A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology

The Real-World Burden of Moderate-to-Severe Psoriasis in Patients Under Systemic Treatment from Baltic Countries: Data from the CRYSTAL Observational Study

Background and Objectives: Data on disease control, treatment, and quality of life (QoL) in patients with psoriasis from Baltic countries are lacking. In this study, we aimed to assess the disease control, treatment, and QoL of patients with psoriasis in countries from Central and Eastern Europe, and we report data for the Baltic countries. Materials and Methods: In a cross-sectional, international study (CRYSTAL), we retrospectively assessed the real-world disease severity and QoL in adult patients (18-75 years) from Estonia, Latvia, and Lithuania with moderate-to-severe psoriasis receiving continuous systemic treatment ≥ 24 weeks. Analyses included 50 patients from each country and were descriptive. Results: The median disease duration was 15.2-19.9 years across the countries. Most patients (78.0% in Estonia, 100% in Latvia, and 68.0% in Lithuania) were receiving monotherapy with biological agents, mainly TNF inhibitors. An absolute PASI score ≤ 3 was achieved by 82.0%, 70.0%, and 64.0% of patients in the overall study population and 89.7%, 70.0%, and 61.8% of patients receiving biologic monotherapy in Estonia, Latvia, and Lithuania, respectively. Across the countries, impairments in QoL as expressed by a Dermatology Life Quality Index score > 5 were reported by 14.0-34.0% of patients, while 88.0-96.0% of patients were satisfied with their treatment. Conclusions: Although most patients showed low absolute PASI scores and satisfaction with their evolution after ≥24 weeks of systemic treatment, they still reported an impact on QoL. This finding underlines that further optimization of systemic treatment strategies is needed to improve outcomes in moderate-to-severe psoriasis in Baltic countries.

Effectiveness and Safety of Biological Therapies in Very Severe Plaque Psoriasis: A Real-Life Retrospective Study

Psoriasis can have a significant impact on quality of life and productivity, especially with increased severity. However, there is limited evidence on biologics' efficacy in highly severe cases compared to moderate-to-severe ones. This study aimed to evaluate the effectiveness and safety of novel biological therapies in very severe psoriasis. We conducted a retrospective analysis on patients ≥ 18 years old affected by very severe psoriasis who had received a biological agent for at least 16 weeks. We used PASI to assess disease severity and effectiveness at weeks 16, 52, 104, and 156. Safety was evaluated by tracking treatment discontinuation rates and adverse events. This study included 29 males and 11 females, with a mean age of 55.80 years (SD 13.82). Cardiometabolic diseases were the most common comorbidities (25.00%). Twenty-eight (70.00%) patients had psoriasis involvement in at least one difficult-to-treat area. All patients completed 16 weeks of treatment. The mean PASI was 31.60 (SD 2.57) at baseline, 3.48 (SD 4.13) at week 16, 0.58 (SD 1.70) at week 52, 0.77 (SD 1.66) at week 104, and 1.29 (SD 2.12) at week 156. PASI90 and 100 were achieved by 52.50% and 30.00% of patients at week 16, by 96.15% and 80.77% at week 52, by 93.33% and 66.67% at week 104, and by 85.71% and 42.86% at week 156. PASIs ≤ 2 were achieved by 50.00% of patients at week 16, 88.46% at week 52, 86.67% at week 104, and 85.71% at week 156. Only two patients discontinued biologics due to complete remission, and mild AEs were reported by four patients. Our findings show that biologics are effective and well tolerated for treating very severe psoriasis, maintaining long-term effectiveness.

PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines

BACKGROUND

Response to treatments in psoriasis can be assessed using the PASI response 50, 75, 90 or 100. Achieving a PASI 100 response would mean a complete resolution of the patient's basal lesions. Therefore, PASI 100 score has been increasingly used in the context of research, but its role in daily practice is currently controversial.

OBJECTIVE

(1) To analyze PASI 100 response rates to pharmacological treatments; (2) To examine clinical practice guidelines (CPGs) recommendations/comments on PASI 100.

METHODS

We conducted a systematic literature review (SLR). Selection criteria concerned patients with psoriasis, reporting PASI 100.

RESULTS

Overall, 65 studies were included. Patients on methotrexate achieved at 16 weeks a PASI 100 of 7.3%. For TNF inhibitors rates were: 3.7-11.1% at 12 weeks, 13.7-20% at 16 weeks, 10.7-24% at 24 weeks and 21.8-34.8% at 1 year. IL-17 inhibitors achieved 23.3-44% at 12 weeks, 44.3-57.2% at 16 weeks, 39.7-67.5% at 24 weeks and 41.4-67.5% at 1 year. And the reported by IL-12/23 inhibitors were 12%/23.8% at 12 weeks, 32.7%/50% at 16 weeks, 44% at 24 weeks and 41.8%/56.3% at 1 year. PASI 100 response is scarcely commented in the CPGs.

CONCLUSIONS

PASI 100 response rate is an endpoint fundamentally restricted to research.