safety of psoriasis treatment after the failure of initial biologic therapy, especially when patients switch to a second biologic. Twenty-four randomized clinical trials were analyzed, including 12,661 patients with psoriasis and eight switching categories.The researchers found that between week 4 and week 0, there were significant differences observed in terms of a 90 percent or greater improvement in the Psoriasis Area and Severity Index (PASI 90). Across various PASI response metrics, specifically PASI 90, PASI 75, and PASI 100, substantial disparities were noted (odds ratios, 28.61, 11.11, and 18.76, respectively). Safety outcomes did not differ between the end point and week 0, including in serious adverse events, severe adverse events, and treatment-related adverse events. Switching from antitumor necrosis factor-α agents to <a href="/conditions/il-inhibitors" target="_blank" rel="noopener noreferrer">anti-interleukin</a> (IL)-23p19, anti-IL17A, or anti-IL-12/23p40 agents was associated with the highest risk for infection, with rates of 0.62, 0.54, and 0.39 percent, respectively."Our results also emphasize the vigilance for infections while switching to different biologics," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2837167">Abstract/Full Text</a>

Highest risk for infection associated with switching from anti-TNF-α to anti-IL-23p19, anti-IL-17A, anti-IL-12/23p40

Interclass Biologic Switching Effective for Patients With Psoriasis

TUESDAY, July 22, 2025 (HealthDay News) -- Subclinical synovitis is significantly more common among patients with <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a> without musculoskeletal involvement than healthy controls, according to a review published online July 16 in JAMA Dermatology.Shanti Mehta, from the University of Toronto, and colleagues conducted a systematic literature review and meta-analysis to evaluate the prevalence of synovitis on ultrasonograms and magnetic resonance imaging (MRI) among patients with psoriasis without musculoskeletal involvement.Based on data from 12 studies (1,593 patients with psoriasis, 327 patients with psoriatic arthritis, and 686 healthy controls), the researchers found that synovitis was significantly more likely among patients with psoriasis than controls (risk ratio, 2.55; 95 percent confidence interval, 1.18 to 5.52). Compared with ultrasonography (risk ratio, 2.50; 95 percent confidence interval, 1.10 to 5.67), detection rates were higher with MRI (risk ratio, 6.40; 95 percent confidence interval, 1.87 to 21.95). While not statistically significant, synovitis was more frequent among patients with psoriatic arthritis than those with psoriasis (risk ratio, 0.50; 95 percent confidence interval, 0.13 to 1.87)."This study suggests that subclinical synovitis is more prevalent among patients with psoriasis without musculoskeletal involvement than healthy controls, suggesting that imaging may help identify those at increased risk of transition to <a href="/conditions/psoriatic-arthritis" target="_blank" rel="noopener noreferrer">psoriatic arthritis</a>," the authors write.One author disclosed ties to AbbVie, Janssen, Novartis, Sandoz, and Amgen.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2836501">Abstract/Full Text</a>

Authors say imaging may aid in identifying individuals at risk for progression to psoriatic arthritis

Subclinical Synovitis Risk Higher in Psoriasis Without Musculoskeletal Involvement

WEDNESDAY, May 7, 2025 (HealthDay News) -- Roflumilast foam, 0.3 percent, improves the signs and symptoms of psoriasis on the scalp and body, according to a study published online May 7 in JAMA Dermatology.Melinda J. Gooderham, M.D., from the SKiN Centre for Dermatology in Peterborough, Ontario, Canada, and colleagues conducted a phase 3, double-blind trial involving participants aged 12 years and older with plaque psoriasis with a minimum Scalp-Investigator Global Assessment (S-IGA) score of 3 (moderate) and minimum Body-IGA (B-IGA) score of 2 (mild). A total of 432 patients were included and randomly assigned to receive either roflumilast foam or vehicle (281 and 151 patients, respectively).The researchers found that at week 8, 66.4 and 27.8 percent of the roflumilast and vehicle groups, respectively, achieved S-IGA success (clear [0] or almost clear [1] plus ≥2 grade improvement), and 45.5 and 20.1 percent of the roflumilast and vehicle groups, respectively, achieved B-IGA success. At week 2, rates for S-IGA success were significantly higher for roflumilast versus vehicle, as were rates for the Scalp Itch-Numeric Rating Scale (SI-NRS) and Worst Itch-NRS at weeks 2, 4, and 8. As early as the first assessment (24 hours after the first application), improvements in SI-NRS were greater for the roflumilast group versus vehicle group. Favorable tolerability profiles and low rates of adverse events were seen in both groups."The results of this phase 3 randomized clinical trial indicate that once-daily roflumilast foam, 0.3 percent, is uniquely formulated for hair-bearing areas to improve tolerance and adherence," the authors write. "Roflumilast effectively reduced pruritus, a symptom associated with considerable burden to patients with psoriasis, with significantly greater improvements compared with vehicle observed within 24 hours after first application."Several authors disclosed ties to the biopharmaceutical industry; Arcutis Biotherapeutics sponsored the study and provided the roflumilast and vehicle foams.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2833460">Abstract/Full Text</a>

More patients in roflumilast group achieved scalp-IGA and body-IGA success at week 8 versus vehicle group

Roflumilast Foam Improves Signs and Symptoms of Psoriasis

Treatment with roflumilast cream results in better clinical status at eight weeks versus vehicle cream among patients with chronic plaque psoriasis, according to a study published in the Sept. 20 issue of the Journal of the American Medical Association.Mark G. Lebwohl, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the efficacy of roflumilast cream, 0.3 percent, applied once daily for eight weeks in two multicenter trials involving patients with plaque psoriasis (DERMIS-1, 439 patients; DERMIS-2, 442 patients). Patients were randomly assigned to receive roflumilast cream or vehicle cream (trial 1, 286 and 153 patients, respectively; trial 2, 290 and 152 patients, respectively).The researchers found that the mean Investigator Global Assessment (IGA) scores were all 2.9 for roflumilast and vehicle in both trials 1 and 2. Significantly greater percentages of roflumilast- versus vehicle-treated patients had IGA success at week 8 in both trials (trial 1: 42.4 versus 6.1 percent; trial 2: 37.5 versus 6.9 percent). Significant differences were seen favoring roflumilast in eight and nine of nine secondary end points in trials 1 and 2, respectively, including intertriginous IGA success, 75 percent reduction in the Psoriasis Area and Severity Index score, and Worst Itch Numeric Rating Scale score of 4 or higher at baseline achieving 4-point reduction."Further research is needed to assess efficacy compared with other active treatments and to assess longer-term efficacy and safety," the authors write.Several authors disclosed financial ties to biopharmaceutical companies, including Arcutis Biotherapeutics, which manufactures roflumilast and funded the study.<a class="rm-stats-tracked" target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jama/article-abstract/2796379">Abstract/Full Text (subscription or payment may be required)&nbsp;</a><a class="rm-stats-tracked" target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jama/article-abstract/2796397">Editorial (subscription or payment may be required)&nbsp;</a>

Two multicenter trials show significantly greater percentage of patients treated with roflumilast versus vehicle had IGA success at week 8

Roflumilast Yields Better Results for Chronic Plaque Psoriasis

WEDNESDAY, June 18, 2025 (HealthDay News) -- Patients with <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">atopic dermatitis</a> (AD) prescribed <a href="/conditions/il-inhibitors" target="_blank" rel="noopener noreferrer">dupilumab</a> have an increased relative risk for developing <a href="/conditions/psoriasis" target="_blank" rel="noopener noreferrer">psoriasis</a>, according to a study published online June 18 in JAMA Dermatology.Teng-Li Lin, M.D., from the Buddhist Tzu Chi Medical Foundation in Chiayi, Taiwan, and colleagues compared psoriasis risk in patients with AD prescribed dupilumab versus other systemic agents in a population-based retrospective cohort study with three-year follow-up. After propensity score matching, 9,860 individuals newly prescribed dupilumab (dupilumab cohort) and 9,860 patients newly prescribed other systemic agents without dupilumab exposure (control cohort) were included.The researchers found that compared with the control cohort, the dupilumab cohort had higher three-year cumulative psoriasis incidence (2.86 versus 1.79 percent). For dupilumab versus other systemic agents, the number needed to harm for psoriasis was 94. An increased risk for psoriasis was seen in the dupilumab cohort (hazard ratio, 1.58; 95 percent confidence interval, 1.25 to 1.99), while the risk for psoriatic arthritis was not significant (hazard ratio, 1.97; 95 percent confidence interval, 0.75 to 5.18). Various AD subgroups had an increased risk, including those without atopic comorbidities or with pretreatment immunoglobulin E levels less than 0.048 mg/dL (hazard ratios [95 percent confidence intervals], 1.42 [1.06 to 1.89] and 1.59 [1.26 to 2.01], respectively). Validation in patients with asthma without AD further supported the association between dupilumab and psoriasis (hazard ratio, 2.13; 95 percent confidence interval, 1.38 to 3.31)."Despite the increased relative risk, an estimated number needed to harm of 94 reflected the limited clinical relevance of the absolute risk," the authors write. "This risk should be weighed against dupilumab’s proven efficacy in treating AD."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2835236">Abstract/Full Text</a>

Three-year cumulative psoriasis incidence higher for those receiving dupilumab versus other systemic agents

Psoriasis Risk Higher for Patients With Eczema Treated With Dupilumab

MONDAY, June 2, 2025 (HealthDay News) -- Both mild and moderate-to-severe psoriasis are significantly associated with an increased risk for sleep disorders, according to a study published online May 13 in JEADV Clinical Practice.Michael J. Diaz, from the College of Medicine at the University of Florida in Gainesville, and colleagues quantified the extent to which psoriasis severity correlates with the risk for developing specific sleep disorders. The analysis included 7,743 adults with psoriasis identified from the All of Us database matched 1:4 to age-, sex-, and race/ethnicity-matched controls.The researchers found that mild psoriasis was significantly associated with restless leg syndrome, insomnia, and obstructive sleep apnea when adjusting for sociodemographic variables and comorbidities. The associations were even stronger with moderate-to-severe psoriasis. The risk for sleep disorder was magnified in non-White patients, particularly for insomnia and obstructive sleep apnea."By highlighting these variations in a nationally diverse sample, we underscore the necessity for personalized, culturally sensitive approaches in the clinical management of psoriasis and its associated comorbidities," the authors write. "Study limitations include the use of electronic health records and potential for diagnostic misclassification."Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1002/jvc2.70022">Abstract/Full Text</a>

Psoriasis was significantly associated with restless leg syndrome, insomnia, and obstructive sleep apnea

Psoriasis Tied to Increased Risk for Sleep Disorders

TUESDAY, June 3, 2025 (HealthDay News) -- Central adiposity measures are strongly associated with psoriasis risk, with a stronger association in women, according to a research letter published online May 27 in the Journal of Investigative Dermatology.Ravi Ramessur, B.M.B.Sc., from King's College London, and colleagues analyzed data from 336,806 participants in the U.K. Biobank of White British ancestry, including 9,305 with psoriasis, to describe and quantify patterns of adiposity associated with psoriasis. Twenty-five adiposity measures were assessed. To examine how measures conferring the greatest risk for psoriasis relate to genetic determinants of disease, interaction testing was conducted between adiposity measures and psoriasis polygenic risk scores (PRSs).The researchers found that central adiposity measures, including waist-to-hip ratio, abdominal fat ratio, total abdominal adipose tissue index, and waist circumference were four of the five measures with the largest effect size for association with psoriasis. Of the total adiposity measures, percentage body fat was associated with psoriasis with the largest effect size. In women, the relationship between central adiposity and psoriasis was particularly pronounced. There was a significant interaction between the full psoriasis PRS and waist-to-hip ratio on psoriasis risk. When HLA-C*06:02 was excluded from the PRS, the interaction effect was no longer significant. Waist-to-hip ratio was associated with psoriasis, with a larger effect size in HLA-C*06:02-negative versus HLA-C*06:02-positive individuals."Our research shows that where fat is stored in the body matters when it comes to psoriasis risk," Ramessur said in a statement. "Central fat -- especially around the waist -- seems to play a key role. This has important implications for how we identify individuals who may be more likely to develop psoriasis or experience more severe disease, and how we approach prevention and treatment strategies."Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(25)00391-4/fulltext">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(25)00456-7/fulltext">Editorial</a>

Significant interaction seen for full psoriasis polygenic risk score with waist-to-hip ratio on psoriasis risk

Central Adiposity Measures Associated With Psoriasis Risk

WEDNESDAY, June 4, 2025 (HealthDay News) -- For patients with plaque psoriasis, there is no difference in the effectiveness of adalimumab monotherapy versus adalimumab with concomitant methotrexate, according to a study published online June 4 in JAMA Dermatology.Zenas Z. N. Yiu, Ph.D., from the University of Manchester in the United Kingdom, and colleagues examined the effectiveness of using methotrexate with adalimumab in people with plaque psoriasis in a target trial emulation cohort study. The study included 231 participants in the intervention arm (adalimumab, 40 mg, every other week and methotrexate weekly, with the dosage determined by the clinician) and 1,553 participants in the comparator arm (adalimumab, 40 mg, every other week).The researchers found that drug survival at one year was 78.1 and 79.1 percent for the comparator and intervention arms, with no evidence of difference. A 75 percent reduction in the Psoriasis Area and Severity Index at one and three years occurred in 52.0 and 32.4 percent, respectively, in the comparator arm and 49.4 and 37.2 percent, respectively, in the intervention arm; no evidence was seen for differences at one year and three years. There was also no evidence seen for a difference between the arms in terms of serious adverse events and adalimumab concentrations; the intervention arm had a lower antidrug antibody level."Given the importance of adalimumab and methotrexate as accessible treatment options globally, the results of this study potentially have broad-reaching clinical implications worldwide," the authors write. "Methotrexate may not a good option to use along with adalimumab as it does not come with substantial therapeutic benefit but may increase the risk of serious infections."Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2834649">Abstract/Full Text</a>

No difference seen in effectiveness of adalimumab monotherapy versus adalimumab with concomitant methotrexate

Adalimumab Comparable to Adalimumab + Methotrexate for Plaque Psoriasis

TUESDAY, May 27, 2025 (HealthDay News) -- The U.S. Food and Drug Administration has approved Zoryve (roflumilast) topical foam 0.3 percent for the treatment of plaque psoriasis of the scalp and body in adult and pediatric patients 12 years of age and older.Through a supplemental new drug application, Zoryve foam was approved as a once-daily, steroid-free topical treatment.The approval was based on results from the ARRECTOR phase 3 trial and Trial 204, a phase 2 trial, that together randomly assigned 736 adults and adolescents aged 12 years and older with mild-to-severe plaque psoriasis of the scalp and body to either Zoryve foam 0.3 percent or vehicle foam applied once daily for eight weeks (2:1). Treatment effectiveness was gauged using the Investigator Global Assessment (IGA) clinical scale.In the ARRECTOR trial, 66.4 percent of individuals treated with Zoryve foam versus 27.8 percent treated with a matching vehicle foam achieved Scalp-IGA success ("clear" or "almost clear" plus a 2-point improvement from baseline) at week 8, while 45.5 and 20.1 percent, respectively, achieved Body-IGA success at week 8. Similar benefits were seen in Trial 204 at week 8, with 56.7 percent of individuals treated with Zoryve foam achieving Scalp-IGA success versus 11.0 percent of individuals treated with a matching vehicle foam, and 39.0 versus 7.4 percent, respectively, achieving Body-IGA success."In clinical trials, Zoryve foam not only effectively cleared psoriasis plaques on the body and scalp, but also provided rapid itch relief. Zoryve can be safely used for any duration and offers two highly convenient formulations, cream or foam, for health care providers to choose from," Jennifer Soung, M.D., director of clinical research at Southern California Dermatology in Santa Ana, and one of the clinical trial investigators, said in a statement. "Zoryve foam allows patients to treat their whole body with one prescription, transforming the treatment landscape for scalp and body psoriasis."Approval of Zoryve was granted to Arcutis Biotherapeutics.<a target="_blank" rel="noopener noreferrer" href="https://www.arcutis.com/arcutis-zoryve-roflumilast-topical-foam-0-3-approved-by-u-s-fda-for-the-treatment-of-plaque-psoriasis-in-adults-and-adolescents-ages-12-and-older/">More Information</a>

Approval is for once-daily 0.3 percent roflumilast topical foam for patients 12 years and older

FDA Approves Topical Foam for Plaque Psoriasis of the Scalp and Body

WEDNESDAY, May 21, 2025 (HealthDay News) -- For patients with psoriasis receiving biologic therapy, residual inflammation (RI), defined as increased inflammatory markers in blood, characterized by high-sensitivity C-reactive protein, despite receiving optimal medical therapy, is observed in about one-third of patients, according to a study published online May 20 in the Journal of Investigative Dermatology.Alba Lecumberri, M.D., from the Hospital Universitario Ramón y Cajal in Madrid, and colleagues examined RI in patients with psoriasis undergoing biologic therapy in a prospective observational study conducted across three international cohorts. The cohorts included 209 patients with psoriasis who achieved a Psoriasis Area and Severity Index (PASI) score of ≤2 after stable biologic therapy.The researchers found that 36.3 percent of patients had RI, which was significantly associated with higher body mass index, metabolic dysfunction-associated steatotic liver disease, increased baseline systemic inflammation, and visceral adipose tissue. In the three cohorts, female sex was a predictor of RI."Despite treatment with biologic drugs and adequate skin control, a significant proportion of patients persisted with systemic inflammation, suggesting that nonvisible inflammation may still contribute to cardiovascular risk," the authors write. "Addressing RI in patients with psoriasis could ultimately lead to more comprehensive treatment strategies aimed at reducing both skin and systemic inflammation."Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(25)00377-X/fulltext">Abstract/Full Text</a>

Residual inflammation significantly linked to higher BMI, metabolic dysfunction-associated steatotic liver disease, baseline systemic inflammation

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