Psoriasis

Key clinical point: For a certain body mass index (BMI), abdominal subcutaneous adipose tissue (ASAT) was negatively associated with coronary atherosclerosis burden in men with psoriasis.

Major finding: After adjusting for traditional risk factors and each patient's BMI, ASAT was negatively associated with noncalcified and lipid-rich necrotic core burden in men (β, −0.17; P = .03; β, −0.20; P = .03, respectively) but not in women (β, −0.06; P = .57; β, 0.09; P = .49, respectively) with psoriasis.

Study details: The data come from a cross-sectional study of 232 patients with psoriasis and without known cardiovascular disease, of which 92 were women.

Disclosures: The study was supported by National Heart, Lung, and Blood Institute Intramural Research Program (Bethesda, Maryland). Dr. Mehta declared being a current full-time U.S. government employee and receiving a research grant from various sources. Dr. Khera declared serving as a scientific advisor and receiving speaker fees from various sources.

Source: Teklu M et al. Am J Prev Cardiol. 2021 Aug 22. doi: 10.1016/j.ajpc.2021.100231.

Key clinical point: For a certain body mass index (BMI), abdominal subcutaneous adipose tissue (ASAT) was negatively associated with coronary atherosclerosis burden in men with psoriasis.

Major finding: After adjusting for traditional risk factors and each patient's BMI, ASAT was negatively associated with noncalcified and lipid-rich necrotic core burden in men (β, −0.17; P = .03; β, −0.20; P = .03, respectively) but not in women (β, −0.06; P = .57; β, 0.09; P = .49, respectively) with psoriasis.

Study details: The data come from a cross-sectional study of 232 patients with psoriasis and without known cardiovascular disease, of which 92 were women.

Disclosures: The study was supported by National Heart, Lung, and Blood Institute Intramural Research Program (Bethesda, Maryland). Dr. Mehta declared being a current full-time U.S. government employee and receiving a research grant from various sources. Dr. Khera declared serving as a scientific advisor and receiving speaker fees from various sources.

Source: Teklu M et al. Am J Prev Cardiol. 2021 Aug 22. doi: 10.1016/j.ajpc.2021.100231.

Key clinical point: For a certain body mass index (BMI), abdominal subcutaneous adipose tissue (ASAT) was negatively associated with coronary atherosclerosis burden in men with psoriasis.

Major finding: After adjusting for traditional risk factors and each patient's BMI, ASAT was negatively associated with noncalcified and lipid-rich necrotic core burden in men (β, −0.17; P = .03; β, −0.20; P = .03, respectively) but not in women (β, −0.06; P = .57; β, 0.09; P = .49, respectively) with psoriasis.

Study details: The data come from a cross-sectional study of 232 patients with psoriasis and without known cardiovascular disease, of which 92 were women.

Disclosures: The study was supported by National Heart, Lung, and Blood Institute Intramural Research Program (Bethesda, Maryland). Dr. Mehta declared being a current full-time U.S. government employee and receiving a research grant from various sources. Dr. Khera declared serving as a scientific advisor and receiving speaker fees from various sources.

Source: Teklu M et al. Am J Prev Cardiol. 2021 Aug 22. doi: 10.1016/j.ajpc.2021.100231.

Key clinical point: Clobetasol propionate 0.025% vs 0.05% cream displayed comparable efficacy with a better systemic safety profile in moderate-to-severe psoriasis.

Major finding: At day 28 of twice-daily application, patient proportion with an abnormal adrenocorticotropic hormone stimulation test was numerically lower for 0.025% formulations 5 (20.7%) and 13 (17.2%) than for 0.05% cream (30.0%; P = .320). All treatments caused a comparable decrease in burning/stinging/pruritus scores, whereas Psoriasis Global Assessment success rates were higher for formulations 5 (38.9%) and 13 (36.8%) than for 0.05% cream (30.8%).

Study details: Findings are from a phase 2a, randomized, multicenter, investigator-blinded, 3-arm study involving 88 patients aged 18 years or above with moderate-to-severe psoriasis randomly assigned to clobetasol propionate 0.025% formulation 5, clobetasol propionate 0.025% formulation 13, or clobetasol propionate 0.05% cream.

Disclosures: The study was sponsored by Dr. Reddy’s Laboratories. S Sidgiddi, in addition to owning stocks in the company, declared serving as an employee of Dr. Reddy’s Laboratories along with SMH Naqvi, R Mittal, S Mehta, and A Mane. Some of the authors declared receiving research funds from Dr. Reddy’s Laboratories.

Source: Sidgiddi S et al. Dermatol Ther (Heidelb). 2021 Aug 28. doi: 10.1007/s13555-021-00591-z.

Key clinical point: Clobetasol propionate 0.025% vs 0.05% cream displayed comparable efficacy with a better systemic safety profile in moderate-to-severe psoriasis.

Major finding: At day 28 of twice-daily application, patient proportion with an abnormal adrenocorticotropic hormone stimulation test was numerically lower for 0.025% formulations 5 (20.7%) and 13 (17.2%) than for 0.05% cream (30.0%; P = .320). All treatments caused a comparable decrease in burning/stinging/pruritus scores, whereas Psoriasis Global Assessment success rates were higher for formulations 5 (38.9%) and 13 (36.8%) than for 0.05% cream (30.8%).

Study details: Findings are from a phase 2a, randomized, multicenter, investigator-blinded, 3-arm study involving 88 patients aged 18 years or above with moderate-to-severe psoriasis randomly assigned to clobetasol propionate 0.025% formulation 5, clobetasol propionate 0.025% formulation 13, or clobetasol propionate 0.05% cream.

Disclosures: The study was sponsored by Dr. Reddy’s Laboratories. S Sidgiddi, in addition to owning stocks in the company, declared serving as an employee of Dr. Reddy’s Laboratories along with SMH Naqvi, R Mittal, S Mehta, and A Mane. Some of the authors declared receiving research funds from Dr. Reddy’s Laboratories.

Source: Sidgiddi S et al. Dermatol Ther (Heidelb). 2021 Aug 28. doi: 10.1007/s13555-021-00591-z.

Key clinical point: Clobetasol propionate 0.025% vs 0.05% cream displayed comparable efficacy with a better systemic safety profile in moderate-to-severe psoriasis.

Major finding: At day 28 of twice-daily application, patient proportion with an abnormal adrenocorticotropic hormone stimulation test was numerically lower for 0.025% formulations 5 (20.7%) and 13 (17.2%) than for 0.05% cream (30.0%; P = .320). All treatments caused a comparable decrease in burning/stinging/pruritus scores, whereas Psoriasis Global Assessment success rates were higher for formulations 5 (38.9%) and 13 (36.8%) than for 0.05% cream (30.8%).

Study details: Findings are from a phase 2a, randomized, multicenter, investigator-blinded, 3-arm study involving 88 patients aged 18 years or above with moderate-to-severe psoriasis randomly assigned to clobetasol propionate 0.025% formulation 5, clobetasol propionate 0.025% formulation 13, or clobetasol propionate 0.05% cream.

Disclosures: The study was sponsored by Dr. Reddy’s Laboratories. S Sidgiddi, in addition to owning stocks in the company, declared serving as an employee of Dr. Reddy’s Laboratories along with SMH Naqvi, R Mittal, S Mehta, and A Mane. Some of the authors declared receiving research funds from Dr. Reddy’s Laboratories.

Source: Sidgiddi S et al. Dermatol Ther (Heidelb). 2021 Aug 28. doi: 10.1007/s13555-021-00591-z.

Key clinical point: Psoriasis was associated with an unfavorable cardiovascular and venous thromboembolism (VTE) risk profile in patients with pulmonary embolism (PE) but lower in-hospital mortality.

Major finding: Despite patients with PE and psoriasis being younger than those without psoriasis (median age, 68 years vs 72 years; P < .001), those with psoriasis showed a higher prevalence of VTE and traditional cardiovascular risk factors such as obesity, essential arterial hypertension, hyperlipidemia, and diabetes mellitus (all P < .001) but lower in-hospital mortality (11.1% vs 16.0%; P < .001).

Study details: The study evaluated 1,076,384 hospitalized patients with PE, of which 3,145 (0.3%) patients also had psoriasis.

Disclosures: No specific funding was disclosed for the study. JMG disclosed being an editor for a few journals, co-patent holder of resiquimod for treating cutaneous T cell lymphoma, and Board Director for the International Psoriasis Council. Some of the authors declared receiving consultation fees, research grants, or speaker honoraria from various sources.

Source: Keller K et al. Int J Cardiol. 2021 Sep 1. doi: 10.1016/j.ijcard.2021.08.042.

Key clinical point: Psoriasis was associated with an unfavorable cardiovascular and venous thromboembolism (VTE) risk profile in patients with pulmonary embolism (PE) but lower in-hospital mortality.

Major finding: Despite patients with PE and psoriasis being younger than those without psoriasis (median age, 68 years vs 72 years; P < .001), those with psoriasis showed a higher prevalence of VTE and traditional cardiovascular risk factors such as obesity, essential arterial hypertension, hyperlipidemia, and diabetes mellitus (all P < .001) but lower in-hospital mortality (11.1% vs 16.0%; P < .001).

Study details: The study evaluated 1,076,384 hospitalized patients with PE, of which 3,145 (0.3%) patients also had psoriasis.

Disclosures: No specific funding was disclosed for the study. JMG disclosed being an editor for a few journals, co-patent holder of resiquimod for treating cutaneous T cell lymphoma, and Board Director for the International Psoriasis Council. Some of the authors declared receiving consultation fees, research grants, or speaker honoraria from various sources.

Source: Keller K et al. Int J Cardiol. 2021 Sep 1. doi: 10.1016/j.ijcard.2021.08.042.

Key clinical point: Psoriasis was associated with an unfavorable cardiovascular and venous thromboembolism (VTE) risk profile in patients with pulmonary embolism (PE) but lower in-hospital mortality.

Major finding: Despite patients with PE and psoriasis being younger than those without psoriasis (median age, 68 years vs 72 years; P < .001), those with psoriasis showed a higher prevalence of VTE and traditional cardiovascular risk factors such as obesity, essential arterial hypertension, hyperlipidemia, and diabetes mellitus (all P < .001) but lower in-hospital mortality (11.1% vs 16.0%; P < .001).

Study details: The study evaluated 1,076,384 hospitalized patients with PE, of which 3,145 (0.3%) patients also had psoriasis.

Disclosures: No specific funding was disclosed for the study. JMG disclosed being an editor for a few journals, co-patent holder of resiquimod for treating cutaneous T cell lymphoma, and Board Director for the International Psoriasis Council. Some of the authors declared receiving consultation fees, research grants, or speaker honoraria from various sources.

Source: Keller K et al. Int J Cardiol. 2021 Sep 1. doi: 10.1016/j.ijcard.2021.08.042.

Key clinical point: Compared with calcipotriol monotherapy, short-term therapy with a calcipotriol-betamethasone compound formulation was more efficacious with a similar safety profile in patients with plaque psoriasis.

Major finding: Short-term topical sequential therapy with a calcipotriol-betamethasone compound and calcipotriol improved the Psoriasis Area and Severity Index score (mean difference, −0.94; P < .0001) without any significant difference in overall adverse reaction rate (risk ratio, 0.50; P = .10) compared with calcipotriol monotherapy.

Study details: The data come from a meta-analysis of 22 randomized control trials that included a total of 2,832 patients with plaque psoriasis.

Disclosures: The study was funded by Tianjin municipal health and Health Committee. The authors declared no potential conflict of interests.

Source: Ren J et al. Arch Dermatol Res. 2021 Aug 20. doi: 10.1007/s00403-021-02272-5.

Key clinical point: Compared with calcipotriol monotherapy, short-term therapy with a calcipotriol-betamethasone compound formulation was more efficacious with a similar safety profile in patients with plaque psoriasis.

Major finding: Short-term topical sequential therapy with a calcipotriol-betamethasone compound and calcipotriol improved the Psoriasis Area and Severity Index score (mean difference, −0.94; P < .0001) without any significant difference in overall adverse reaction rate (risk ratio, 0.50; P = .10) compared with calcipotriol monotherapy.

Study details: The data come from a meta-analysis of 22 randomized control trials that included a total of 2,832 patients with plaque psoriasis.

Disclosures: The study was funded by Tianjin municipal health and Health Committee. The authors declared no potential conflict of interests.

Source: Ren J et al. Arch Dermatol Res. 2021 Aug 20. doi: 10.1007/s00403-021-02272-5.

Key clinical point: Compared with calcipotriol monotherapy, short-term therapy with a calcipotriol-betamethasone compound formulation was more efficacious with a similar safety profile in patients with plaque psoriasis.

Major finding: Short-term topical sequential therapy with a calcipotriol-betamethasone compound and calcipotriol improved the Psoriasis Area and Severity Index score (mean difference, −0.94; P < .0001) without any significant difference in overall adverse reaction rate (risk ratio, 0.50; P = .10) compared with calcipotriol monotherapy.

Study details: The data come from a meta-analysis of 22 randomized control trials that included a total of 2,832 patients with plaque psoriasis.

Disclosures: The study was funded by Tianjin municipal health and Health Committee. The authors declared no potential conflict of interests.

Source: Ren J et al. Arch Dermatol Res. 2021 Aug 20. doi: 10.1007/s00403-021-02272-5.

Key clinical point: Patients with psoriasis receiving methotrexate therapy were less prone to develop composite cardiovascular outcomes than those receiving retinoids.

Major finding: Methotrexate vs. retinoids was associated with lower risks for composite cardiovascular outcomes (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.76-0.94) and all-cause mortality (aHR, 0.75; 95% CI, 0.66-0.85).

Study details: This was a retrospective nationwide cohort study that included 19,797 patients with psoriasis, of which 13,777 and 6,020 patients received MTX and retinoids, respectively.

Disclosures: This study was supported by the Taiwan Ministry of Science and Technology. The authors declared no potential conflict of interests.

Source: Tsai MH et al. Clin Epidemiol. 2021 Aug 11. doi: 10.2147/CLEP.S305126.

Key clinical point: Patients with psoriasis receiving methotrexate therapy were less prone to develop composite cardiovascular outcomes than those receiving retinoids.

Major finding: Methotrexate vs. retinoids was associated with lower risks for composite cardiovascular outcomes (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.76-0.94) and all-cause mortality (aHR, 0.75; 95% CI, 0.66-0.85).

Study details: This was a retrospective nationwide cohort study that included 19,797 patients with psoriasis, of which 13,777 and 6,020 patients received MTX and retinoids, respectively.

Disclosures: This study was supported by the Taiwan Ministry of Science and Technology. The authors declared no potential conflict of interests.

Source: Tsai MH et al. Clin Epidemiol. 2021 Aug 11. doi: 10.2147/CLEP.S305126.

Key clinical point: Patients with psoriasis receiving methotrexate therapy were less prone to develop composite cardiovascular outcomes than those receiving retinoids.

Major finding: Methotrexate vs. retinoids was associated with lower risks for composite cardiovascular outcomes (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.76-0.94) and all-cause mortality (aHR, 0.75; 95% CI, 0.66-0.85).

Study details: This was a retrospective nationwide cohort study that included 19,797 patients with psoriasis, of which 13,777 and 6,020 patients received MTX and retinoids, respectively.

Disclosures: This study was supported by the Taiwan Ministry of Science and Technology. The authors declared no potential conflict of interests.

Source: Tsai MH et al. Clin Epidemiol. 2021 Aug 11. doi: 10.2147/CLEP.S305126.

Key clinical point: Apremilast significantly improved nail-specific quality of life, clinical signs, and ultrasound parameters, along with a consistent safety profile in patients with psoriasis and predominant nail disease.

Major finding: At 52 weeks, 52% of patients had Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) Patient Benefit Index global weighted score of 2 or more. Median NAPPA Quality of Life and fingernail Nail Psoriasis Severity Index (NAPSI) improved by 57% and 53%, respectively. Ultrasound parameters improved from 16 weeks onward. Adverse events were mostly mild and transient.

Study details: This was a prospective cohort study that included 45 adult patients with plaque and nail psoriasis and a fingernail NAPSI score of 12 or more who were treated with apremilast 30 mg twice a day for 52 weeks.

Disclosures: This study was supported by Amgen. Dr. Muñoz-Santos, Dr. Vidal, and Dr. Guilabert declared receiving personal fees, presentation honoraria, or travel expenses from various sources including Amgen.

Source: Muñoz-Santos C et al. J Dermatol. 2021 Aug 12. doi: 10.1111/1346-8138.16074.

Key clinical point: Apremilast significantly improved nail-specific quality of life, clinical signs, and ultrasound parameters, along with a consistent safety profile in patients with psoriasis and predominant nail disease.

Major finding: At 52 weeks, 52% of patients had Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) Patient Benefit Index global weighted score of 2 or more. Median NAPPA Quality of Life and fingernail Nail Psoriasis Severity Index (NAPSI) improved by 57% and 53%, respectively. Ultrasound parameters improved from 16 weeks onward. Adverse events were mostly mild and transient.

Study details: This was a prospective cohort study that included 45 adult patients with plaque and nail psoriasis and a fingernail NAPSI score of 12 or more who were treated with apremilast 30 mg twice a day for 52 weeks.

Disclosures: This study was supported by Amgen. Dr. Muñoz-Santos, Dr. Vidal, and Dr. Guilabert declared receiving personal fees, presentation honoraria, or travel expenses from various sources including Amgen.

Source: Muñoz-Santos C et al. J Dermatol. 2021 Aug 12. doi: 10.1111/1346-8138.16074.

Key clinical point: Apremilast significantly improved nail-specific quality of life, clinical signs, and ultrasound parameters, along with a consistent safety profile in patients with psoriasis and predominant nail disease.

Major finding: At 52 weeks, 52% of patients had Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) Patient Benefit Index global weighted score of 2 or more. Median NAPPA Quality of Life and fingernail Nail Psoriasis Severity Index (NAPSI) improved by 57% and 53%, respectively. Ultrasound parameters improved from 16 weeks onward. Adverse events were mostly mild and transient.

Study details: This was a prospective cohort study that included 45 adult patients with plaque and nail psoriasis and a fingernail NAPSI score of 12 or more who were treated with apremilast 30 mg twice a day for 52 weeks.

Disclosures: This study was supported by Amgen. Dr. Muñoz-Santos, Dr. Vidal, and Dr. Guilabert declared receiving personal fees, presentation honoraria, or travel expenses from various sources including Amgen.

Source: Muñoz-Santos C et al. J Dermatol. 2021 Aug 12. doi: 10.1111/1346-8138.16074.

Key clinical point: Anxiety and depressive symptoms, individually or in concurrence, were prevalent among patients with plaque psoriasis. Depressive symptoms seemed to have more impact on psoriasis and patient health-related quality of life (QoL) than anxiety symptoms.

Major finding: Overall, 27% and 22% of patients had symptoms of anxiety and depression, respectively, whereas 14% of patients had both. Patients with vs. without depression had significantly higher itch (6.0 vs 3.0; P = .009) and skin pain (2.5 vs 1.0; P = .01) numeric rating scale (NRS) score. However, itch (P = .42) and skin pain (P = .06) NRS were not significantly different in patients with vs. without anxiety.

Study details: Findings are from an analysis of 73 Japanese patients aged 18 years or more with plaque psoriasis without peripheral arthritis symptoms from the ProLOGUE study.

Disclosures: The study was sponsored by Kyowa Kirin Co., Ltd. Dr. Ohata, Dr. Murotani, and Dr. Imafuku declared receiving grants, personal fees, meeting and travel expenses, or nonfinancial support from various sources, including Kyowa Kirin Co., Ltd. Dr. Kanai and Mr. Kitabayashi reported being employees of Kyowa Kirin Co. Ltd.

Source: Ohata C et al. J Eur Acad Dermatol Venereol. 2021 Aug 21. doi: 10.1111/jdv.17621.

Key clinical point: Anxiety and depressive symptoms, individually or in concurrence, were prevalent among patients with plaque psoriasis. Depressive symptoms seemed to have more impact on psoriasis and patient health-related quality of life (QoL) than anxiety symptoms.

Major finding: Overall, 27% and 22% of patients had symptoms of anxiety and depression, respectively, whereas 14% of patients had both. Patients with vs. without depression had significantly higher itch (6.0 vs 3.0; P = .009) and skin pain (2.5 vs 1.0; P = .01) numeric rating scale (NRS) score. However, itch (P = .42) and skin pain (P = .06) NRS were not significantly different in patients with vs. without anxiety.

Study details: Findings are from an analysis of 73 Japanese patients aged 18 years or more with plaque psoriasis without peripheral arthritis symptoms from the ProLOGUE study.

Disclosures: The study was sponsored by Kyowa Kirin Co., Ltd. Dr. Ohata, Dr. Murotani, and Dr. Imafuku declared receiving grants, personal fees, meeting and travel expenses, or nonfinancial support from various sources, including Kyowa Kirin Co., Ltd. Dr. Kanai and Mr. Kitabayashi reported being employees of Kyowa Kirin Co. Ltd.

Source: Ohata C et al. J Eur Acad Dermatol Venereol. 2021 Aug 21. doi: 10.1111/jdv.17621.

Key clinical point: Anxiety and depressive symptoms, individually or in concurrence, were prevalent among patients with plaque psoriasis. Depressive symptoms seemed to have more impact on psoriasis and patient health-related quality of life (QoL) than anxiety symptoms.

Major finding: Overall, 27% and 22% of patients had symptoms of anxiety and depression, respectively, whereas 14% of patients had both. Patients with vs. without depression had significantly higher itch (6.0 vs 3.0; P = .009) and skin pain (2.5 vs 1.0; P = .01) numeric rating scale (NRS) score. However, itch (P = .42) and skin pain (P = .06) NRS were not significantly different in patients with vs. without anxiety.

Study details: Findings are from an analysis of 73 Japanese patients aged 18 years or more with plaque psoriasis without peripheral arthritis symptoms from the ProLOGUE study.

Disclosures: The study was sponsored by Kyowa Kirin Co., Ltd. Dr. Ohata, Dr. Murotani, and Dr. Imafuku declared receiving grants, personal fees, meeting and travel expenses, or nonfinancial support from various sources, including Kyowa Kirin Co., Ltd. Dr. Kanai and Mr. Kitabayashi reported being employees of Kyowa Kirin Co. Ltd.

Source: Ohata C et al. J Eur Acad Dermatol Venereol. 2021 Aug 21. doi: 10.1111/jdv.17621.

High out-of-pocket costs for medications remain a barrier for patients with psoriasis or psoriatic arthritis on Medicare, according to findings from a cross-sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Data from the fourth quarter of 2020.

Mathier/Thinkstock

Although biologics have demonstrated safety and effectiveness for psoriasis and psoriatic arthritis, their costs have risen, which has led patients to switch or discontinue biologics and consequently incur greater health care costs, wrote Sarah P. Pourali and colleagues at Vanderbilt University, Nashville, Tenn.

The authors also noted that Medicare patients in particular experience a financial burden if they have no limits on out-of-pocket spending, and while patient assistance programs may offset some out-of-pocket spending for specialty drugs, not all patients are aware of or qualify for them. Ineligibility for low-income subsidies also serves as a barrier and is associated with lower adherence to treatment.

In a study published in JAMA Dermatology, the researchers identified 5,011 formularies using the CMS data. The medications were etanercept, adalimumab, golimumab, ustekinumab, certolizumab pegol, apremilast, secukinumab, abatacept, ixekizumab, brodalumab, tofacitinib, tofacitinib XR, guselkumab, tildrakizumab, and risankizumab.

Overall, coverage for those 15 specialty medications ranged from 10.0% to 99.8% across products and Part D plans. The most commonly covered medications were adalimumab and ustekinumab (99.8% for both) and the least covered were brodalumab and tildrakizumab (10.9% and 10.0%, respectively).

Prior authorization was required by 90.5%-100% of the plans when medications were covered, and plans with limits on the quantity of medications covered ranged from 1.0% of plans (for guselkumab) to 78% of plans (for tofacitinib).

Copays were relatively rare; 2.4%-5.5% of the plans offered copays on any of the 15 medications.

The standard Medicare benefit for 2021 included a $445 deductible, 25% coinsurance for initial drug spending, and 5% coinsurance for drug spending in the catastrophic phase of coverage, the researchers noted. Overall, apremilast had the lowest estimated out-of-pocket costs for initial fills, under the catastrophic coverage phase, and annual cost, and ustekinumab had the highest. The estimated out-of-pocket costs for an initial fill ranged from $1,234 for apremilast to $3,426 for ustekinumab. Out-of-pocket costs for medications under the catastrophic phase ranged from $181 for apremilast to $1,175 for ustekinumab. Estimated out-of-pocket costs for a year of treatment ranged from $4,423 for apremilast to $6,950 for ustekinumab.

Median point-of-sale prices per fill – meaning pricing with no rebates or discounts – were lowest for apremilast ($3,620.40) and reached $23,492.93 per fill for ustekinumab, the researchers wrote. Other medications with point-of-sale prices above $10,000 were guselkumab ($11,511.52), tildrakizumab ($14,112.13), and risankizumab ($16,248.90).

The study was supported by grants from the Commonwealth Fund and the Leukemia & Lymphoma Society. One author disclosed receiving grants from Arnold Ventures, the Commonwealth Fund, and the Robert Wood Johnson Foundation for unrelated work, as well as honoraria from West Health and the Institute for Clinical and Economic Review.

High out-of-pocket costs for medications remain a barrier for patients with psoriasis or psoriatic arthritis on Medicare, according to findings from a cross-sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Data from the fourth quarter of 2020.

Mathier/Thinkstock

Although biologics have demonstrated safety and effectiveness for psoriasis and psoriatic arthritis, their costs have risen, which has led patients to switch or discontinue biologics and consequently incur greater health care costs, wrote Sarah P. Pourali and colleagues at Vanderbilt University, Nashville, Tenn.

The authors also noted that Medicare patients in particular experience a financial burden if they have no limits on out-of-pocket spending, and while patient assistance programs may offset some out-of-pocket spending for specialty drugs, not all patients are aware of or qualify for them. Ineligibility for low-income subsidies also serves as a barrier and is associated with lower adherence to treatment.

In a study published in JAMA Dermatology, the researchers identified 5,011 formularies using the CMS data. The medications were etanercept, adalimumab, golimumab, ustekinumab, certolizumab pegol, apremilast, secukinumab, abatacept, ixekizumab, brodalumab, tofacitinib, tofacitinib XR, guselkumab, tildrakizumab, and risankizumab.

Overall, coverage for those 15 specialty medications ranged from 10.0% to 99.8% across products and Part D plans. The most commonly covered medications were adalimumab and ustekinumab (99.8% for both) and the least covered were brodalumab and tildrakizumab (10.9% and 10.0%, respectively).

Prior authorization was required by 90.5%-100% of the plans when medications were covered, and plans with limits on the quantity of medications covered ranged from 1.0% of plans (for guselkumab) to 78% of plans (for tofacitinib).

Copays were relatively rare; 2.4%-5.5% of the plans offered copays on any of the 15 medications.

The standard Medicare benefit for 2021 included a $445 deductible, 25% coinsurance for initial drug spending, and 5% coinsurance for drug spending in the catastrophic phase of coverage, the researchers noted. Overall, apremilast had the lowest estimated out-of-pocket costs for initial fills, under the catastrophic coverage phase, and annual cost, and ustekinumab had the highest. The estimated out-of-pocket costs for an initial fill ranged from $1,234 for apremilast to $3,426 for ustekinumab. Out-of-pocket costs for medications under the catastrophic phase ranged from $181 for apremilast to $1,175 for ustekinumab. Estimated out-of-pocket costs for a year of treatment ranged from $4,423 for apremilast to $6,950 for ustekinumab.

Median point-of-sale prices per fill – meaning pricing with no rebates or discounts – were lowest for apremilast ($3,620.40) and reached $23,492.93 per fill for ustekinumab, the researchers wrote. Other medications with point-of-sale prices above $10,000 were guselkumab ($11,511.52), tildrakizumab ($14,112.13), and risankizumab ($16,248.90).

The study was supported by grants from the Commonwealth Fund and the Leukemia & Lymphoma Society. One author disclosed receiving grants from Arnold Ventures, the Commonwealth Fund, and the Robert Wood Johnson Foundation for unrelated work, as well as honoraria from West Health and the Institute for Clinical and Economic Review.

High out-of-pocket costs for medications remain a barrier for patients with psoriasis or psoriatic arthritis on Medicare, according to findings from a cross-sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Data from the fourth quarter of 2020.

Mathier/Thinkstock

Although biologics have demonstrated safety and effectiveness for psoriasis and psoriatic arthritis, their costs have risen, which has led patients to switch or discontinue biologics and consequently incur greater health care costs, wrote Sarah P. Pourali and colleagues at Vanderbilt University, Nashville, Tenn.

The authors also noted that Medicare patients in particular experience a financial burden if they have no limits on out-of-pocket spending, and while patient assistance programs may offset some out-of-pocket spending for specialty drugs, not all patients are aware of or qualify for them. Ineligibility for low-income subsidies also serves as a barrier and is associated with lower adherence to treatment.

In a study published in JAMA Dermatology, the researchers identified 5,011 formularies using the CMS data. The medications were etanercept, adalimumab, golimumab, ustekinumab, certolizumab pegol, apremilast, secukinumab, abatacept, ixekizumab, brodalumab, tofacitinib, tofacitinib XR, guselkumab, tildrakizumab, and risankizumab.

Overall, coverage for those 15 specialty medications ranged from 10.0% to 99.8% across products and Part D plans. The most commonly covered medications were adalimumab and ustekinumab (99.8% for both) and the least covered were brodalumab and tildrakizumab (10.9% and 10.0%, respectively).

Prior authorization was required by 90.5%-100% of the plans when medications were covered, and plans with limits on the quantity of medications covered ranged from 1.0% of plans (for guselkumab) to 78% of plans (for tofacitinib).

Copays were relatively rare; 2.4%-5.5% of the plans offered copays on any of the 15 medications.

The standard Medicare benefit for 2021 included a $445 deductible, 25% coinsurance for initial drug spending, and 5% coinsurance for drug spending in the catastrophic phase of coverage, the researchers noted. Overall, apremilast had the lowest estimated out-of-pocket costs for initial fills, under the catastrophic coverage phase, and annual cost, and ustekinumab had the highest. The estimated out-of-pocket costs for an initial fill ranged from $1,234 for apremilast to $3,426 for ustekinumab. Out-of-pocket costs for medications under the catastrophic phase ranged from $181 for apremilast to $1,175 for ustekinumab. Estimated out-of-pocket costs for a year of treatment ranged from $4,423 for apremilast to $6,950 for ustekinumab.

Median point-of-sale prices per fill – meaning pricing with no rebates or discounts – were lowest for apremilast ($3,620.40) and reached $23,492.93 per fill for ustekinumab, the researchers wrote. Other medications with point-of-sale prices above $10,000 were guselkumab ($11,511.52), tildrakizumab ($14,112.13), and risankizumab ($16,248.90).

The study was supported by grants from the Commonwealth Fund and the Leukemia & Lymphoma Society. One author disclosed receiving grants from Arnold Ventures, the Commonwealth Fund, and the Robert Wood Johnson Foundation for unrelated work, as well as honoraria from West Health and the Institute for Clinical and Economic Review.

During the annual meeting of the Society for Pediatric Dermatology, Amy S. Paller, MD, MS, marveled on the remarkable advances in the treatment of inflammatory skin disorders during the past 2 decades.

“We’ve come a long way, from disease features being red, thick, and scaly and being treated with nonspecific therapy like topical steroids, keratolytics, and tar, to understanding disease pathogenesis and finding new targeted therapies for inflammatory skin disorders in children,” said Dr. Paller, professor and chair of the department of dermatology at Northwestern University, Chicago. “There are now studies moving forward with gene correction, gene replacement, the gene product replaced, or pathway inhibition to prevent the effects of genetic change.”

Technology is leading the way in generating new therapeutic advances, she continued, beyond traditional “omics” to lipidomics, metabolomics, glycomics, and kinomics. “This has enabled us to find new genetic disorders and their causes, to look at changes in gene expression patterns, and to look at changes in protein expression patterns that give us clues as to how to move forward with better therapy,” she said. “When we’re talking about new insights into pathogenesis-based therapy, we’re talking largely about understanding the pathways that lead to either inflammation or promoting cell proliferation and abnormal differentiation.”

Treating pediatric psoriasis

Dr. Paller discussed her approach to managing patients with pediatric psoriasis, an inflammatory disorder with IL-23/Th17 skewing. “First of all, ask about itch and pain with these patients,” she advised. “Interviews have shown that 61% of children experience some itch, 39% have pain or stinging, and in the ixekizumab trials, 72% had what’s considered meaningful itch, with at least 4 out of 10 (mean intensity 5.3) on the itch numeric rating scale. Little is known about the itch associated with psoriasis and its underlying cause – unrelated to the IL-4/IL-13 pathway activation of atopic dermatitis – but it’s worth asking about. I find that itch of the scalp is especially a problem in psoriasis.”

Physicians should also ask pediatric psoriasis patients about joint pain, because about 1% of them have psoriatic arthritis, which is much less common than in adults, “but important to find and manage,” she added. Dr. Paller recommends the new R-JET rapid joint exam technique, which is accompanied by a three-question survey and body diagram that facilitates identification of true arthritis, “so you can know how quickly to refer”.

Several studies have described an increased risk of metabolic syndrome in adolescents with pediatric psoriasis and now in prepubertal children with the disease. In a recent study of 60 consecutive prepubertal children with psoriasis, 70% of whom had mild disease, 40% were overweight or obese, 53% had central obesity, 27% had high levels of the HOMA-IR (homeostasis model assessment of insulin resistance) despite generally normal levels of fasting glucose, and 30% met criteria for metabolic syndrome.

“This really struck me because our AAD [American Academy of Dermatology] guidelines did not recommend screening for type 2 diabetes in prepubertal children, even if overweight, because the risk is so small,” Dr. Paller said. “This report suggests that we may need to reconsider this recommendation in prepubertal children with psoriasis.”

Meanwhile, the number of medications approved by the Food and Drug Administration and the European Medicines Agency for children with psoriasis who are 6 years of age and above continues to expand, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-23 inhibitors, and IL-17 inhibitors. Most children can now achieve a PASI 90 within 12 weeks with the IL-23 inhibitor ustekinumab and the IL-17 inhibitors ixekizumab and secukinumab, Dr. Paller said.

In the ixekizumab trial, there are head-to-head comparison data in a European arm that involved the use of etanercept, she said. “What’s most noticeable is the significant difference in those who were able to achieve PASI 90 or above with this IL-17 inhibitor, versus etanercept,” which she added, raises the question of whether aiming for a PASI 75 is adequate, "or should we strive for PASI 90?” A pediatric psoriasis study published in 2020 found that the greatest improvement in quality of life was associated with a PASI 90 and use of systemic treatments (JAMA Dermatol. 2020;156[1]:72-8).

Looking forward, phase 3 clinical trials are underway in pediatric patients with moderate to severe psoriasis for guselkumab, tildrakizumab, risankizumab, certolizumab, bimekizumab, and brodalumab. “The cost of all of these biologics is high, however. I remind everyone that we still have methotrexate,” she said. “The risk of side effects with our low-dose methotrexate treatment for psoriasis remains low, but methotrexate doesn’t hit these [high] PASI numbers and it’s much slower in its onset than biologics.”

Dr. Paller disclosed that she is a consultant to and/or an investigator for AbbVie, Arena, Bausch, Bristol Myers Squibb, Dermavant, Eli Lilly, Incyte, Forte, LEO Pharma, LifeMax, Pfizer, RAPT Therapeutics, Regeneron, and Sanofi.

Commentary by Robert Sidbury, MD, MPH

Dr. Paller reminds us of some essential features of pediatric psoriasis:
•    It can hurt. Ask your patients if it does.
•    It can itch. Look for excoriations, especially in the scalp.
•    It is often associated with metabolic syndrome, so check relevant biometrics and labs, and consider coincident insulin resistance.
•    Our traditional clinical trial target of PASI75, or a 75% reduction in body surface area involvement, is just not good enough. Studies have shown that the most meaningful quality-of-life gains come at PASI90 or above. 
•    With our newer biologics, such as IL-12/23 blockers (for instance, ustekinumab) and IL-17 blockers (for example, ixekizumab and secukinumab), PASI90 and better is a reasonable expectation, not a pipe dream. 

Dr. Sidbury is chief of dermatology at Seattle Children's Hospital and professor, department of pediatrics, University of Washington, Seattle. He is a site principal investigator for dupilumab trials, for which the hospital has a contract with Regeneron.

This article was updated 6/16/22.

During the annual meeting of the Society for Pediatric Dermatology, Amy S. Paller, MD, MS, marveled on the remarkable advances in the treatment of inflammatory skin disorders during the past 2 decades.

“We’ve come a long way, from disease features being red, thick, and scaly and being treated with nonspecific therapy like topical steroids, keratolytics, and tar, to understanding disease pathogenesis and finding new targeted therapies for inflammatory skin disorders in children,” said Dr. Paller, professor and chair of the department of dermatology at Northwestern University, Chicago. “There are now studies moving forward with gene correction, gene replacement, the gene product replaced, or pathway inhibition to prevent the effects of genetic change.”

Technology is leading the way in generating new therapeutic advances, she continued, beyond traditional “omics” to lipidomics, metabolomics, glycomics, and kinomics. “This has enabled us to find new genetic disorders and their causes, to look at changes in gene expression patterns, and to look at changes in protein expression patterns that give us clues as to how to move forward with better therapy,” she said. “When we’re talking about new insights into pathogenesis-based therapy, we’re talking largely about understanding the pathways that lead to either inflammation or promoting cell proliferation and abnormal differentiation.”

Treating pediatric psoriasis

Dr. Paller discussed her approach to managing patients with pediatric psoriasis, an inflammatory disorder with IL-23/Th17 skewing. “First of all, ask about itch and pain with these patients,” she advised. “Interviews have shown that 61% of children experience some itch, 39% have pain or stinging, and in the ixekizumab trials, 72% had what’s considered meaningful itch, with at least 4 out of 10 (mean intensity 5.3) on the itch numeric rating scale. Little is known about the itch associated with psoriasis and its underlying cause – unrelated to the IL-4/IL-13 pathway activation of atopic dermatitis – but it’s worth asking about. I find that itch of the scalp is especially a problem in psoriasis.”

Physicians should also ask pediatric psoriasis patients about joint pain, because about 1% of them have psoriatic arthritis, which is much less common than in adults, “but important to find and manage,” she added. Dr. Paller recommends the new R-JET rapid joint exam technique, which is accompanied by a three-question survey and body diagram that facilitates identification of true arthritis, “so you can know how quickly to refer”.

Several studies have described an increased risk of metabolic syndrome in adolescents with pediatric psoriasis and now in prepubertal children with the disease. In a recent study of 60 consecutive prepubertal children with psoriasis, 70% of whom had mild disease, 40% were overweight or obese, 53% had central obesity, 27% had high levels of the HOMA-IR (homeostasis model assessment of insulin resistance) despite generally normal levels of fasting glucose, and 30% met criteria for metabolic syndrome.

“This really struck me because our AAD [American Academy of Dermatology] guidelines did not recommend screening for type 2 diabetes in prepubertal children, even if overweight, because the risk is so small,” Dr. Paller said. “This report suggests that we may need to reconsider this recommendation in prepubertal children with psoriasis.”

Meanwhile, the number of medications approved by the Food and Drug Administration and the European Medicines Agency for children with psoriasis who are 6 years of age and above continues to expand, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-23 inhibitors, and IL-17 inhibitors. Most children can now achieve a PASI 90 within 12 weeks with the IL-23 inhibitor ustekinumab and the IL-17 inhibitors ixekizumab and secukinumab, Dr. Paller said.

In the ixekizumab trial, there are head-to-head comparison data in a European arm that involved the use of etanercept, she said. “What’s most noticeable is the significant difference in those who were able to achieve PASI 90 or above with this IL-17 inhibitor, versus etanercept,” which she added, raises the question of whether aiming for a PASI 75 is adequate, "or should we strive for PASI 90?” A pediatric psoriasis study published in 2020 found that the greatest improvement in quality of life was associated with a PASI 90 and use of systemic treatments (JAMA Dermatol. 2020;156[1]:72-8).

Looking forward, phase 3 clinical trials are underway in pediatric patients with moderate to severe psoriasis for guselkumab, tildrakizumab, risankizumab, certolizumab, bimekizumab, and brodalumab. “The cost of all of these biologics is high, however. I remind everyone that we still have methotrexate,” she said. “The risk of side effects with our low-dose methotrexate treatment for psoriasis remains low, but methotrexate doesn’t hit these [high] PASI numbers and it’s much slower in its onset than biologics.”

Dr. Paller disclosed that she is a consultant to and/or an investigator for AbbVie, Arena, Bausch, Bristol Myers Squibb, Dermavant, Eli Lilly, Incyte, Forte, LEO Pharma, LifeMax, Pfizer, RAPT Therapeutics, Regeneron, and Sanofi.

Commentary by Robert Sidbury, MD, MPH

Dr. Paller reminds us of some essential features of pediatric psoriasis:
•    It can hurt. Ask your patients if it does.
•    It can itch. Look for excoriations, especially in the scalp.
•    It is often associated with metabolic syndrome, so check relevant biometrics and labs, and consider coincident insulin resistance.
•    Our traditional clinical trial target of PASI75, or a 75% reduction in body surface area involvement, is just not good enough. Studies have shown that the most meaningful quality-of-life gains come at PASI90 or above. 
•    With our newer biologics, such as IL-12/23 blockers (for instance, ustekinumab) and IL-17 blockers (for example, ixekizumab and secukinumab), PASI90 and better is a reasonable expectation, not a pipe dream. 

Dr. Sidbury is chief of dermatology at Seattle Children's Hospital and professor, department of pediatrics, University of Washington, Seattle. He is a site principal investigator for dupilumab trials, for which the hospital has a contract with Regeneron.

This article was updated 6/16/22.

During the annual meeting of the Society for Pediatric Dermatology, Amy S. Paller, MD, MS, marveled on the remarkable advances in the treatment of inflammatory skin disorders during the past 2 decades.

“We’ve come a long way, from disease features being red, thick, and scaly and being treated with nonspecific therapy like topical steroids, keratolytics, and tar, to understanding disease pathogenesis and finding new targeted therapies for inflammatory skin disorders in children,” said Dr. Paller, professor and chair of the department of dermatology at Northwestern University, Chicago. “There are now studies moving forward with gene correction, gene replacement, the gene product replaced, or pathway inhibition to prevent the effects of genetic change.”

Technology is leading the way in generating new therapeutic advances, she continued, beyond traditional “omics” to lipidomics, metabolomics, glycomics, and kinomics. “This has enabled us to find new genetic disorders and their causes, to look at changes in gene expression patterns, and to look at changes in protein expression patterns that give us clues as to how to move forward with better therapy,” she said. “When we’re talking about new insights into pathogenesis-based therapy, we’re talking largely about understanding the pathways that lead to either inflammation or promoting cell proliferation and abnormal differentiation.”

Treating pediatric psoriasis

Dr. Paller discussed her approach to managing patients with pediatric psoriasis, an inflammatory disorder with IL-23/Th17 skewing. “First of all, ask about itch and pain with these patients,” she advised. “Interviews have shown that 61% of children experience some itch, 39% have pain or stinging, and in the ixekizumab trials, 72% had what’s considered meaningful itch, with at least 4 out of 10 (mean intensity 5.3) on the itch numeric rating scale. Little is known about the itch associated with psoriasis and its underlying cause – unrelated to the IL-4/IL-13 pathway activation of atopic dermatitis – but it’s worth asking about. I find that itch of the scalp is especially a problem in psoriasis.”

Physicians should also ask pediatric psoriasis patients about joint pain, because about 1% of them have psoriatic arthritis, which is much less common than in adults, “but important to find and manage,” she added. Dr. Paller recommends the new R-JET rapid joint exam technique, which is accompanied by a three-question survey and body diagram that facilitates identification of true arthritis, “so you can know how quickly to refer”.

Several studies have described an increased risk of metabolic syndrome in adolescents with pediatric psoriasis and now in prepubertal children with the disease. In a recent study of 60 consecutive prepubertal children with psoriasis, 70% of whom had mild disease, 40% were overweight or obese, 53% had central obesity, 27% had high levels of the HOMA-IR (homeostasis model assessment of insulin resistance) despite generally normal levels of fasting glucose, and 30% met criteria for metabolic syndrome.

“This really struck me because our AAD [American Academy of Dermatology] guidelines did not recommend screening for type 2 diabetes in prepubertal children, even if overweight, because the risk is so small,” Dr. Paller said. “This report suggests that we may need to reconsider this recommendation in prepubertal children with psoriasis.”

Meanwhile, the number of medications approved by the Food and Drug Administration and the European Medicines Agency for children with psoriasis who are 6 years of age and above continues to expand, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-23 inhibitors, and IL-17 inhibitors. Most children can now achieve a PASI 90 within 12 weeks with the IL-23 inhibitor ustekinumab and the IL-17 inhibitors ixekizumab and secukinumab, Dr. Paller said.

In the ixekizumab trial, there are head-to-head comparison data in a European arm that involved the use of etanercept, she said. “What’s most noticeable is the significant difference in those who were able to achieve PASI 90 or above with this IL-17 inhibitor, versus etanercept,” which she added, raises the question of whether aiming for a PASI 75 is adequate, "or should we strive for PASI 90?” A pediatric psoriasis study published in 2020 found that the greatest improvement in quality of life was associated with a PASI 90 and use of systemic treatments (JAMA Dermatol. 2020;156[1]:72-8).

Looking forward, phase 3 clinical trials are underway in pediatric patients with moderate to severe psoriasis for guselkumab, tildrakizumab, risankizumab, certolizumab, bimekizumab, and brodalumab. “The cost of all of these biologics is high, however. I remind everyone that we still have methotrexate,” she said. “The risk of side effects with our low-dose methotrexate treatment for psoriasis remains low, but methotrexate doesn’t hit these [high] PASI numbers and it’s much slower in its onset than biologics.”

Dr. Paller disclosed that she is a consultant to and/or an investigator for AbbVie, Arena, Bausch, Bristol Myers Squibb, Dermavant, Eli Lilly, Incyte, Forte, LEO Pharma, LifeMax, Pfizer, RAPT Therapeutics, Regeneron, and Sanofi.

Commentary by Robert Sidbury, MD, MPH

Dr. Paller reminds us of some essential features of pediatric psoriasis:
•    It can hurt. Ask your patients if it does.
•    It can itch. Look for excoriations, especially in the scalp.
•    It is often associated with metabolic syndrome, so check relevant biometrics and labs, and consider coincident insulin resistance.
•    Our traditional clinical trial target of PASI75, or a 75% reduction in body surface area involvement, is just not good enough. Studies have shown that the most meaningful quality-of-life gains come at PASI90 or above. 
•    With our newer biologics, such as IL-12/23 blockers (for instance, ustekinumab) and IL-17 blockers (for example, ixekizumab and secukinumab), PASI90 and better is a reasonable expectation, not a pipe dream. 

Dr. Sidbury is chief of dermatology at Seattle Children's Hospital and professor, department of pediatrics, University of Washington, Seattle. He is a site principal investigator for dupilumab trials, for which the hospital has a contract with Regeneron.

This article was updated 6/16/22.

Several recent studies have evaluated that association between psoriasis and known comorbidities including cardiovascular disease, non-alcoholic fatty liver disease (NAFLD), and malignancy. Several recent studies have added to our understanding of the relationship between these conditions.

Using the largest database of hospitalized patients in the United States, Edgen et al found that hospitalization rates for patients with psoriasis are increasing. While the proportion of patients with psoriasis hospitalized with psoriasis as a primary diagnosis decreased about four-fold over a 20-year period (1999-2018), incidence of hospitalizations with any diagnosis of psoriasis has increased. Hospitalized psoriasis patients are increasingly more likely to have other comorbid conditions as during the study period the proportion of hospitalized psoriasis patients with a Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9%. Psoriasis severity, medication use, and reasons for hospitalization were not reported. The authors suggest that screening and management of comorbidities in the outpatient setting may help reduce preventable psoriasis hospitalizations.

Both NAFLD and cardiovascular disease are well-known psoriasis comorbidities, Gonzalez-Cantaro et al studied two cohorts of patients to better define the relationship between these two conditions. In a European cohort of 76 psoriasis patients and 76 control patients, psoriasis patients with NAFLD had a higher prevalence of subclinical atherosclerosis than both psoriasis patients without NAFLD (61% vs 23%) and age, sex, and BMI-matched controls with NAFLD (61% vs 32%). Psoriasis patients were also more likely that control patients to have insulin resistance, higher weight circumference, and dysplipidemia. Among 162 psoriasis patients who underwent PET and coronary CT angiography, higher hepatic FDG uptake (indicating NAFLD) was associated higher atherosclerotic disease burden. Importantly, both the NAFLD and CAD were subclinical in these patients. While the cross-sectional study design precludes any conclusions about causality, physicians should be aware that these two comorbidities are related. Lower waist circumference and greater physical activity were both associated with lower rates of NAFLD among patients with psoriasis, providing some guidance for counseling patients.

Several recent studies have found that cancer rates among patients with psoriasis are higher than what is observed in the general population. The association of psoriasis with lymphohematologic malignancies (LHM) has been controversial. A systematic review and meta-analysis of 25 observational studies including over 2.5 million subjects (Bellinato et al.) found a 1.55-fold increased risk of LHM in patients with moderate to severe psoriasis. Strikingly, the risk of cutaneous T cell lymphoma (CTCL) was increased 6.22-fold, with more severe psoriasis being associated with the highest risk of CTCL. A causal relationship cannot be established from this type of studies, but the authors hypothesize that drugs used to treat psoriasis or the chronic T cell activation caused by active disease may contribute to the risk of LMH. Additionally, psoriasis and CTCL can share clinical features and some cases may be due to misdiagnosis. Interestingly, two psoriasis comorbities, diabetes and obesity, are also associated with an increased risk of LHM.

Early identification and management of comorbidities can help in reducing morbidity and mortality. With so many psoriasis treatments available, understanding how different therapies may impact comorbid conditions is important in helping dermatologists to choose the best therapy for each individual patient.

Several recent studies have evaluated that association between psoriasis and known comorbidities including cardiovascular disease, non-alcoholic fatty liver disease (NAFLD), and malignancy. Several recent studies have added to our understanding of the relationship between these conditions.

Using the largest database of hospitalized patients in the United States, Edgen et al found that hospitalization rates for patients with psoriasis are increasing. While the proportion of patients with psoriasis hospitalized with psoriasis as a primary diagnosis decreased about four-fold over a 20-year period (1999-2018), incidence of hospitalizations with any diagnosis of psoriasis has increased. Hospitalized psoriasis patients are increasingly more likely to have other comorbid conditions as during the study period the proportion of hospitalized psoriasis patients with a Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9%. Psoriasis severity, medication use, and reasons for hospitalization were not reported. The authors suggest that screening and management of comorbidities in the outpatient setting may help reduce preventable psoriasis hospitalizations.

Both NAFLD and cardiovascular disease are well-known psoriasis comorbidities, Gonzalez-Cantaro et al studied two cohorts of patients to better define the relationship between these two conditions. In a European cohort of 76 psoriasis patients and 76 control patients, psoriasis patients with NAFLD had a higher prevalence of subclinical atherosclerosis than both psoriasis patients without NAFLD (61% vs 23%) and age, sex, and BMI-matched controls with NAFLD (61% vs 32%). Psoriasis patients were also more likely that control patients to have insulin resistance, higher weight circumference, and dysplipidemia. Among 162 psoriasis patients who underwent PET and coronary CT angiography, higher hepatic FDG uptake (indicating NAFLD) was associated higher atherosclerotic disease burden. Importantly, both the NAFLD and CAD were subclinical in these patients. While the cross-sectional study design precludes any conclusions about causality, physicians should be aware that these two comorbidities are related. Lower waist circumference and greater physical activity were both associated with lower rates of NAFLD among patients with psoriasis, providing some guidance for counseling patients.

Several recent studies have found that cancer rates among patients with psoriasis are higher than what is observed in the general population. The association of psoriasis with lymphohematologic malignancies (LHM) has been controversial. A systematic review and meta-analysis of 25 observational studies including over 2.5 million subjects (Bellinato et al.) found a 1.55-fold increased risk of LHM in patients with moderate to severe psoriasis. Strikingly, the risk of cutaneous T cell lymphoma (CTCL) was increased 6.22-fold, with more severe psoriasis being associated with the highest risk of CTCL. A causal relationship cannot be established from this type of studies, but the authors hypothesize that drugs used to treat psoriasis or the chronic T cell activation caused by active disease may contribute to the risk of LMH. Additionally, psoriasis and CTCL can share clinical features and some cases may be due to misdiagnosis. Interestingly, two psoriasis comorbities, diabetes and obesity, are also associated with an increased risk of LHM.

Early identification and management of comorbidities can help in reducing morbidity and mortality. With so many psoriasis treatments available, understanding how different therapies may impact comorbid conditions is important in helping dermatologists to choose the best therapy for each individual patient.

Several recent studies have evaluated that association between psoriasis and known comorbidities including cardiovascular disease, non-alcoholic fatty liver disease (NAFLD), and malignancy. Several recent studies have added to our understanding of the relationship between these conditions.

Using the largest database of hospitalized patients in the United States, Edgen et al found that hospitalization rates for patients with psoriasis are increasing. While the proportion of patients with psoriasis hospitalized with psoriasis as a primary diagnosis decreased about four-fold over a 20-year period (1999-2018), incidence of hospitalizations with any diagnosis of psoriasis has increased. Hospitalized psoriasis patients are increasingly more likely to have other comorbid conditions as during the study period the proportion of hospitalized psoriasis patients with a Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9%. Psoriasis severity, medication use, and reasons for hospitalization were not reported. The authors suggest that screening and management of comorbidities in the outpatient setting may help reduce preventable psoriasis hospitalizations.

Both NAFLD and cardiovascular disease are well-known psoriasis comorbidities, Gonzalez-Cantaro et al studied two cohorts of patients to better define the relationship between these two conditions. In a European cohort of 76 psoriasis patients and 76 control patients, psoriasis patients with NAFLD had a higher prevalence of subclinical atherosclerosis than both psoriasis patients without NAFLD (61% vs 23%) and age, sex, and BMI-matched controls with NAFLD (61% vs 32%). Psoriasis patients were also more likely that control patients to have insulin resistance, higher weight circumference, and dysplipidemia. Among 162 psoriasis patients who underwent PET and coronary CT angiography, higher hepatic FDG uptake (indicating NAFLD) was associated higher atherosclerotic disease burden. Importantly, both the NAFLD and CAD were subclinical in these patients. While the cross-sectional study design precludes any conclusions about causality, physicians should be aware that these two comorbidities are related. Lower waist circumference and greater physical activity were both associated with lower rates of NAFLD among patients with psoriasis, providing some guidance for counseling patients.

Several recent studies have found that cancer rates among patients with psoriasis are higher than what is observed in the general population. The association of psoriasis with lymphohematologic malignancies (LHM) has been controversial. A systematic review and meta-analysis of 25 observational studies including over 2.5 million subjects (Bellinato et al.) found a 1.55-fold increased risk of LHM in patients with moderate to severe psoriasis. Strikingly, the risk of cutaneous T cell lymphoma (CTCL) was increased 6.22-fold, with more severe psoriasis being associated with the highest risk of CTCL. A causal relationship cannot be established from this type of studies, but the authors hypothesize that drugs used to treat psoriasis or the chronic T cell activation caused by active disease may contribute to the risk of LMH. Additionally, psoriasis and CTCL can share clinical features and some cases may be due to misdiagnosis. Interestingly, two psoriasis comorbities, diabetes and obesity, are also associated with an increased risk of LHM.

Early identification and management of comorbidities can help in reducing morbidity and mortality. With so many psoriasis treatments available, understanding how different therapies may impact comorbid conditions is important in helping dermatologists to choose the best therapy for each individual patient.