Recent Findings About Plaque Psoriasis

More Evidence Needed on Combined Use of Systemic Agents for Plaque Psoriasis

To evaluate the combined use of systemic agents to achieve disease control in therapy-resistant patients with plaque-type psoriasis, Busard et al (JAMA Dermatol. doi:10.1001/jamadermatol.2014.1111) conducted an electronic search of randomized clinical trials. They found that most studies favored combination therapy, but the significance level and quality of evidence was low. Etanercept plus methotrexate was investigated with an adequate sample size and demonstrated superior efficacy compared to etanercept monotherapy. Although it was associated with an increase in adverse events, the overall safety profile was acceptable.

Practice Point: Patients with plaque psoriasis may benefit from combination therapy with systemic agents, but there is insufficient evidence. Etanercept plus methotrexate may be beneficial, with dose reductions to minimize adverse effects.

>>Read more at JAMA Dermatology

Plaque Psoriasis Familial Risk Highest in First-Degree Relatives

Psoriasis is known to be a highly heritable disease. In a cross-sectional study of 640 consecutive, unrelated adult patients with chronic plaque psoriasis, Di Lernia et al (Clin Exp Dermatol. 2014;39:801-805) found a positive familial history of psoriasis in more than half (59.37%) of patients. Of these patients, 27.18% had at least 1 parent with psoriasis, 16.56% had at least 1 second-degree relative with psoriasis, and 5.31% had 1 third-degree relative with psoriasis.

Practice Point: There is a high familial recurrence risk for plaque psoriasis.

>>Read more at Clinical and Experimental Dermatology

Secukinumab Efficacy for Plaque Psoriasis

Two phase 3, double-blind, 52-week trials (ERASURE and FIXTURE) evaluated subcutaneous secukinumab at a dose of 300 or 150 mg (administed once weekly for 5 weeks, then every 4 weeks), placebo, or (in the FIXTURE study only) etanercept at a dose of 50 mg (administered twice weekly for 12 weeks, then once weekly) in patients with moderate to severe plaque psoriasis. Langley et al, in conjunction with the ERASURE Study Group and FIXTURE Study Group, reported (N Engl J Med. 2014;371:326-338) that the proportion of patients who met the criterion for a reduction of 75% or more from baseline in the psoriasis area and severity index score (PASI 75) at week 12 was higher with each secukinumab dose than with placebo or etanercept. The proportion of patients with a response of 0 (clear) or 1 (almost clear) on the modified investigator global assessment at week 12 was higher with each secukinumab dose than with placebo or etanercept.

This study was funded by Novartis Pharmaceuticals.

Practice Point: Efficacy of secukinumab has been documented in randomized trials of patients with moderate to severe plaque psoriasis, validating IL-17A as a therapeutic target.

>>Read more at the New England Journal of Medicine