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We carried out a study looking at the use of biosimilars in the UK and Ireland using data from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR), a large multicentre register of patients with severe psoriasis based in the UK and Ireland. Psoriasis is a chronic skin disease that affects 1.5% of the UK population, causing itchy and scaly skin patches. Tumour necrosis factor-alpha inhibitors (TNFi) are effective but previously costly injectable treatments for moderate-to-severe psoriasis. [Extracted from the article]

Summary: Background: Patients with psoriasis are often concerned about the risk of serious infection associated with systemic psoriasis treatments. Objectives: To develop and externally validate a prediction model for serious infection in patients with psoriasis within 1 year of starting systemic therapies. Methods: The risk prediction model was developed using the British Association of Dermatologists Biologic Interventions Register (BADBIR), and the German Psoriasis Registry PsoBest was used as the validation dataset. Model discrimination and calibration were assessed internally and externally using the C‐statistic, the calibration slope and the calibration in the large. Results: Overall 175 (1·7%) out of 10 033 participants from BADBIR and 41 (1·7%) out of 2423 participants from PsoBest developed a serious infection within 1 year of therapy initiation. Selected predictors in a multiple logistic regression model included nine baseline covariates, and starting infliximab was the strongest predictor. Evaluation of model performance showed a bootstrap optimism‐corrected C‐statistic of 0·64 [95% confidence interval (CI) 0·60–0·69], calibration in the large of 0·02 (95% CI −0·14 to 0·17) and a calibration slope of 0·88 (95% CI 0·70–1·07), while external validation performance was poor, with C‐statistic 0·52 (95% CI 0·42–0·62), calibration in the large 0·06 (95% CI −0·25 to 0·37) and calibration slope 0·36 (95% CI −0·24 to 0·97). Conclusions: We present the first results of the development of a multivariable prediction model. This model may help patients and dermatologists in the U.K. and the Republic of Ireland to identify modifiable risk factors and inform therapy choice in a shared decision‐making process. What's already known about this topic? Patients and their clinicians are often concerned about the risk of serious infection associated with biological therapies for the treatment of psoriasis.However, there are no current tools available to estimate an individual's risk of serious infection when starting a systemic therapy. What does this study add? This study found that the serious infection risk prediction model had good calibration and moderate discriminationThe model included chronic obstructive pulmonary disease, alcohol intake, number of comorbidities and employment status, in addition to age, sex, Psoriasis Area and Severity Index, choice of starting therapy and body mass index.These are the first results of the multivariable prediction model, which may help patients and dermatologists in the U.K. and the Republic of Ireland to identify modifiable risk factors and inform therapy choice in a shared decision‐making process. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Psoriasis is a common skin condition affecting approximately 2% of the population, with up to 1.8 million people affected in the U.K. alone. This article reports the work from a group of U.K. and Republic of Ireland based researchers who set out to determine if secukinumab, a medicine known as an IL‐17A inhibitor, was safe and effective in patients with moderate/severe chronic plaque psoriasis for whom previous treatment with a medicine called a TNFα inhibitor had not remained effective. 53 dermatology centres in the U.K. and Republic of Ireland took part. Patients were randomly assigned to to receive secukinumab at a dose of either 300mg or 150 mg subcutaneously (by injection) every week for 4 weeks, then 4‐weekly thereafter. The Psoriasis Area Severity Index (PASI) is used to record the redness, thickness and scaling of a patient's psoriasis and to measure how well a treatment works, as a reduction in the PASI score means a reduction in these symptoms. If a patient achieves PASI 75, it means they had a 75% or more reduction in their PASI score from the start. In total, 233 patients were analysed. 77 of 118 patients (65·3%) in the 300mg dose group and 51 of 115 patients (44·3%) in the 150mg dose group had achieved PASI 75 at week 16. After 72 weeks of treatment, 77.1% of patients in the 300 mg group who remained on that treatment throughout the study achieved PASI 75. Improvements in patients' quality of life were also seen at week 16 and were maintained to week 72. The safety profile of secukinumab was generally consistent with previous secukinumab studies, although a higher incidence of some adverse events, meaning unwanted side effects, were observed (e.g. candida infections, a type of fungal infection). This study has shown evidence of the efficacy and safety of secukinumab for treatment of psoriasis patients for whom prior TNFα‐inhibitor therapy has not been effective. Linked Article: Warren et al. Br J Dermatol 2020; 183:60–70. [ABSTRACT FROM AUTHOR]