Psoriasis and comorbidities
Paolo Gisondi (Italy)
Moderate to severe psoriasis is often associated with comorbidities which can be classified as inflammatory, metabolic and psychological/psychiatric. The most frequent inflammatory comorbidity is psoriatic arthritis; the most frequent metabolic comorbidity is non-alcoholic fatty liver disease, very often in obese patients and with metabolic syndrome; whilst the most frequent psychological comorbidity is anxiety-depressive syndrome.
The dermatologist plays an important role in the recognition, diagnosis and treatment of psoriasis but also in the general management of its comorbidities. In the case of psoriatic arthritis, for example, the dermatologist plays a “sentinel” role since psoriatic arthritis occurs after the onset of psoriasis (in most cases). Therefore, it is important that the dermatologist is ready to be able to recognize it and has the right tools and/or collaborates efficiently with the rheumatologist.
Recognizing comorbidities is also important in the choice of psoriasis treatment because there may be comorbidities that contraindicate the choice of certain drugs or treatments.
Obesity can be associated with other metabolic diseases such as diabetes and fatty liver; furthermore, obesity can reduce the patient’s clinical response to biological treatments, making them less effective, for example weight loss is recommended for patients with moderate to severe psoriasis and concomitant obesity.
Biosimilars for psoriasis
Nikolai Loft (Denmark)
Biosimilars are drugs with similar structures and mechanisms of action as to biologics and can be licensed following the expiration of the patent of the original biologic. The approval process of biosimilars requires a study showing comparative pharmacokinetic and dynamic (phase I trial) and a study showing comparative efficacy (phase III trial). Today, biosimilars available for psoriasis include infliximab, etanercept, and adalimumab biosimilars, and a biosimilar for ustekinumab is currently undergoing assessment in a phase III trial. Biosimilars are often less expensive than the original biologic which might lead to health insurance companies and policymakers opting for the cheaper alternative and demandimg non-medical switches in patients with stable disease. The use of biosimilars, and especially non-medical switches between original biologic and biosimilar, have been heavily debated and several concerns have been raised. The most recent biologic for which a biosimilar has been approved is the most widely used tumor necrosis factor (TNF)-α inhibitor, adalimumab. The presentation will focus on the use of adalimumab biosimilars and will cover the fundamentals of biosimilars, non-medical switches, some of the concerns regarding biosimilars, real-world evidence, pros and cons of biosimilars, the future of biosimilars, and what’s in the pipeline.
Treatment goal: PASI 100
Paolo Gisondi (Italy)
Setting a therapeutic goal has been shown to be a valid and efficient strategy in the medical field that improves clinical outcomes. Asking yourself the question: “what does the patient want?” and “what can I do to help him/her?” is important at the beginning of the doctor-patient relationship in order to build an effective alliance. Surveys have been carried out on patients, which have shown that most patients want the so-called “skin clearance” or complete remission of psoriasis. Achieving “skin clearance” means having a PASI100 improvement. Achieving PASI100 is associated with a significant improvement in the patient’s quality of life. Many national and international guidelines and/or recommendations and/or consensus statements support the PASI100 as a current treatment goal. Fortunately, thanks to biologics, particularly IL-17 and IL-23 inhibitors, achieving PASI100 is a realistic goal today.
Moreover, it is not only important to reach the PASI100, but also to maintain it over time.
The interesting hypothesis that achieving and maintaining PASI100 over time can reduce the incidence of comorbidities associated with psoriasis, such as psoriatic arthritis, is the subject of studies, research and speculation.
Presentations and treatment of psoriasis in pregnancy
Julia-Tatjana Maul (Switzerland)
Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden of disease for women. Treatment options are the same for both sexes, except during pregnancy and lactation. Various treatment options are contraindicated due to fear of fetal or neonate harm and lack of data.
The aim of this presentation is to provide an update on the current therapeutic landscape for the treatment of psoriasis in pregnancy, highlighting the treatment options with topicals, conventional systemic as well as biologics.
The presentation will offer a historical overview of the treatment options for psoriasis and during pregnancy that have been developed in recent years to deliver the best holistic care.