News Headlines: Psoriasis
Efalizumab Is Safe For Long-Term Use in Psoriasis Patients
Psoriasis Linked to Seven New Genetic Variations
Enbrel Reduces Marker of Inflammation in Plaque Psoriasis
Remicade Improves Plaques in Majority of Psoriasis Patients
Malignancy Risk Not Increased in Psoriatic Arthritis
Severe Psoriasis Linked to Earlier Death
Disease Screening Important If You Have Psoriasis
Smoking Increases Risk of Psoriasis
Efalizumab Is Safe For Long-Term Use in Psoriasis Patients
A new study based on 10 years of experience using the biologic agent efalizumab (Raptiva) to treat chronic plaque psoriasis – a chronic form of the scaling disease that accounts for about 75 percent of psoriasis cases – confirms that that the drug has a favorable long-term safety profile.
The study analyzed data from more than 40,000 patients who received the drug, with a cumulative clinical experience that corresponds to more than 28,000 patient-years of exposure. It included three and a half years of post-market data obtained from spontaneous reports, published literature, regulatory authorities, epidemiological databases, clinical trials, and observational studies.
"We found that the data from continuous post-marketing surveillance confirm the favorable safety profile of efalizumab that was demonstrated in clinical trials," says Kim Papp, MD, director of Probity Medical Research Inc. in Waterloo, Canada, who presented the findings at the 5th European Association of Dermatology and Venereology (EADV) Spring Symposium. "Specifically, there was no increase in the reporting rate for infections (including tuberculosis) or malignancies, no reports of seizures or cases of multiple sclerosis, and no apparent increase in the risk of cardiovascular disorders."
"We believe out findings strengthen earlier evidence demonstrating a role for efalizumab as a suitable treatment for many patients with moderate-to-severe chronic plaque psoriasis," Dr. Papp says. 5/29/08
Psoriasis Linked To Seven New Genetic Variations
Scientists at the Washington University School of Medicine in St. Louis have discovered new sites of common DNA variation that increase the risk of psoriasis and, for some, psoriatic arthritis rheumatoid arthritis and other autoimmune disorders.
In a whole genome association study, the investigators scanned over 300,000 points of common variation in the genome called single nucleotide polymorphisms (SNPs) of 223 psoriasis patients. This included 91 with psoriatic arthritis. The DNA of these patients was compared to that of 519 healthy patients in a control group, seeking specific differences between the groups. Then, a second study was performed with 577 psoriasis patients, 576 with psoriatic arthritis, and over 1,200 healthy controls.
The team discovered seven new variations that were linked to psoriasis. Additionally, the DNA variations that were located on chromosome 4 were strongly linked to psoriatic arthritis. These variations were also associated with type 1 diabetes, rheumatoid arthritis, Grave's disease (the result of an overproductive thyroid gland), and celiac disease (an inability to digest gluten).
These variations point scientists in the direction of different biological pathways that could underlie psoriasis on a basic level. This could eventually lead to new targeted drugs and treatments that attack specific pathways, according to the investigators.
This work was published in the open-access journal PLoS Genetics. 4/4/08
Enbrel Reduces Marker of Inflammation in Plaque Psoriasis
The biologic agent etanercept (Enbrel) reduced C-reactive protein (CRP), a marker of inflammation, in patients with moderate to severe plaque arthritis following 12 weeks of treatment, according to a study presented at the American Academy of Dermatology Scientific Meeting in San Antonio, Texas.
Median reduction in CRP levels was 10 times greater in the Enbrel-treated group compared to the placebo-treated group.
The 501 patients studied had intermediate to high baseline CRP levels, a finding which reinforces that psoriasis is not only a skin disease, but in some patients may be a serious systemic inflammatory disease, says Bruce Strober, MD, PhD, study investigator and co-director of the Psoriasis and Psoriatic Arthritis Center of New York University Medical Center. “The results from this study are encouraging because they show that Enbrel not only improved the symptoms of patients with moderate to severe psoriasis, but reduced their levels of CRP as well,” he says. “However, further research is needed to better understand whether reducing CRP levels lowers the risk for developing conditions such as cardiovascular disease that may derive from increased systemic inflammation.” 2/18/08
Remicade Improves Plaques in Majority of Psoriasis Patients
Data from an analysis of three randomized, placebo-controlled trials shows patients with moderate to severe plaque psoriasis receiving infliximab (Remicade) achieved a consistently high level of skin clearance in each of the four body regions.
At week 10 of the analysis, involving nearly 1,500 patients, 71 percent of those receiving Remicade at a dose of 3 milligrams per kilogram of body weight (mg/kg) and 79 percent of those receiving 5 mg/kg achieved a 75 percent or greater improvement in the chronic inflammatory condition based on the Psoriasis Area Severity Index (PASI), a widely used measure of disease severity. In contrast, only 3 percent of those on placebo experienced similar improvement. Additionally, 39 percent and 52 percent of patients receiving Remicade at 3 mg/kg and 5mg/kg, respectively, achieved a PASI 90, or nearly complete skin clearance, versus one percent of patients receiving placebo.
“This analysis shows that treatment with Remicade resulted in a consistently high level of clinical response in each quadrant of the body evaluated by PASI, and the results were consistent with patients’ overall psoriasis improvement,” says Alan Menter, MD, dermatologist, Baylor Research Institute, Dallas. “Remicade remains an important advancement and biologic treatment option for a broad spectrum of patients with severe psoriasis.“
Investigators reported these findings at the 66th Annual Meeting of the
Malignancy Risk Not Increased in Psoriatic Arthritis
While there is much concern that some forms of arthritis and the treatments used for them may increase cancer risk, new research published in the January issue of Arthritis & Rheumatism suggests for at least once form of arthritis – psoriatic arthritis – such fears may be unfounded.
Researchers at the Univerity of Toronto analyzed the data on 665 patients who were followed between 1978 and 2004 at the
Over all, 10.2 percent of the participants developed a malignancy at an average age of 62.4 years. The most common were breast, lung, and prostate cancer, seen in 20.6 percent, 13.2 percent and 8.8 percent of participants, respectively. No form of cancer occurred at a significantly different rate in the psoriatic arthritis patients compared with the general population.
The researchers noted that neither joint activity nor medication use was associated with an increased cancer risk on the psoriatic arthritis patients.
Severe Psoriasis Linked to Earlier Death
A new study confirms the effects of the inflammatory skin disease psoriasis can be more than skin deep. Working with
The study, which appears in the December 2007 issue of the Archives of Dermatology, was based on general practitioner data spanning from 1987 to 2002 from the
Mild psoriasis was defined as "any patient with a diagnostic code of psoriasis but no history of systemic therapy."
Severe psoriasis was defined as "any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis."
This study appears to show there is a significant difference between the mild and severe forms of the disease. While the study has not found what that is, it highlights the importance of keeping a close eye on patients with severe psoriasis, to make sure they are taking care of their health, and perhaps to screen them more closely for other risk factors, such as heart disease, which has been found to be more common in psoriasis. 12/19/07
Disease Screening Important if You Have Psoriasis
For people with psoriasis, rigorous screening for other diseases is crucial, Canadian investigator Wayne Gulliver, MD, advised attendees of a workshop in support of World Psoriasis Day.
Dr. Gulliver, chairman of the Division of Dermatology at the Memorial University of Newfoundland in St. John's, made the recommendation on the basis of years of research demonstrating a strong association between psoriasis and multiple co-morbidities. He and his team performed the research using four Canadian including a total of 713, 000 individuals.
Their key findings:
- The incidence of diabetes is 10 percent in people with mild to moderate psoriasis and 12 percent in those with severe psoriasis compared with only 4 percent in the general population.
- 44 percent of deaths in psoriasis patients are apparently due to cardiovascular causes, versus 36 percent of deaths in the general population
- Patients with psoriasis have an average expectancy that is 10 years shorter than the Canadian average. Life expectancy is lower for those whose psoriasis develops before age 25.
- People with psoriasis have increased risk of genitourinary disease. 11/2/07
New Study Shows Smoking Increases Risk of Psoriasis
A new study offers yet another good reason not to smoke – Smoking increases the risk of developing psoriasis. And the more you smoke the greater your risk.
The study, published by U.S. and Canadian researchers in the November 2007 issue of The American Journal of Medicine is the largest prospective study of smoking to date. Using data from the Nurses Health Study II – an ongoing study of 116,608 female registered nurses from 15 states between the ages of 25 and 42 years at baseline who completed and returned an initial questionnaire in 1989 – the researchers documented 887 incident cases of psoriasis during the 14 years of follow-up. Lifetime smoking exposure was measured in pack-years, equal to smoking 20 cigarettes per day for one year.
Compared with women who never smoked, the risk of psoriasis was 37 percent higher among past smokers and 78 percent higher among current smokers. Risk increased with the number of pack-years.
The good news: The risk of psoriasis decreased slowly when smokers stopped smoking. After 20 years, the researchers found, the risk was no greater than for those who had never smoked. 10/29/07
