Establishment of the Western Japan Psoriasis Registry and first cross‐sectional analysis of registered patients

Abstract

The efficacy and safety of new psoriatic treatments are confirmed in clinical trials, but such clinical trial data are limited by the number and heterogeneity of patients. Furthermore, the prevalence and characteristics of psoriasis differ among racial groups. Therefore, it is important to obtain real-world evidence in specific regions. To identify the optimal systemic treatment for psoriatic patients in Western Japan, we established the Western Japan Psoriasis Registry (WJPR). This registry is led by a neutral physicians' league associated with university hospitals, general hospitals, and clinics that specialize in treatment of psoriasis. Systemically treated psoriatic patients who provided written informed consent were enrolled, and data were collected on their background information, several patient-reported outcomes, dermatologists' objective evaluations, and treatment regimens. Patient enrollment began in 2019, and 1394 patients had been recruited by the end of 2020. The prevalence of psoriatic arthritis was 27.2% and that of pustular psoriasis was 7.5%. The mean body mass index was 24.1 kg/m 2 , and 12% of patients had severe obesity (body mass index ≥30 kg/m 2 ). Major comorbidities were hypertension (35.0%), diabetes (14.1%), and hyperlipidemia (12.2%). Serological data showed that hepatitis B virus surface antigen, anti-hepatitis B virus core antibody, anti-hepatitis C virus antibody, and human T-cell leukemia virus type 1 antibody were detected in 1.1%, 18.0%, 3.1%, and 3.7% of patients, respectively. The most frequently used small-molecule-systemic intervention was apremilast (18.0%), followed by methotrexate (7.7%), etretinate (4.2%), and cyclosporin (3.7%). The most frequently used biologics were interleukin (IL)-17 inhibitors (31.8%), followed by IL-23 inhibitors (including IL-12/23 inhibitors) (26.7%), and tumor necrosis factor inhibitors (11.1%). The WJPR is the first Japanese prospective observational cohort of psoriatic patients. Annual WJPR updates may provide the incidences of comorbidities such as cardiovascular events or onset of arthritis in systemically treated patients, identify rare complications, and identify the optimal treatment regimens for various psoriatic patients.

Patient perceptions of psoriatic disease in Japan: Results from the Japanese subgroup of the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey

“…Hypertension was also the most common comorbidity in the WJPR study and the Japanese Society for Psoriasis Research (JSPR) survey (≥30% of patients), followed by diabetes (≥15% of patients). 15,17 Cancer and liver disease were relatively common in Japanese patients in UPLIFT (each occurring in ~21% of patients compared with 8% and 11% of patients in the WJPR study, respectively), 17 and may have influenced PsO treatment choice in favor of topical treatment. 26 Patients with PsO are also known to be at increased risk of depression, 1,2 which was reported by 28% of Japanese patients in UPLIFT.…”

“…In a recently published analysis of data from the WJPR (September 2019 to December 2020; n = 1349), a similarly high proportion of patients (76%) had BSA involvement of ≤3%. 17 It was thought that this may reflect the superior efficacy of the latest systemic drugs. 17 The most frequently used oral drug in the WJPR study was apremilast (18.0%), followed by methotrexate (8%), etretinate (4%), and cyclosporin (4%), and the most frequently used biologics were interleukin (IL)-17 inhibitors (32%), followed by IL-23 inhibitors (27%) and tumor necrosis factor inhibitors (11%).…”

“…17 It was thought that this may reflect the superior efficacy of the latest systemic drugs. 17 The most frequently used oral drug in the WJPR study was apremilast (18.0%), followed by methotrexate (8%), etretinate (4%), and cyclosporin (4%), and the most frequently used biologics were interleukin (IL)-17 inhibitors (32%), followed by IL-23 inhibitors (27%) and tumor necrosis factor inhibitors (11%). 17 Irrespective of the level of skin involvement, PsO occurred in special areas of the body in the majority of Japanese patients in the UPLIFT survey, including 76% of those with BSA involvement of ≤3 palms.…”

“…17 The most frequently used oral drug in the WJPR study was apremilast (18.0%), followed by methotrexate (8%), etretinate (4%), and cyclosporin (4%), and the most frequently used biologics were interleukin (IL)-17 inhibitors (32%), followed by IL-23 inhibitors (27%) and tumor necrosis factor inhibitors (11%). 17 Irrespective of the level of skin involvement, PsO occurred in special areas of the body in the majority of Japanese patients in the UPLIFT survey, including 76% of those with BSA involvement of ≤3 palms. Scalp and face PsO were the most common special areas, affected in 48% and 26% of patients, respectively, and genital involvement was the least common, reported in 10% of patients.…”

“…5 Since the MAPP survey was conducted, new systemic therapies with different mechanisms of action and better efficacy have been approved, and these have changed the treatment landscape of psoriatic disease in Japan. 9,[15][16][17] The recent Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey conducted in 2020 reported that globally there was still persistently high disease burden and undertreatment of patients with PsO and/or PsA. 11 In Asian countries, including Japan, patients with PsO may experience high levels of social stigma and discrimination for cultural and socioeconomic reasons, 18 and the impact of PsO on patient QoL in these countries may be even greater than that observed in Western countries.…”