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Psoriasis is a common, chronic immune-mediated disorder that occurs worldwide. The prevalence of psoriasis in Taiwan is lower than that in Caucasian countries. Nevertheless, an increasing trend in the prevalence of psoriasis and psoriatic arthritis has been observed in Taiwan over the past decade. Accumulating studies have also suggested that psoriasis is not a disease limited to the skin and joints but has far-reaching systemic effects, associated with a higher prevalence of comorbid diseases, such as cardiovascular diseases, diabetes mellitus, metabolic syndrome, depression, and chronic kidney disease, than in the normal population. To date, our understanding of the mechanisms linking psoriasis and comorbidities remains far from complete. Psoriasis and its comorbid diseases confer substantial disease and health care burdens and have a significant negative impact on the quality of life of affected patients. The discovery of new, promising drugs has revolutionized psoriasis treatment, but patients still have unmet needs that require further investigation. Studies specifically on the Taiwanese population with psoriasis remain scarce. Herein, we review the medical literature, with a focus on studies examining the Taiwanese population, with regard to epidemiology, comorbidities, and effects of antipsoriatic agents on comorbidities, as well as the efficacy and safety of novel antipsoriatic treatments for patients with psoriasis. Keywords: Psoriasis, Epidemiology, Comorbidity, Biologics, Interleukin-17a inhibitor, Interleukin-23 inhibitor

Background/Objective: To date, no clinical trials have evaluated the therapeutic response among psoriasis patients switching from ustekinumab to secukinumab. The objective of this study was to report our experience of treating psoriasis patients with secukinumab therapy who had ever received ustekinumab previously. Methods: We retrospectively reviewed the therapeutic responses of nine patients with moderate-to-severe psoriasis who attended the clinical trials of first ustekinumab and then secukinumab. Ustekinumab (45 mg) was given at Weeks 0, 4, and 16, and patients were evaluated for safety and efficacy at Weeks 12 and 16. After the end of the ustekinumab treatment period, patients were treated as needed by other modalities. In 2011, eligible patients were recruited again in a Phase 3, double-blind, secukinumab trial (ERASURE). Secukinumab (150 mg or 300 mg) was given at Weeks 0, 1, 2, 3, and 4 and then every 4 weeks. A single evaluator performed all the assessments. Results: Among the nine patients, five patients (55.6%) had at least 75% reduction in the Psoriasis Area Severity Index (PASI75) score response, and four patients (44.4%) had at least 90% reduction in the Psoriasis Area Severity Index (PASI90) score response at Week 12 during secukinumab therapy. Their prior experience during ustekinumab therapy revealed at least PASI75 response in four patients (44.4%) and at least PASI90 response also in four patients (44.4%) at Week 12. Mean absolute PASI change at Week 12 of secukinumab therapy in our patients was −17.47. Conclusion: Biologic switch is effective and valuable. Patients who have ever responded to ustekinumab seem to have a better response to secukinumab.

Background/Objective(s): Few studies have evaluated the therapeutic response among switchers of biologics in patients with psoriasis. We report our experience of ustekinumab in patients with psoriasis who did not respond adequately to tumor necrosis factor (TNF) blockers treatment previously. Methods: We retrospectively reviewed the therapeutic response of 20 patients with moderate-to-severe psoriasis who had failed conventional treatment and had inadequate therapeutic response to previous etanercept and/or adalimumab between 2012 and 2013. Inadequate therapeutic response is defined by

Background: Azathioprine is used as an immunosuppressant and corticosteroid-sparing agent for the treatment of several cutaneous diseases. The mutation of thiopurine methyltransferase (TPMT) and inosine triphosphate pyrophosphatase (ITPA) has been reported to result in the accumulation of toxic thiopurine metabolites and to increase the adverse effects during azathioprine treatment. In the Chinese population, TPMT∗3C and ITPA C94A polymorphisms have been documented. Methods: Genotyping was performed for TPMT and ITPA polymorphisms in 92 unrelated healthy volunteers and in 74 dermatology patients (46 with adverse effects and 28 without adverse effects) during azathioprine treatment. Results: Two functional polymorphisms, TPMT∗3C and ITPA C94A, were detected. After analysis, ITPA C94A showed weak association with nausea/vomiting induced by azathioprine. Furthermore, we revealed that the ITPA 94 A allele was most common in patients with nausea/vomiting and developing slow-appearing adverse effects (67%), followed by patients with nausea/vomiting but not developing slow-appearing adverse effects (50%) and patients without nausea/vomiting but developing slow-appearing adverse effects (25%). Conclusion: Adverse reaction to azathioprine cannot be predicted by TPMT polymorphism. However, genetic testing of ITPA polymorphism may be more important for the prediction of nausea/vomiting in Taiwanese. Currently, regular blood tests and clinical vigilance remain most important in preventing severe drug reactions during clinical use of azathioprine.

Background: Few studies exist that evaluate the therapeutic response among switchers of tumor necrosis antagonists in patients with psoriasis, especially Asian patients. Objective: This study aimed to evaluate the safety and effectiveness of adalimumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic response to prior etanercept. Methods: This is a single-center, open-labeled, retrospective study on the effects of adalimumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic responses to prior etanercept. We included 13 patients who had received etanercept for at least 3s months but showed inadequate therapeutic response, as defined by less than 50% improvement in psoriasis area and severity index (PASI) 50, compared to baseline after 6 months or less than PASI25 improvement after 3 months in our hospital during 2006–2012. Adalimumab 40 mg was given every other week with a loading dose of 80 mg. Patients were evaluated monthly for safety and effectiveness. PASI, physician global assessment, and scores of scalp lesions were calculated at Weeks 12 and 24. Scalp lesions were assessed separately. Results: At Week 12, one patient (7%) had at least PASI90, two (15%) had at least PASI75, four (31%) had at least PASI50, and eight (61.5%) had at least PASI25 response. At Week 24, two patients (15%) had at least PASI90, three (23%) had at least PASI75, six (46%) had at least PASI50, and nine (69%) had at least PASI25 response. No severe adverse events were recorded in our series. For scalp lesion, adalimumab showed similar efficacy to etanercept nonresponders. Conclusion: Safety profiles of adalimumab were similar to those of etanercept, and PASI50 was achieved in 46% of patients, who failed prior etanercept therapy, after 24 weeks of adalimumab treatment.

Background: Dactylitis is a characteristic feature of psoriatic arthritis (PsA). However, early diagnosis of mild dactylitis is challenging and image examination, such as ultrasonography (US), can be helpful. Objectives: We aimed to compare the clinical diagnosis of dactylitis made by the dermatologist and ultrasonographic diagnosis by the rheumatologist. Methods: Consecutive patients diagnosed with peripheral PsA seen in the dermatologic clinics were referred to the same dermatologist for evaluation of dactylitis. Consecutive patients with and without clinical dactylitis were diagnosed in 19 and 19 patients, respectively, by the referred dermatologist. All patients were then referred to an experienced rheumatologist unaware of the clinical diagnosis for sonographic examination of all 20 digits. Dactylitis under US was diagnosed when both proximal and distal parts of a digit were at least 0.25 mm larger than the contralateral digit. Results: For the clinical dactylitis group, 7 (36.8%) patients had more dactylitis diagnosed by US than clinically, and 2 (10.5%) patients had no dactylitis diagnosed by US. For the clinically no dactylitis group, 4 (21.1%) patients had no diagnosis of dactylitis by US, and most of these patients (78.9%) were diagnosed with dactylitis under US by the rheumatologist. More digits affected by dactylitis were found for both groups, although no statistically significant differences were found, probably due to the small sample size. Conclusion: The results revealed concordance between the dermatologist and rheumatologist for clinical dactylitis but not for patients without dactylitis. For PsA patients, US is more sensitive and useful for early dactylitis diagnosis in a dermatologic clinic.