Psoriasis

Patients with multiple sclerosis (MS) may be more likely to develop psoriasis if they take certain B cell-depleting therapies, a new study finds. However, overall rates of reported disease are very low, and there’s no confirmation of a connection.

“People with MS and comorbid psoriasis – or those at a known high-risk for developing psoriasis – may benefit from a careful consideration of disease-modifying therapy (DMT), specifically when B cell-depleting therapies are considered,” study coauthor and Medical College of Wisconsin neurologist Ahmed Obeidat, MD, PhD, said in an interview. The findings were presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC).

Dr. Obeidat and colleagues launched the study after noticing cases of psoriasis that developed months to years after patients started taking ocrelizumab, a B cell-depleting therapy. “We referred to the published literature and only found very scant reports of MS, psoriasis, and B cell-depleting therapy use,” he said. “Thus we decided to pursue an investigation of a large [Food and Drug Administration] database to examine for possible out-of-proportion reports for psoriasis in patients with MS who were receiving B cell-depleting therapy.”

The researchers tracked case reports of psoriasis in patients with MS on DMTs from 2009 to 2020 via the FDA Adverse Event Reporting System. They found 517 psoriasis reports among 45,547 reports of skin/cutaneous conditions. The reports were linked to interferon beta 1a (136 reports, 26% of total), natalizumab (107, 21%), fingolimod (75, 15%), dimethyl fumarate (64, 12%), ocrelizumab (49, 10%), teriflunomide (28, 5%), interferon beta 1b (22, 4%), glatiramer acetate (12, 2%), rituximab (10, 2%), and alemtuzumab (9, 2%).

The total numbers of cases is low, but this may reflect underreporting due to the assumption that “autoimmunity begets autoimmunity” and therefore cases of psoriasis in MS are not alarming, medical student Mokshal H. Porwal, the study lead author, said in an interview.

The average age of patients – 48-51 – was similar for all of the drugs except alemtuzumab (mean age 41), which had a very small number of cases. The percentage of cases in females was 71%-77% for most of the drugs, with a few exceptions: rituximab (60%), ocrelizumab (63%), and alemtuzumab (33%).

Other drugs – cladribine, siponimod, and ozanimod – had 1, 1, and 0 reports, respectively, and were not included in the age and gender analyses.

The researchers also found that psoriasis made up about 65% of all skin/cutaneous adverse reports for rituximab, the highest number among DMTs. By comparison, that number was about 30% for ocrelizumab and under 1% for dimethyl fumarate and alemtuzumab.

Links between psoriasis and MS are murky, Dr. Obeidat said. “Some studies consider the presence of psoriasis as a possible indicator of increased future risk for MS, but there’s no clear association between the two conditions,” he said.

As for DMTs, “a few case reports of psoriasis in association with interferon-beta and rare case reports in association with ocrelizumab therapy have been published. However, the possible association between certain DMTs and psoriasis remains unclear,” he said.

Going forward, “we advise that patients with psoriasis on B cell-depleting agents are monitored more closely,” Dr. Obeidat said. “If the psoriasis worsens, it may be beneficial to think about potential alternative therapies.”

No study funding is reported. Dr. Obeidat reports various disclosures; the other authors report no disclosures.

Patients with multiple sclerosis (MS) may be more likely to develop psoriasis if they take certain B cell-depleting therapies, a new study finds. However, overall rates of reported disease are very low, and there’s no confirmation of a connection.

“People with MS and comorbid psoriasis – or those at a known high-risk for developing psoriasis – may benefit from a careful consideration of disease-modifying therapy (DMT), specifically when B cell-depleting therapies are considered,” study coauthor and Medical College of Wisconsin neurologist Ahmed Obeidat, MD, PhD, said in an interview. The findings were presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC).

Dr. Obeidat and colleagues launched the study after noticing cases of psoriasis that developed months to years after patients started taking ocrelizumab, a B cell-depleting therapy. “We referred to the published literature and only found very scant reports of MS, psoriasis, and B cell-depleting therapy use,” he said. “Thus we decided to pursue an investigation of a large [Food and Drug Administration] database to examine for possible out-of-proportion reports for psoriasis in patients with MS who were receiving B cell-depleting therapy.”

The researchers tracked case reports of psoriasis in patients with MS on DMTs from 2009 to 2020 via the FDA Adverse Event Reporting System. They found 517 psoriasis reports among 45,547 reports of skin/cutaneous conditions. The reports were linked to interferon beta 1a (136 reports, 26% of total), natalizumab (107, 21%), fingolimod (75, 15%), dimethyl fumarate (64, 12%), ocrelizumab (49, 10%), teriflunomide (28, 5%), interferon beta 1b (22, 4%), glatiramer acetate (12, 2%), rituximab (10, 2%), and alemtuzumab (9, 2%).

The total numbers of cases is low, but this may reflect underreporting due to the assumption that “autoimmunity begets autoimmunity” and therefore cases of psoriasis in MS are not alarming, medical student Mokshal H. Porwal, the study lead author, said in an interview.

The average age of patients – 48-51 – was similar for all of the drugs except alemtuzumab (mean age 41), which had a very small number of cases. The percentage of cases in females was 71%-77% for most of the drugs, with a few exceptions: rituximab (60%), ocrelizumab (63%), and alemtuzumab (33%).

Other drugs – cladribine, siponimod, and ozanimod – had 1, 1, and 0 reports, respectively, and were not included in the age and gender analyses.

The researchers also found that psoriasis made up about 65% of all skin/cutaneous adverse reports for rituximab, the highest number among DMTs. By comparison, that number was about 30% for ocrelizumab and under 1% for dimethyl fumarate and alemtuzumab.

Links between psoriasis and MS are murky, Dr. Obeidat said. “Some studies consider the presence of psoriasis as a possible indicator of increased future risk for MS, but there’s no clear association between the two conditions,” he said.

As for DMTs, “a few case reports of psoriasis in association with interferon-beta and rare case reports in association with ocrelizumab therapy have been published. However, the possible association between certain DMTs and psoriasis remains unclear,” he said.

Going forward, “we advise that patients with psoriasis on B cell-depleting agents are monitored more closely,” Dr. Obeidat said. “If the psoriasis worsens, it may be beneficial to think about potential alternative therapies.”

No study funding is reported. Dr. Obeidat reports various disclosures; the other authors report no disclosures.

Patients with multiple sclerosis (MS) may be more likely to develop psoriasis if they take certain B cell-depleting therapies, a new study finds. However, overall rates of reported disease are very low, and there’s no confirmation of a connection.

“People with MS and comorbid psoriasis – or those at a known high-risk for developing psoriasis – may benefit from a careful consideration of disease-modifying therapy (DMT), specifically when B cell-depleting therapies are considered,” study coauthor and Medical College of Wisconsin neurologist Ahmed Obeidat, MD, PhD, said in an interview. The findings were presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC).

Dr. Obeidat and colleagues launched the study after noticing cases of psoriasis that developed months to years after patients started taking ocrelizumab, a B cell-depleting therapy. “We referred to the published literature and only found very scant reports of MS, psoriasis, and B cell-depleting therapy use,” he said. “Thus we decided to pursue an investigation of a large [Food and Drug Administration] database to examine for possible out-of-proportion reports for psoriasis in patients with MS who were receiving B cell-depleting therapy.”

The researchers tracked case reports of psoriasis in patients with MS on DMTs from 2009 to 2020 via the FDA Adverse Event Reporting System. They found 517 psoriasis reports among 45,547 reports of skin/cutaneous conditions. The reports were linked to interferon beta 1a (136 reports, 26% of total), natalizumab (107, 21%), fingolimod (75, 15%), dimethyl fumarate (64, 12%), ocrelizumab (49, 10%), teriflunomide (28, 5%), interferon beta 1b (22, 4%), glatiramer acetate (12, 2%), rituximab (10, 2%), and alemtuzumab (9, 2%).

The total numbers of cases is low, but this may reflect underreporting due to the assumption that “autoimmunity begets autoimmunity” and therefore cases of psoriasis in MS are not alarming, medical student Mokshal H. Porwal, the study lead author, said in an interview.

The average age of patients – 48-51 – was similar for all of the drugs except alemtuzumab (mean age 41), which had a very small number of cases. The percentage of cases in females was 71%-77% for most of the drugs, with a few exceptions: rituximab (60%), ocrelizumab (63%), and alemtuzumab (33%).

Other drugs – cladribine, siponimod, and ozanimod – had 1, 1, and 0 reports, respectively, and were not included in the age and gender analyses.

The researchers also found that psoriasis made up about 65% of all skin/cutaneous adverse reports for rituximab, the highest number among DMTs. By comparison, that number was about 30% for ocrelizumab and under 1% for dimethyl fumarate and alemtuzumab.

Links between psoriasis and MS are murky, Dr. Obeidat said. “Some studies consider the presence of psoriasis as a possible indicator of increased future risk for MS, but there’s no clear association between the two conditions,” he said.

As for DMTs, “a few case reports of psoriasis in association with interferon-beta and rare case reports in association with ocrelizumab therapy have been published. However, the possible association between certain DMTs and psoriasis remains unclear,” he said.

Going forward, “we advise that patients with psoriasis on B cell-depleting agents are monitored more closely,” Dr. Obeidat said. “If the psoriasis worsens, it may be beneficial to think about potential alternative therapies.”

No study funding is reported. Dr. Obeidat reports various disclosures; the other authors report no disclosures.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.

Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.

Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).

Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.

Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.

Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.

Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.

Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).

Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.

Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.

Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.

Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.

Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).

Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.

Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.

Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.

Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.

Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).

Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.

Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.

Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.

Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.

Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).

Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.

Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.

Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.

Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.

Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).

Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.

Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.

Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.

Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.

Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.

Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.

Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.

Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.

Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.

Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.

Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.

Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.

Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.

Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.

Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.

Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.

Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.

Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.

Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.

Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.

Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.

Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.

Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.

Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.

Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.

Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.

Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.

Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.

Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.

Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.

Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.

Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.

Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.

Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.

Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.

Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.

Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.

Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.

Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.

Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.

Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.

Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.

Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.

Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.

Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.

Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.

Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.

Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.

Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.

Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.

Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.

Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.

Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.

Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.

Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.

Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.

Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.

Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.

Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.

Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.

Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.

Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.

Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.

Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.

Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.

Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.

Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.

Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.

Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.

Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.

Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.

Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.

Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.

Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.

Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.

Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.

Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.

Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.

Key clinical point: The disease severity assessment, guiding initiation of systemic therapy, differed when either patient- or clinician-reported outcomes were considered alone, highlighting the complementary value of both for appropriate treatment.

Major finding: Overall, 72.4% (95% confidence interval [CI], 67.3%-77.0%) of patients who qualified for systemic therapy initiation on account of Psoriasis Area Severity Index (PASI) scores or body surface area (BSA) of 10 or higher had a Dermatology Life Quality Index (DLQI) score of less than 10. Conversely, 10.4% (95% CI, 8.8%-12.1%) of patients with a DLQI score higher than 10 did not qualify for systemic therapy based on PASI scores or BSA.

Study details: Findings are from a cross-sectional, observational study including 1,733 patients with mild, moderate, or severe psoriasis who met the criteria for initiation of systemic therapy based on DLQI score, PASI score, or BSA.

Disclosures: No specific funding for the study was disclosed. Dr. Gelfand declared receiving consultation fees and research grants from various sources.

Source: Barbieri JS et al. JAMA Dermatol. 2021 Sep 8. doi: 10.1001/jamadermatol.2021.3341.

Key clinical point: The disease severity assessment, guiding initiation of systemic therapy, differed when either patient- or clinician-reported outcomes were considered alone, highlighting the complementary value of both for appropriate treatment.

Major finding: Overall, 72.4% (95% confidence interval [CI], 67.3%-77.0%) of patients who qualified for systemic therapy initiation on account of Psoriasis Area Severity Index (PASI) scores or body surface area (BSA) of 10 or higher had a Dermatology Life Quality Index (DLQI) score of less than 10. Conversely, 10.4% (95% CI, 8.8%-12.1%) of patients with a DLQI score higher than 10 did not qualify for systemic therapy based on PASI scores or BSA.

Study details: Findings are from a cross-sectional, observational study including 1,733 patients with mild, moderate, or severe psoriasis who met the criteria for initiation of systemic therapy based on DLQI score, PASI score, or BSA.

Disclosures: No specific funding for the study was disclosed. Dr. Gelfand declared receiving consultation fees and research grants from various sources.

Source: Barbieri JS et al. JAMA Dermatol. 2021 Sep 8. doi: 10.1001/jamadermatol.2021.3341.

Key clinical point: The disease severity assessment, guiding initiation of systemic therapy, differed when either patient- or clinician-reported outcomes were considered alone, highlighting the complementary value of both for appropriate treatment.

Major finding: Overall, 72.4% (95% confidence interval [CI], 67.3%-77.0%) of patients who qualified for systemic therapy initiation on account of Psoriasis Area Severity Index (PASI) scores or body surface area (BSA) of 10 or higher had a Dermatology Life Quality Index (DLQI) score of less than 10. Conversely, 10.4% (95% CI, 8.8%-12.1%) of patients with a DLQI score higher than 10 did not qualify for systemic therapy based on PASI scores or BSA.

Study details: Findings are from a cross-sectional, observational study including 1,733 patients with mild, moderate, or severe psoriasis who met the criteria for initiation of systemic therapy based on DLQI score, PASI score, or BSA.

Disclosures: No specific funding for the study was disclosed. Dr. Gelfand declared receiving consultation fees and research grants from various sources.

Source: Barbieri JS et al. JAMA Dermatol. 2021 Sep 8. doi: 10.1001/jamadermatol.2021.3341.