Day 3: Friday 14 September

At the third day of the 27th European Academy of Dermatology and Venereology (EADV) meeting, the delegates took a closer look at topics including environmental dermatology, clinical application of genetics, clinical oncology and took part in practical workshops. Here are some of the highlights of today’s sessions around the challenges and triumphs in the management of psoriasis and hidradenitis suppurativa (HS).

Psoriasis and metabolic syndrome

Professor James Kruger of the Rockefeller University, US led a fascinating overview of the relationship between metabolic syndrome and psoriasis. He explained how the formal definitions of metabolic syndrome vary between international bodies, including the International Diabetes Federation (IDF), National Cholesterol Educational Program (NCEP) and others.

Regardless of the definition, however, patients with psoriasis have an increased risk of metabolic disease, thought to be due to the increased inflammation associated with both conditions. This link was reinforced by the CANTOS study, a randomised, double-blind trial of canakinumab, a monoclonal antibody targeting interleukin-1β. The study included 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of ≥2 mg/L (Ridker P et al. N Engl J Med 2017; 377:1119–1131). This study reported a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering.

However, as Professor Kruger explained, more research is required to fully explore the relationship between these two conditions. He went on to discuss the possible role of the presence of vascular inflammation in psoriasis patients, a phenomenon not reported in matched controls. As patients’ body weight increases, so does the presence of inflammatory markers, with psoriasis itself being a risk factor for obesity. 

Professor Kruger summarised his session by recapping that psoriasis is more than just skin deep, and extends into the adipose layer of the skin, driving systemic inflammation and cardiovascular risk. 

Patient-reported outcomes in the VOYAGE-2 study

Dr Lyn Guenther’s poster presentation reported findings from the VOYAGE-2 study, looking at the efficacy of guselkumab in 992 patients with moderate-to-severe plaque  psoriasis, who had not achieved a PASI 90 response to adalimumab after 28 weeks of treatment.

Dr Guenther, of the Western University, Ontario, Canada, explained that patients were randomised into 3 treatment groups; 1) guselkumab 100 mg at Weeks 0, 4, 12, and 20; 2) placebo at Week 0 followed by guselkumab 100 mg at Weeks 16 and 20; or 3) adalimumab 80 mg at Week 0 followed by adalimumab 40 mg at Week 1 and every 2 weeks (q2w) thereafter through Week 23. 

At Week 28, patients receiving guselkumab who did not achieve a PASI 90 response continued guselkumab 100 mg q8w while adalimumab patients who failed to achieve a PASI 90 response switched to guselkumab 100 mg, receiving doses at Weeks 28 and 32 and q8w thereafter (N=112).

At Week 28, in all 3 treatment groups, patients who did not achieve a PASI 90 response reported that their psoriasis still greatly affected their health-related quality of life (HRQoL) and the majority did not achieve a DLQI score of 0 or 1, indicating that their condition still impacted their HRQoL. After switching from adalimumab to guselkumab, the proportions of patients with a DLQI score of 0 or 1 increased from 14.4% at Week 28, to 65.3% at Week 100. Psoriasis Symptom and Sign Diary (PSSD) scores also increased, and similar improvements were seen in patients switching from placebo to guselkumab, and in PASI 90 adalimumab non-responders.

Dr Guenther's group concluded that adult patients with plaque psoriasis and an inadequate response to adalimumab at Week 28 showed marked improvements in patient-reported outcomes (DLQI and PSSD) from Week 28 through Week 100 after switching to treatment with guselkumab. 

Real-world use of secukinumab for moderate-to-severe psoriasis

Professor Diamant Thaçi of the University of Lübeck, Germany presented a poster detailing a review of real-world data for the use of secukinumab in 2,000 patients enrolled in the German PROSPECT study. This 24-week single-cohort study included patients with moderate-to-severe psoriasis treated with secukinumab according to the local label. 

Effectiveness was assessed in all subjects that received ≥1 dose of secukinumab, with no prior secukinumab trial involvement (n=1,692). Baseline PASI was available for 89.3%, with a mean PASI of 20.1. By Week 24, a PASI 75, 90, and 100 response was achieved by 86.1%, 68.5% and 39.7% of patients with no missing baseline values (n=905). Baseline mean Dermatology Life Quality Index (DLQI) was captured for 34.9% of patients (n=590), with a mean DLQI of 15.0. At Week 24, mean DLQI was 2.8 (n=317), with 59.3% achieving DLQI 0/1. The report concluded that that PASI response rates in real-world studies are comparable to those reported in pivotal secukinumab clinical trials, with no new safety signals observed.

Hidradenitis suppurativa and biologic therapy; efficacy and safety in surgery

Dr Virginia Sanz Motilva, of the Hospital De Manises, Spain, reviewed the use of adalimumab and infliximab in the treatment of HS at her centre in this thought-provoking poster. The discontinuation of biologics for patients with HS requiring surgery is a controversial practice, as the use of biologics can help to control inflammatory activity before and after surgery.

This retrospective study assessed the safety and efficacy of TNF-α blockers in HS patients before and after fascio-cutaneous flap surgery to cover wide wounds. Patients had all reached Hidradenitis Suppurativa Clinical Response (HiSCR). Eight patients were included in the study, with a median follow-up of 6 months. One patient discontinued treatment due to a stoma requirement, and recommenced treatment 3 months later. During 4 weeks follow-up post-surgery, 3 patients experienced dehiscence without infection, 2 were managed with conservative measures to promote second intention healing, and 1 case underwent minor surgery; no long-term complications were detected. 

The study concluded that, whilst treatment should be personalised as far as possible, anti-TNF-α use can be beneficial to patients with HS undergoing cutaneous surgery.