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Background Safety is an important consideration in decisions on treatment for patients with moderate-to-severe psoriasis and the study of drug safety is the main purpose of the BIOBADADERM registry. The combination of a biologic agent and a conventional systemic drug [generally methotrexate (MTX)] is a common treatment in clinical practice. However, there is a paucity of evidence from real-world practice on the safety of such combination regimens in the treatment of psoriasis. Objectives The primary objective of this study was to ascertain whether the use of regimens combining biologic drugs with MTX in the management of moderate-to-severe psoriasis increases the risk of adverse events (AEs) or serious AEs (SAEs). We compared monotherapy using tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors with the use of the same drugs in combination with MTX. Methods Using data from the BIOBADADERM registry, we compared biologic monotherapies with therapies that were combined with MTX. We estimated adjusted incidence rate ratios (aIRR) using a random effects Poisson regression with 95% confidence intervals for all AEs, SAEs, infections and serious infections and other AEs by system organ class. Results We analysed data from 2829 patients and 5441 treatment cycles, a total of 12 853 patient-years. The combination of a biologic with MTX was not associated with statistically significant increases in overall risk of AEs or SAEs in any treatment group. No increase in the total number of infections or serious infections in patients receiving combined therapy was observed for any group. However, treatment with a TNF inhibitor combined with MTX was associated with an increase in the incidence of gastrointestinal AEs (aIRR 2.50, 95% CI 1.57–3.98; P < 0.002). Conclusions The risk of AEs and SAEs was not significantly increased in patients with moderate-to-severe psoriasis receiving different classes of biologic drugs combined with MTX compared with those on biologic monotherapy. [ABSTRACT FROM AUTHOR]

Byline: Alba. Sánchez-Velázquez, Daniel. Falkenhain-López, Alba. López-Valle, Jose. Rodríguez Peralto, Pablo. Ortiz Romero, Raquel. Rivera-Díaz Dear Editor, Interleukin (IL)-17 inhibitors have been recently linked to the development of eczematous eruptions. [...]

The mean baseline PASI at the start of biosimilar treatment was 7.4 (SD 6.2), and 156 patients (27%) had concomitant PsA. Biosimilar treatment was started de novo in 411 patients (70.8%), whereas nonmedical switch was done in 170 (29.1%). Biosimilar drugs are very similar to the originator products, with no meaningful differences in efficacy and safety.1-4 Several biosimilars of infliximab, etanercept, and adalimumab have been approved by the European Medicines Agency (EMA) in Europe for the treatment of immune-mediated diseases.5-7 Previous studies have suggested that drug survival of biosimilars in patients with psoriasis is similar to that of the corresponging originator products.8,9 On the other hand, patients switching from originator to biosimilar biologics are more likely to discontinue treatment than those who continue on the originator; the hazard ratio is 3.57 ( I p i < 0.001) for infliximab across several indications.10 The aim of this study was to describe the real-world drug survival of adalimumab biosimilars in patients with moderate to severe psoriasis from 17 large hospitals representative of different regions in Spain, and to identify potential differences associated with patients' characteristics or type of treatment initiation. Our data indicate that drug survival in patients with long-standing good response to the originator who undergo nonmedical switching to the corresponding biosimilar ("switchers") is better than in patients who start adalimumab biosimilar de novo. Fewer biologic alternatives were then available with superior efficacy to adalimumab, and the goals of treatment have now become more ambitious; this might provide some explanation for the decreased drug survival of adalimumab biosimilars in our current biologic-naïve patients. [Extracted from the article]

The article presents a case study of a 69-year-old woman with migratory arthralgias and acral paraesthesia. Examinations revealed linear palpable purpura in underwear-compressed areas, and leukocytoclastic vasculitis, and a diagnosis of mixed cryoglobulinaemia-induced vasculitis with mild peripheral neuropathy was made. The condition is a potentially life-threatening disorder and this is a first report of Koebner phenomenon in the subset of cryoglobulinaemia.

Treatment of moderate to severe psoriasis may be a therapeutic challenge for dermatologists in the era of biological drugs when there is an underlying oncological condition. The treatment of patients with moderate to severe psoriasis and chronic neoplasias entails an emerging issue. Psoriasis: which therapy for which patient. [Extracted from the article]

This article discusses the use of upadacitinib, a selective JAK1 inhibitor, for the treatment of overlapping psoriasis and atopic dermatitis (AD). Psoriasis and AD are both T-cell-mediated inflammatory skin diseases, but they have different pathogenesis and immune pathways. The overlap of these two conditions is rare but can present diagnostic and therapeutic challenges. Two previous case series have shown positive results with upadacitinib treatment, and this study presents 11 additional patients who experienced improvement in their symptoms after using upadacitinib. However, adverse effects were reported in three patients. Overall, upadacitinib may be a promising therapeutic option for this challenging condition. [Extracted from the article]

Introduction: Generalized pustular psoriasis (GPP) is a chronic, rare, and potentially life-threatening skin condition characterized by flares comprising widespread sterile pustules and systemic inflammation. Both the rarity and heterogeneity of the disease have made GPP classification and standardization of clinical criteria challenging. Before the approval of spesolimab (IL-36R antibody) in 2022, there were no approved treatments in the USA or Europe for GPP flares. Treatment for GPP has amounted to off-label use of medicines approved to treat plaque psoriasis. Our aim was to describe the sociodemographics, clinical characteristics, and treatment patterns of patients with GPP in Spain., Methods: Non-interventional, descriptive, multi-center, retrospective chart review of patients diagnosed with GPP in Spain., Results: 56 patients (50% women) were included, with a mean (standard deviation, SD) age at diagnosis of 53.7 (20.5) and a mean (SD) time of follow-up of 3.7 (3.1) years. In 80% of patients, GPP diagnosis was associated with a flare and 67.3% had known risk factors for GPP (such as previous diagnosis or family history of plaque psoriasis, comorbidities, smoking or stress). Hypertension and plaque psoriasis were the most frequent comorbidities (44.6% each). The number of GPP flares per patient-year was 0.55 with (range 0-4) a mean (SD) body surface area involvement of 21.3% (19.1). The most frequent manifestations of GPP flares were pustules (88.5%), erythema (76.9%), and scaling (76.9%). Additionally, 65.4% of patients had plaque psoriasis, 53.8% had unspecified skin lesions, and 30.8% experienced pain. The treatments used for GPP flares were off-label conventional systemic drugs (75%), mostly corticosteroids, cyclosporine, and acitretin. In the periods between flares, off-label biologics were used in 56.5% of patients. During the study period, 9 patients (16.1%) had at least one complication and 5 of them required hospitalization., Conclusion: This is the first multicenter study in Spanish GPP patients. Most patients were in their fifties, with personal or family history of plaque psoriasis, stress, smoking and a wide range of comorbidities and complications. Even though the number of flares per patient/year was 0.55, there was variability between patients. Both off-label conventional systemics and off-label biologics were used for flare management without a clear treatment pattern., (© 2024 The Author(s). Published by S. Karger AG, Basel.)