Day 5: Sunday 16 September

With the fifth and final day of the EADV scientific program full of insights into aesthetic dermatology we have taken the opportunity to review some of the interesting data presented on psoriatic manifestations beyond plaque psoriasis as well as insights into comorbidities associated with hidradenitis suppurativa (HS).

Ixekizumab and ustekinumab in the treatment of nail lesions

Dr Norman Wasel of Stratica Medical and Probity Medical Research in Edmonton, Canada and his group reported results from the IXORA-S study that assessed use of ixekizumab or ustekinumab to treat nail lesions in patients with moderate-to-severe psoriasis over 52 weeks.  In this phase 3b multicentre, randomised double-blind study, patients received either ixekizumab (two 80 mg injections, then 80 mg every 2 weeks for 12 weeks, then 80 mg every 4 weeks; n = 136) or ustekinumab (45 mg/90 mg weight-based dosing at Weeks 0, 4, and every 12 weeks thereafter per label; n = 166).

The study reported that 61.8% of ixekizumab patients and 63.3% of ustekinumab patients had nail psoriasis at baseline with mean Nail Psoriasis Severity Index (NAPSI) scores of 28.3 and 24.8, respectively. Progressive improvement was observed in both treatment groups although more patients in the ixekizumab group achieved complete resolution of their nail psoriasis by Week 16 compared with the ustekinumab-treated patients (31.0% vs 16.2%, p=0.0227) and this trend continued through to Week 52 (61.9% vs. 28.6%; p<0.0001). The study reported that, by Week 52, average improvement in NAPSI score from baseline was significantly greater with ixekizumab compared to ustekinumab (p<0.0001).

The study concluded that ixekizumab may provide significantly greater clearance of nail psoriasis than ustekinumab, but longer periods of observation are required to determine improvements beyond 1 year of treatment.

Risankizumab for nail and skin psoriasis

Professor Hervé Bachelez of the Saint-Louis Hospital, Paris, France presented safety and efficacy findings for the anti-IL-23 biologic risankizumab in moderate-to-severe plaque psoriasis. Results were presented from three phase 3 studies, in which patients received either 150 mg risankizumab (n = 1005) at weeks 0 and 4 or matched placebo (n = 300) for 16 weeks. Mean baseline PASI and body surface area (BSA) were 20.3 and 26.1%, respectively. At Week 16, patients treated with risankizumab achieved significantly higher PASI 90 (74.3%) and static Physicians Global Assessment (sPGA) 0/1 (84.9%) compared to those treated with placebo (3.0%, 6.7%, p<0.001 for both). Furthermore, the Dermatology Quality of Life Index (DLQI), NAPSI, Palmoplantar Psoriasis Area and Severity Index (PPASI), and Psoriasis Scalp Severity Index (PSSI) scores were also significantly improved at this time point compared to placebo, while treatment-emergent adverse events (TEAEs) were similar in each treatment group.

Professor Bachelez concluded that treatment with risankizumab was associated with superior efficacy compared with placebo in adult patients with moderate-to-severe plaque psoriasis. Risankizumab treatment was also superior to placebo in the treatment of psoriasis with involvement of nails, hands and/or feet, and scalp with no new safety signals reported.

These results were complemented by a presentation from Dr Mark Lebwohl of the Icahn School of Medicine at Mount Sinai, New York, USA, who reported that treatment with risankizumab was superior to placebo regardless of baseline demographics or disease characteristics.

Adalimumab for radiological disease progression in psoriatic arthritis

Dr Pranav Sheth of Group Health Associates, Ohio, USA reported on the benefits of adalimumab in inhibiting radiographic progression in patients with moderate-to-severe psoriatic arthritis in a post-hoc analysis of the ADEPT study (Mease PJ et al. Arthritis Rheum 2005;52:3279–8).

This analysis included TNF inhibitor-naïve patients who had completed the 24-week ADEPT study and continued into the 120-week open-label extension with adalimumab 40 mg every other week. Of the 285 patients enrolled, 81% had baseline radiological damage. In those without baseline damage, fewer patients progressed by Week 144 if they had received adalimumab compared to placebo in the ADEPT study (11.8% vs. 24.3%). Patients without radiographic progression at baseline had less radiographic progression at Weeks 24, 96 and 144 compared to those who did have radiographic progression at baseline. Similarly, those treated with adalimumab in the ADEPT study had less progression than those treated with placebo.

The results reported in this study support early treatment initiation with adalimumab in patients with moderate-to-severe psoriatic arthritis.

Comorbidities, disease characteristics and demographic factors in hidradenitis suppurativa

Dr Astrid-Helene Ravn Jørgensen of Bispebjerg Hospital, Copenhagen, Denmark shared details of a fascinating study of  the characteristics of patients with HS, with the aim of aiding the development of personalised treatment approaches.

Information was recorded from 20 newly-referred HS patients based on clinical examination and interviews whilst in hospital. A total of 21% had Hurley stage I, compared to 64% at Hurley stage II and 15% at Hurley stage III; 38% had a family history of HS. Most (80%) were smokers, and 78% were employed. The majority (81%) had one or more conventional cardiovascular risk factor, including obesity (36%), hypertension (48%), diabetes (10%) or dyslipidaemia (62%). A psychiatric diagnosis of depression, anxiety, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) or schizophrenia was reported in 30% of patients; with other comorbidities less commonly reported including asthma/chronic obstructive pulmonary disorder (COPD) (10%), psoriasis (7%), inflammatory bowel disease (7%); arthritis (6%) and polycystic ovary syndrome (3%). Both arthritis and asthma/COPD were significantly associated with a family history of HS (p<0.05 for both).

The study concluded that there is a high occurrence of comorbidities in patients with HS, which differ with disease characteristics and demographic factors. In future, it is hoped that identification of these factors may help in the development of personalised treatment programs.

These captivating sessions marked the end of another excellent EADV Congress, continuing with its heritage of exceptional scientific debate and discussions, alongside practical learning sessions for application in real-life clinical practice.

To find out more about the meeting you can visit previous days’ highlights here.

12 September

13 September

14 September

15 September