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Engaging global key opinion leaders, the International Psoriasis Council (IPC) held a day-long roundtable discussion with the primary purpose to discuss the treatment goals of psoriasis patients and worldwide barriers to optimal care. Setting clear expectations might ultimately encourage undertreated psoriasis patients to seek care in an era in which great gains in therapeutic efficacy have been achieved. Here, we discuss the option for early treatment of all categories of psoriasis to alleviate disease impact while emphasizing the need for more focused attention for psoriasis patients with mild and moderate forms of this autoimmune disease. In addition, we encourage policy changes to keep pace with the innovative therapies and clinical science and highlight the demand for greater understanding of treatment barriers in resource-poor countries.

Background Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. Objectives To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. Methods A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. Results and implications After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.

BackgroundIxekizumab (IXE), a monoclonal high affinity antibody that selectively targets interleukin-17A, was superior to placebo (PBO) in achieving clinical responses and improving health related quality of life (HRQoL) for psoriatic arthritis (PsA) patients who were biologic-naïve.1 Herein, results are presented from a phase 3 trial (SPIRIT-P2; NCT02349295) with IXE in patients with active PsA and previous inadequate response to tumor necrosis factor-inhibitors (TNF-i).ObjectivesTo explore the impact of IXE on patient reported HRQoL outcomes up to 24 weeks (wks) in patients with active PsA.MethodsIn this phase 3, multicentre, double-blind study, 363 adult patients with active PsA were randomly assigned in the ratio of 1:1:1 to subcutaneous administration of either 80-mg IXE every 4 wks (Q4W; N=122) or every 2 wks (Q2W; N=123) following a 160-mg starting dose at Wk 0 or PBO (N=118). All patients entering the study had an inadequate response to one or two TNF-i or were intolerant to TNF-i. At baseline and Wk 24, HRQoL was measured by the Short Form-36 Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS), European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D VAS), Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP; absenteeism; presenteeism, work productivity, and activity impairment), the itch Numeric Rating Scale (NRS), and the Dermatology Life Quality Index (DLQI). Itch NRS, DLQI, and Psoriasis Area Severity Index (PASI) responses were assessed in patients with baseline psoriatic lesion involving ≥3% body surface area (BSA; N=203). Treatment comparisons were made by a mixed model for repeated measures for continuous data and by a logistic regression model for categorical data with missing values imputed by nonresponder imputation.ResultsMean baseline (Wk 0) scores for HRQoL measures indicated impaired physical and mental function, quality of life, and work productivity (Table). At Wk 24, clinical efficacy was shown by 50.6% and 58.1% of IXE-treated patients achieving ACR20 and PASI75 responses, respectively. Patients receiving IXE (Q4W or Q2W) reported significantly greater improvements in SF-36 PCS and MCS, EQ-5D VAS, and WPAI-SHP (presenteeism, work productivity, and activity impairment) than patients treated with PBO (Table; p<.05). For PsA patients with co-morbid psoriasis (≥3% BSA), IXE treatment (Q4W or Q2W) resulted in significantly greater improvements in itch NRS and DLQI than PBO treatment (Table; p<.001). Finally, 51.5% of IXEQ4W patients and 50.0% of IXEQ2W patients reached a DLQI total score of 0 or 1 at Wk 24, which is significantly greater than patients treated with PBO (9.0%, p<.001).ConclusionsIn patients with active PsA and previous inadequate response to TNF-i, IXE provided significant improvement through 24 wks in all joint and skin associated HRQoL outcomes, including physical and mental function, quality of life, work productivity, DLQI, and itch.References Mease P et al. 2017 ARD 76(1):79. Disclosure of InterestA. Kav...