Psoriasis patients should undergo a comprehensive work-up for associated diseases, a Canadian investigator said here at a journalists workshop held in support of World Psoriasis Day.
Wayne Gulliver, MD, Chairman of the Division of Dermatology at the Memorial University of Newfoundland in St. John’s, made the recommendation on the basis of research demonstrating a strong association between psoriasis and multiple co-morbidities. The data also show an increased mortality risk in psoriasis patients.
His team has been conducting a study to examine the link between psoriasis and co-morbidities using information gathered from four databases covering the Newfoundland and Labrador founder population, which include a total of 713,000 individuals.
Thusfar, analyses have revealed that the incidence of diabetes is 10% in individuals with mild to moderate psoriasis and 12% in those with severe psoriasis compared with only 4% in the general population. Also, 44% of deaths in psoriasis patients are apparently due to cardiovascular causes versus 36% of deaths in the general population.
Results also document an increased prevalence of death due to genitourinary disease and an increased prevalence of genitourinary disease in psoriasis patients.
Patients with psoriasis have an average life expectancy that is 10 years shorter than the Canadian average. Psoriasis patients whose psoriasis develops when they are less than 25 years of age have a life expectancy that is decreased by 25 to 30 years.
Dr. Gulliver maintained that shared pathogenetic mechanisms may explain the link between psoriasis and several chronic illnesses. “In short, cytokines in the skin are also driving the risk for cardiovascular disease, hypertension, and diabetes,” he explained.
“The message to clinicians treating psoriasis patients is clear,” he said. “You need to check their blood pressure, blood sugar, and lipids, and you also need to do an electrocardiogram. Essentially, what you need to do is screen patients for these common, complex diseases that are occurring at a much higher rate in psoriasis patients than in the general population.”
“At present, no treatment can alter the course of psoriasis, and existing therapies are aimed at controlling symptoms, Torello Lotti, MD, professor of dermatology at the University of Florence, observed. Treatment may involve topical therapies for mild disease while phototherapy and/or systemic therapy are prescribed for more severe disease. Traditional systemic treatments are frequently limited by adverse side effects, poor convenience, or low efficacy, he said.
While new biological therapies offer patients a safer, well-tolerated, and long-term treatment, all biologicals are not the same, he added. “In fact, each biological agent has a distinct safety and efficacy profile,” he added.
Efalizumab (Raptiva), which specifically targets and modulates T-cells involved in the immunopathogenesis of psoriasis, is the only biological treatment that has shown longlasting disease reduction over three years in patients with chronic moderate-to- severe symptoms, he said.
Dr. Lotti reviewed the results of a phase III trial in which the medication achieved clinically meaningful sustained responses in up to 94 percent of responding patients who continued treatment. In addition, Psoriasis Area Severity Index (PASI) 75 was obtained in 73 percent of responders after three years of treatment. “Importantly,” he noted, “the study is the longest to date to examine continuous therapy with a biological.”
He added that safety data in over 3,500 patients who have participated in clinical trials have documented a good safety record with this drug. “Proven three-year favorable safety profile enables patients with chronic moderate-to- severe plaque psoriasis to be treated long-term and continuously with efalizumab,” he said.
By Jill Stein
Jillstein03 at cs.com