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Psoriasis is now considered a systemic disease, and several comorbidities have been described such as cardiovascular diseases, neurologic and psychiatric disorders, chronic inflammatory bowel disease, psoriatic arthritis, etc. Regarding cardiovascular comorbidities, major adverse cardiovascular events have been reported in psoriasis patients by multiple epidemiologic studies. Moreover, smoking, obesity, metabolic syndrome, hypertension, dyslipidemia, diabetes and reduced physical activity are associated with psoriasis, increasing cardiovascular risk. Consequently, several aspects should be considered when making the treatment decision. The aim of this review manuscript was to investigate the effectiveness and safety of biologic drugs acting on molecular mechanisms involved in the pathogenesis of psoriasis in preventing cardiovascular complications. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Dermatological Treatment, presents the preliminary results of a study on the effect of tildrakizumab on adipokine production in patients with psoriasis and obesity. Adipokines are peptides and proteins produced by adipocytes that play a role in cell signaling and autoimmune processes. The study found that tildrakizumab led to a significant reduction in the Psoriasis Area Severity Index (PASI) and resistin levels in fast responder patients, but not in slow responder patients. The authors suggest that targeting IL-23 with tildrakizumab may reduce adipokine levels and improve clinical outcomes in psoriasis patients. However, the exact mechanism behind the correlation between adipokines and psoriasis is still unknown. [Extracted from the article]

Psoriasis is now considered to be the cutaneous phenotype of a systemic inflammatory condition, recognized under the term Psoriatic Disease (PsD). PsD has several extracutaneous manifestations, such as inflammatory articular and entheseal involvement, leading to psoriatic arthritis (PsA), and the less frequent intestinal and ocular manifestations with colitis/inflammatory bowel disease and uveitis, respectively. There have also been several reports of an increased frequency of comorbidities such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome and cardiovascular manifestations during the course of PsD. The link between psoriasis and related comorbidities is considered a long-term disease sequela, often characterized by an unhealthy lifestyle and a consequence of systemic inflammation; hence, psoriasis requires adequate and prompt treatment, with the aim of controlling not only cutaneous manifestations but also extracutaneous manifestations and systemic inflammation. Pharmacological strategies for PsD have significantly increased over recent years. Recently, the targeted synthetic DMARDs, Janus kinase (JAK) inhibitors, tofacitinib and upadacitinib, were added to the therapeutic armamentarium for treating PsA, and deucravacitinib for psoriasis. These oral agents act directly on inflammatory mechanisms underlining the disease, as antagonists of the intracellular JAK signal pathway and, by STAT phosphorylation, inhibit gene proinflammatory cytokine transcription. JAK inhibitors represent a recent additional treatment strategy for PsD management and, among these, tofacitinib and upadacitinib have recently been approved for PsA, and deucravacitinib for psoriasis. In this review we describe ongoing and recent phase II and III randomized controlled trials (RCTs) evaluating the efficacy and safety of investigational JAK inhibitors in psoriasis and PsA. [ABSTRACT FROM AUTHOR]

Background: Recent knowledge of psoriasis pathogenesis has led to the development of selective drugs. Among these, brodalumab is a monoclonal antibody targeting the interleukin (IL)-17A receptor approved for the treatment of moderate-to-severe plaque psoriasis. Biologics may be considered in patients with milder diseases in case of active psoriatic arthritis, severe impact on patient's quality of life, and involvement of sensitive and difficult-to-treat areas. These skin locations commonly require systemic drugs. Recently, psoriasis severity monitoring has also changed. Indeed, the clinical evaluation by means of specific efficacy scores was combined with serological evaluation by means of the assay of specific inflammatory biomarkers.Methods: An observational study enrolled patients affected by moderate-to-severe plaque psoriasis involving difficult-to-treat areas, undergoing treatment with brodalumab to evaluate the effectiveness and safety of brodalumab in patients with psoriasis affecting difficult-to-treat areas (scalp and palmoplantar regions). Secondary outcomes were the assessment of the development of serum markers of inflammation during the treatment period as well as the evaluation of the dermoscopic features of the affected sites to quantify disease activity and response to treatment.Results: Twenty-five patients were included in the study. A statistically significant reduction from baseline in PASI, PSSI, ppPASI and DLQI values as early as week 24 was observed, with further improvement up to week 52. Plasma levels of MMP-3, VEGF-A, and hs-PCR decreased during treatment from week 0 to week 52.Conclusion: Our real-life experience suggests brodalumab as a valuable option for the management of psoriasis located in difficult-to-treat areas. Moreover, our study highlights that the use of brodalumab reduces the plasmatic levels of inflammatory biomarkers (MMP-3, VEGF-A and hs-PCR), showing how the drug modulates the skin inflammatory response by reducing systemic inflammation. [ABSTRACT FROM AUTHOR]

The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays a critical role in orchestrating immune and inflammatory responses, and it is essential for a wide range of cellular processes, including differentiation, cell growth, and apoptosis. Over the years, this pathway has been heavily investigated due to its key role in the pathogeneses of several chronic inflammatory conditions, e.g., psoriasis, atopic dermatitis (AD), and inflammatory bowel diseases (IBDs). Nevertheless, the impact of this pathway on the pathogenesis of inflammatory conditions remains unclear. This review describes the role of the JAK/STAT signaling pathway in the pathogenesis of inflammatory diseases such as psoriasis (Pso), psoriatic arthritis (PsA), AD, and IBD with a focus on ulcerative colitis (UC) and briefly resumes the use of JAK inhibitors in their clinical management. [ABSTRACT FROM AUTHOR]

At baseline, the following data were collected for each patient: (i) personal and demographic data; (ii) psoriasis duration and presence of psoriatic arthritis; (iii) comorbidities; (iv) previous treatments for psoriasis; (v) psoriasis severity through body surface area (BSA) and psoriasis activity severity index (PASI). A "last observation carried forward" method, where if a patient dropped out of the study the last available value was "carried forward" until the end of the treatment, was used. The introduction of biologic drugs has revolutionized the management of moderate-to-severe psoriasis.[1] In particular, anti-interleukin (IL)-23s have been recently approved.[2] Tildrakizumab is a fully human immunoglobulin G1 antibody selectively targeting the p19 subunit of IL-23 without binding to p40 subunit shared by IL-12 and 23.[3] Even if two randomized controlled trials (CTs) (reSURFACE 1 and reSURFACE 2) showed the superiority of tildrakizumab compared with placebo and etanercept, real-life data are limited.[[4], [6], [8]] Thus, the aim of our 28-week retrospective study was to assess the effectiveness and safety of tildrakizumab for moderate-to-severe psoriasis in a real-life setting. [Extracted from the article]

Eleven biologic drugs are currently approved for psoriasis management. Real‐life studies are needed to guide clinicians in choosing a tailored‐tail therapy. The aim of our retrospective study is to indirectly compare the efficacy and safety of ixekizumab and brodalumab in psoriasis patients. A single‐centre real‐life retrospective study was performed enrolling moderate‐to‐severe psoriatic patients under biologic treatment with ixekizumab or brodalumab. For each patient, clinical and demographic data were collected and the effectiveness and safety of brodalumab and ixekizumab treatment were evaluated at weeks 4, 12, and 24. Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) were used for psoriasis severity. A total of 139 patients were included in the study: 98(70.5%) and 41(29.5%) patients received ixekizumab and brodalumab, respectively. Mean PASI and BSA significantly reduced at each follow up for both ixekizumab and brodalumab groups. Even if ixekizumab reached higher rates of PASI90 and PASI100 than brodalumab (PASI90: 43.8% vs. 39.0% PASI100: 20.4% vs. 17.1% at week4 and PASI90: 83.6% vs. 75.6% PASI100: 71.5% vs. 60.9% at week24), these results were not statistically significant. Adverse events, mainly mild, were registered in 25.5% of ixekizumab and 26.8% of brodalumab group, respectively. Discontinuation rate was higher for brodalumab (17.1% vs. 9.1%), without statistical significance. Our study showed comparable efficacy and safety for ixekizumab and brodalumab. [ABSTRACT FROM AUTHOR]

Guselkumab, tildrakizumab, and risankizumab, acting on interleukin(IL)23 axis, have been recently approved for psoriasis management. However, real-life data regarding their comparison are scant. The aim of our real life study was to perform an indirect efficacy and safety comparison among anti-IL23s, particularly focusing on difficult-to-treat areas. A 2-year single-center retrospective observational study was performed enrolling moderate-to-severe psoriasis patients treated with anti-IL23. For each patient, clinical and demographical data were collected at baseline and at week4, week16, and week28. PASI, BSA, NAPSI, and specific BSA regarding difficult to treat areas were evaluated. One hundred and fifty patients were included in the study: 63 (42%) received guselkumab, 21 (14%) tildrakizumab, and 66 (44%) risankizumab. The three groups were comparable for age, sex, and disease severity, only differing for psoriasis duration, psoriatic arthritis prevalence (higher in guselkumab), and previous systemic treatment failure (lower for tildrakizumab). Mean PASI and BSA significantly reduced from baseline up to week 28 without significant differences among the 3 drugs (reduction of 95–97.3% for PASI and 94.8–96.7% for BSA). No significant differences were registered for PASI75, 90, or 100 responses, in particular, PASI100 was reached by 73.4–85% of patients. As regards difficult-to-treat areas, all the drugs displayed a high efficacy, with significant differences registered only for the rapidity of action on palmoplantar psoriasis. Our 28-weeks study demonstrated a comparable efficacy and safety profile for all anti-IL23, with guselkumab and risankizumab appearing slightly faster than tildrakizumab particularly on palmoplantar lesions in the short-term. The interleukins (IL) 23/17 axis seems to play a key role in psoriasis management. Guselkumab, tildrakizumab, and risankizumab, selectively blocking the IL23 signaling, have been recently approved for psoriasis management. Real-world data regarding different anti-IL23 comparisons are scant. Our 28-weeks study showed that there were not any significant differences in terms of efficacy and safety between each anti-IL-23 apart from palmoplantar area where guselkumab and risankizumab showed higher efficacy. Globally risankizumab and guselkumab appeared slightly faster than tildrakizumab. Guselkumab, tildrakizumab, and risankizumab are valid weapons for psoriasis management, also for difficult-to-treat areas (scalp, nails, genitalia, lower limbs, and palmo-plantar area). [ABSTRACT FROM AUTHOR]

Purpose: To determine the efficacy and safety of adalimumab (ADA) and etanercept (ETA) biosimilars in elderly and children with psoriasis. Methods: A real-life retrospective observational study was conducted on pediatric (< 18 years) and geriatric (≥ 65 years) psoriasis patients treated with anti-TNF biosimilar agents referring to the Psoriasis Unit of the University of Naples Federico II, Italy, from January 2018 to January 2022. At baseline, demographic characteristics (age and sex), data on psoriasis duration and severity (measured by Psoriasis Area Severity Index [PASI] and body surface area [BSA]), presence of psoriatic arthritis if applicable, comorbidities, and previous psoriasis treatments were recorded. Patients were monitored by regular follow-ups (week 12, 24, 48 and 72) through clinical and haematological assessments and adverse events (AEs) were registered. Results: A total of 11 children and 23 elderly psoriasis patients were enrolled. Concerning children, 6 (54.5%) were under ADA biosimilar and 5 (45.5%) under ETA biosimilar. ETA and ADA biosimilars were equally effective and safe for up to 72 weeks (mean PASI and BSA < 3). No significant AEs were reported, and none discontinued treatment. In the elderly, 15 (65.2%) were treated with ADA biosimilar and 8 (34.8%) with ETA biosimilar. ETA and ADA biosimilars were equally effective up to 72 weeks (mean PASI < 4 and mean BSA < 5%). AEs (mainly mild) were registered in 9 subjects (39.1%). Also, 4 (17.4%) patients discontinued biologicals for secondary lack of efficacy (3, 75%) or AEs (1, 25%). Conclusion: Our study found that ADA and ETA biosimilars are effective and safe for the treatment of moderate-to-severe psoriasis in children and the elderly. No statistically significant efficacy and safety differences were found between ADA and ETA biosimilars in both children and the elderly. Geriatric patients displayed a higher discontinuation rate and side effects than the pediatric counterpart even if without approaching statistical significance. [ABSTRACT FROM AUTHOR]

Introduction: Guselkumab safety and efficacy profiles in psoriasis have been showed by VOYAGE (1 and 2) trials. Although trial results have been already previously confirmed by real-life studies, long-term real-life data, and drug survival data about guselkumab are still poor. Patients and Methods: We performed a 3-year retrospective study, with the aim of assessing guselkumab efficacy and safety profile in the management of plaque psoriasis in a real-life setting. Results: Thirty-one patients completed the study. Both Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) statistically improved since week 16, and up to week 144 [PASI reduction from 16.4 ± 6.2 to 0.6 ± 0.9 (p < 0.0001) at week 144 while BSA from 33.2 ± 14.6 to 1.9 ± 1.4 (p < 0.0001)]. At week 12 PASI90 and PASI100 were achieved by 19 (61.3%) and 11 (35.4%) patients, respectively, as well as 24 (77.4%) and 18 (58.1%) subjects reached PASI 90 and PASI 100 at week 144. As regards the safety, no cases of injection site reaction, candida, serious AEs, malignancy, or major cardiovascular events were reported. Of note, mild AEs were collected with pharyngitis as the main one (7, 22.6%), followed by headache (5, 16.1%) and flu-like illness (5, 16.1%), all without requiring treatment discontinuation. Conclusion: Our experience confirmed the efficacy and safety of guselkumab in daily clinical practice up to 3 years, suggesting this drug as an effective treatment option in psoriasis long-term management. [ABSTRACT FROM AUTHOR]

Psychometric validation of the psoriasis symptoms and impacts measure (P-SIM): a novel patient-reported outcome instrument for patients with plaque psoriasis, using reported data from the BE RADIANT phase 3b trial. Erythrodermic psoriasis (EP) is a rare variant of psoriasis characterized by a severe, in some cases life-threatening, clinical course.[1] EP affects about 1%-2% of psoriasis patients with generalized erythema and scaling covering the entire body surface.[2] In recent years, numerous therapeutic alternatives are available for EP treatment; however, there are still no standardized international guidelines, and most biologics are used on the basis of clinical practice, case reports, or small case series.[1] Bimekizumab is a novel humanized monoclonal antibody that neutralizes both interleukin (IL)-17A and IL-17F.[3] IL-17A and IL-17F have been shown to be functionally dysregulated in different immune-mediated inflammatory diseases such as psoriasis and psoriatic arthritis.[3] Given the overlapping biology of these two cytokines, Bimekizumab was developed in order to provide a greater depth of clinical response rather than IL-17A inhibition alone.[3] It has been recently approved for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy.[3] Bimekizumab use in EP, as the case of the other biological drugs, is still off label. Following the onset of COVID-19 pandemic, the patient suspended outpatient follow-ups and adalimumab treatment, experiencing a progressive worsening of the disease. [Extracted from the article]

Several strategies have been adopted to fight against COVID-19.1 Among these, vaccination is the main weapon to overcome the pandemic.2 Currently, two viral vector-based vaccines Ad26.COV2.S (Johnson & Johnson) and AZD1222 (AstraZeneca) and two mRNA vaccines [mRNA-1273 (Moderna) BNT162b2 (Pfizer/BioNTech)] have been authorized by the Italian Medicines Agency.2 The possible impaired efficacy of vaccines in patients with psoriasis under immunosuppressive/immunomodulant treatment is being widely debated. Only mRNA vaccines were considered; patients receiving viral vector-based vaccination or with a history of COVID-19 infection were excluded. Immune response to COVID-19 mRNA vaccination in patients with psoriasis undergoing treatment with biologics. [Extracted from the article]

Indeed, in literature there are studies that have not shown superiority of secukinumab and ixekizumab compared with adalimumab on PsA according to ACR20.6 Hence, treating algorithm selection in PsA patients maybe not always easy. Psoriasis has a prevalence of 2%-4% in western adults, and 20%-30% of psoriasis patients may develop psoriatic arthritis (PsA).1 PsA is an inflammatory musculoskeletal disease, affecting both men and women and usually following psoriasis development; hence PsA screening questionnaires are frequently used for a prompt diagnosis.2 It is a complex disease that affects multiple organ systems including peripheral and axial joints, entheses, skin, and nails. [Extracted from the article]

Keywords: biologic treatment; COVID-19; psoriasis; psoriasis management EN biologic treatment COVID-19 psoriasis psoriasis management 880 882 3 02/28/22 20220301 NES 220301 ACKNOWLEDGEMENT Open Access Funding provided by Universita degli Studi di Napoli Federico II within the CRUI-CARE Agreement. To the best of our knowledge, psoriasis treatment adherence, particularly biologics, was evaluated during the COVID-19 pandemic,7 confirming the safety and efficacy of these drugs during this period. COVID-19, psoriasis, biologic treatment, psoriasis management. [Extracted from the article]

Letter to the editor regarding article "Yalici-Armagan B, Tabak GH, Dogan-Gunaydin S, Gulseren D, Akdogan N, Atakan N. Treatment of psoriasis with biologics in the early COVID-19 pandemic: A study examining patient attitudes toward the treatment and disease course. Herein, we describe our experience at the Dermatology Centre of the University of Naples Federico II, reporting that only 16/965 psoriasis patients (1.6%) stopped the biologic treatment during the early pandemic period (February 2020-June 2020).2 Among these, 13/16 (81.3%) voluntarily interrupted biologic therapy and the remaining (3/16, 18.8%) after seeking medical advice. Keywords: biologic treatment; COVID-19; psoriasis; psoriasis management EN biologic treatment COVID-19 psoriasis psoriasis management 4073 4075 3 12/02/21 20211201 NES 211201 CONFLICT OF INTEREST None. [Extracted from the article]

Even if the incidence of PsA is significantly reduced in patients undergoing biologic treatment for psoriasis, biologic drug does not seem to completely protect against the possibility of a future development of PsA ([3]). Indeed, existing biologics for psoriasis act on cytokines that are highly involved in PsA pathogenesis so that Chan et al. do not believe that the presence of PsA should change what treatment we initiate for psoriasis. However, clinicians should keep in mind the possibility of new-onset PsA onset also in patients undergoing biologic treatment, continuing PsA screening in each follow-up visit. [Extracted from the article]

Due to the rarity of this condition, recommendations are limited to case reports and few real-life experiences.3 First line treatment of ACH is characterized by conventional topical and systemic therapies for psoriasis such as topical and systemic corticosteroids, calcipotriol, topical calcineurin inhibitors, methotrexate and cyclosporine.3 However, ACH is usually refractory to these therapies. Acrodermatitis continua of Hallopeau (ACH) is considered a form of chronic and relapsing localized pustular psoriasis, initially affecting the tips of fingers and/or toes with an unknown pathogenesis.1 ACH strongly affects the quality of life of patients and it is characterized by a sterile pustular eruption with a slow growth, which can lead to atrophy, onychodystrophy and osteolysis, hence requiring prompt diagnosis and treatment.2,3 Herein we describe a case of a 72-year-old man referring to our department for nail dystrophy, painful pustules and periungual erythema of the right third fingernail, refractory to topical corticosteroids. [Extracted from the article]

Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up. [ABSTRACT FROM AUTHOR]