Day 4: Saturday 15 September

As the meeting reached its fourth day, delegates were enthralled with discussion of treatment options associated with aging, autoimmune diseases, and took part in workshops exploring sexually transmitted infections. We take this opportunity to review some key posters providing further insights into the management of psoriasis and hidradenitis suppurativa (HS). 

Managing relapse in HS with adalimumab

Dr Maria Cannizzaro’s group at the University of Rome Tor Vergata, Rome, Italy presented a poster discussing the management of HS with adalimumab, and treatment of disease relapses. 

A questionnaire investigating the number, duration and severity of relapses was administered to 19 patients with stage II–III HS under treatment with adalimumab.

Relapsing episodes were treated either with topical or systemic antibiotics, immunomodulatory agents (methotrexate, steroids) or zinc, according to the severity of the lesions. Patients were monitored at baseline and at each follow-up visit, and relapses defined as mild, moderate or severe according to number of nodules or draining fistulas, and number of episodes per month. 

After 3 months of treatment, lesion improvement was observed in 6 patients (31.5%); this was further improved in patients reaching 24 weeks of treatment. Four (21%) patients had mild relapses that were controlled with topical therapy, while five (26.3%) patients had moderate relapses requiring treatment with clindamycin (n=2), ciprofloxacin 500mg/day (n=1), or rifampicin (n=2). Two patients (10.5%) experienced severe relapses that were treated with meropenem.

The study concluded that treatment with adalimumab can dramatically affect quality of life, and halt disease progression. Relapsing episodes were demonstrated to be more frequent in the first period after the beginning of adalimumab therapy. The severity of relapses correlates with the severity of HS at baseline, but not with the duration of adalimumab treatment. Interestingly, relapsing episodes did not affect the hidradenitis suppurativa clinical response (HiSCR). 

Characteristics of patients with psoriasis across disease severity subtypes

Dr Jashun Wu of the Kaiser Permanente Los Angeles Medical Centre, USA shared data from his centre on the differences in patient demographic, clinical and quality of life impact by disease severity, amongst patients enrolled in the Corrona PsO registry (https://www.corrona.org/registries/psoriasis) The study included 1,449 patients enrolled on biologic or non-biologic treatment for their psoriasis between April 2015 and December 2017.

Dr Wu’s group reported that 10%, 45% and 45% were classified by body surface area (BSA) as mild, moderate or severe. Mild and moderate patients were more likely to be female (mild 53%, p<0.01; moderate 52%, p<0.01; severe 47%) and white (mild 82%, p<0.01; moderate 84%, p<0.01; severe 78%), whereas moderate patients had lower mean body mass index (BMI) (mild 30.9 kg/m2, p=0.16; moderate 30.1 kg/m2, p<0.01; severe 31.9 kg/m2).

Patients with mild and moderate psoriasis reported lower impact on quality of life and impairment of daily activities, with lower levels of fatigue, pain and itch. They also experienced less frequent incidence of plaque, scalp, nail and inverse psoriasis, whereas palmoplantar psoriasis was more common.  However, somewhat surprisingly, the proportion of patients with cancer, cardiovascular, metabolic and gastrointestinal diseases, as well as depression and anxiety, was similar across all psoriasis severity groups.

Dr Wu’s study concluded that, whilst patients with severe psoriasis had greater disease burden, the magnitude of differences was modest, suggesting a substantial burden even among mild and moderate psoriasis patients. Further studies are required to understand if early treatment of less severe psoriasis could lower the burden of disease.

Patient preference for the treatment of moderate-to-severe psoriasis

Stephen Feldman and his group at the Wake Forest University School of Medicine, North Carolina, USA looked at the factors driving patient preference for psoriasis treatment, which can play an important role in patient satisfaction and treatment success. This study included 300 patients with moderate-to-severe psoriasis, who took part in an online discrete choice experiment, inviting participants to choose between different treatment attributes. These included:

  1. proportion of patients achieving clear or almost clear skin after 1 year
  2. risk of serious infection in the first year
  3. risk of mild to moderate injection site reaction
  4. number of treatments in the first year
  5. number of years large studies have proven the medicine works with no changes in efficacy or side effect.

The average age of the patients was 46 years; 79% had experienced psoriasis symptoms in the previous week, whilst 49% had self-reported psoriasis, and 50% had previous experience with biologics. 

Patients reported the most important attribute to be a treatment resulting in clear or almost clear skin. Some other attributes were deemed by patients to be of similar importance, however the risk of mild-to-moderate injection-site reactions was more important than the risk of serious infection. After ranking these, patients were asked to survey additional attributes including:

  1. getting clear or almost clear skin more quickly
  2. effective on psoriatic arthritis [PsA] and hard-to-treat psoriasis areas
  3. complete relief of psoriasis symptoms
  4. risk of the medicine becoming less effective due to anti-drug antibodies
  5. number of injections required each time the medicine is taken.

The study reported that symptom relief and getting clear skin were most important to patients, whilst injection frequency and number of injections was least important.

Interestingly, further analysis showed that having 5 years instead of 1 year of supporting data was more important than having fewer annual treatments. Dr Wu’s group stated that this is the first study to evidence the importance of long-term clinical data for patients with moderate-to-severe psoriasis when selecting biologic treatment.

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