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Background: Adalimumab therapy has an established record of high efficacy in psoriasis treatment. However, only a limited number of studies have investigated long-term results in clinical practice., Objectives: To evaluate the effectiveness and safety of adalimumab in a center for biological therapy in the Czech Republic., Methods: Retrospectively, we analyzed 90 patients with moderate to severe psoriasis who were treated with adalimumab between 2008 and 2016. The proportion of patients achieving PASI75, 90, and 100 after 3, 6, 12, 18, 24, 30, and 36 months was determined., Results: The mean period of treatment was 4.4 years (maximum duration reached was 8.6 years). PASI75 was observed in 85.6% of patients after 3 months, PASI90 in 50%, and PASI100 in 23.3%. Throughout the 3-year analysis, PASI90 was persistent in 91.4% and PASI100 in 51.7%. The majority of patients who reached PASI100 showed a trend to maintain the response in the long-term follow-up. No safety issues were identified., Conclusions: Adalimumab is effective and safe in the long-term treatment of psoriatic patients in daily clinical practice. Once patients achieved PASI100, they tended to remain stable in treatment.

Psoriasis is a chronic systemic immune-mediated inflammatory dermatosis associated with several comorbidities. Psoriasis patients are at increased risk of developing cardiovascular diseases (CVD), namely, coronary heart disease, stroke or peripheral vascular disease, and psoriasis seems to be an independent cardiovascular risk factor. Antipsoriatic systemic therapy, especially anti-tumor necrosis factor (TNF)-α, seems to exert a beneficial effect on these comorbidities. The purpose of this study was: (i) to measure the level of cardiovascular serum markers in psoriasis patients in comparison with healthy volunteers; and (ii) to compare the serum level of the same markers in patients before and 3 months after adalimumab therapy. We investigated six biomarkers connected to CVD: C-reactive protein (measured high sensitively, hsCRP), oxidized low-density lipoproteins (oxLDL), oxLDL/β-glycoprotein I complex (oxLDL/β2GPI), vascular endothelial adhesion molecule 1 (VCAM-1), E-selectin and interleukin (IL)-22. These biomarkers were measured in 21 patients with moderate/severe psoriasis before and after treatment with adalimumab and in healthy volunteers. hsCRP (P < 0.05), oxLDL-β2GPI complex (P < 0.05), E-selectin (P < 0.001) and IL-22 (P < 0.001) were significantly increased in comparison with healthy controls, whereas oxLDL and VCAM-1 were also higher in psoriasis patients but the difference did not reach statistical significance. A decrease of E-selectin (P < 0.001) and IL-22 (P < 0.001) was observed after 3 months of adalimumab therapy. Inhibition of TNF-α seems to not only improve psoriasis but also decreases serum cardiovascular biomarkers. E-selectin and IL-22 could serve for monitoring of the efficacy of antipsoriatic systemic therapy on cardiovascular risk., (© 2016 Japanese Dermatological Association.)

Patients with psoriasis are at increased risk of atherosclerosis, which is characterized by endothelial dysfunction associated with systemic inflammation. It appears that anti-tumor necrosis alpha treatment may reduce this risk. The purpose of this study was to measure serum marker levels associated with systemic inflammation in patients with psoriasis compared to healthy subjects and to further evaluate the change in their levels after 3 months and 2 years of treatment with adalimumab. We investigated four biomarkers: highly sensitive C-reactive protein (hsCRP), oxidized low density lipoproteins (OxLDL), E-selectin and Interleukin 22 (IL-22). These markers were determined in healthy volunteers and in 28 patients with moderate to severe psoriasis before and after 3 and 24 months of adalimumab treatment. Patients with psoriasis had elevated markers levels compared to controls. After 3 months of treatment, E-selectin decreased significantly (p < 0.001), same as IL-22 (p < 0.001). HsCRP also decreased, but statistically insignificantly, OxLDLs were slightly higher than originally. After 24 months, 17 patients were still treated with adalimumab. In these patients, HsCRP (p < 0.05), E-selectin (p < 0.001) and IL-22 (p < 0.001) were significantly reduced. The OxLDL value remained elevated. A steady decrease in E-selectin, hsCRP and IL-22 after 24 months confirms that adalimumab suppresses systemic inflammation. [ABSTRACT FROM AUTHOR]

Despite the proven efficacy, some patients lose response to adalimumab over time or experience acute flares as it was shown in the open-label extension PIONEER trial.1 Treatment of these patients can be challenging. Hidradenitis suppurativa (HS) is a chronic disease characterized by inflammatory nodules, sinus tracts and scarring, predominantly in the axillae and groin areas. [Extracted from the article]

Psoriasis is a chronic inflammatory skin disease afFecting about 2-4% of Central-European population. Treatment options include topical or systemic agents, often in combination. Conventional systemic therapies are represented by phototherapy (UVB, PUVA), methotrexate, cyclosporine and acitretin. The newest drugs are so-called biologics: drugs blocking tumor necrosis factor alpha (TNF alpha) - adalimumab, etanercept, infliximab, drugs blocking interleukin-12 and 23 (IL-12/23) - ustekinumab and newly also drugs blocking interleukin 17 - secukinumab. The aim of this paper is to present the long-term efficacy and safety of treatment of patients with moderate to severe psoriasis with adalimumab, a fully human monoclonal antibody against TNF-alpha. Retrospectively we analyzed 90 patients with moderate to severe psoriasis treated with adalimumab in the Center for biological therapy in Dermatovenereology clinic of the Faculty Hospital of Kralovske Vinohrady during the years 2008 and 2015. Although the average PASI of patients assigned to treatment was 22.5, the results shows a rapid onset of action of adalimumab, where PASI75 was observed in 85.6% of patients after 3 months of treatment. The efficacy sustained even in a long-term follow up, after two years PASI75 has been retained in 94.8% and PASI90 in 75.9% patients. After 48 months follow up a cohort of about 80% of patients is still on therapy. The safety profile of adalimumab in our group was very good, no patients have discontinued the treatment due to adverse events. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic suppurative disease characterized by inflammatory nodules, fistulas and scarring predominantly in the armpits and the groins. Systemic therapy including oral antibiotics, retinoids or antiandrogens has only limited effect, advanced stages require surgical treatment of affected areas. Recently, there were some reports of successful therapy of hidradenitis suppurativa by TNF-α antagonists. In contrast to infliximab and etanercept, the positive effect of adalimumab was described only in small cohorts of patients. Nine patients with severe, recalcitrant hidradenitis were treated for 1 year with adalimumab in a standard regimen and followed-up for 1 year. All patients improved within 4-6 weeks and laboratory parameters like CRP and leucocyte count were reduced significantly during the treatment. In four patients we observed a long lasting improvement, five patients showed recurrences several months after the therapy discontinuation. Average recurrence-free interval was 9 months. According to our experience therapy with adalimumab is suitable for treatment and induction of long-term remission in severe hidradenitis suppurativa. [ABSTRACT FROM AUTHOR]