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5 th World Psoriasis & Psoriatic Arthritis Conference 2018
University , Umeå , 2 Department of Medical and Health Sciences , Linköping University , Linköping , 3 Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
Introduction : Psoriasis is a complex , systemic disease associated with comorbidities extending beyond the skin , often affecting psychological well-being which may manifest as clinical depression . Psoriasis can be viewed narrowly by focusing on the skin , or holistically to include associated comorbidities . To date , the complex interplay between psoriasis , comorbidities , and depression has not been adequately described , and an innovative approach is necessary to understand interrelationship between them . Objectives : Calculate incidence rates of depression in psoriasis patients compared to the general population and subsequently explore the risk factors associated with depression onset . Determine the contributions of comorbidities compared to narrowly defined , psoriasis-only symptoms . Methods : 96,666 psoriasis patients were matched to 15 controls and followed from psoriasis onset until incident depression diagnosis or censoring using population-based routine care data . Incidence of depression was calculated using Poisson regression models . Risk of depression onset using a narrow definition of psoriasis was compared to a holistic definition including all comorbidities using a Cox proportional hazards model , with additional adjustment for sociodemographic factors . Comorbidities were represented by ICD chapters with more than 5 % correlation with psoriasis . Sensitivity analysis examined the role of psoriatic arthropathy , alternative depression definitions , and searched for unobserved confounding . Results : Patients with psoriasis have a higher incidence of clinical depression than those without the disease . Holistically , psoriasis was associated with an increased risk of depression onset of 40 % ( HR = 1.404 , p < 0.001 ), compared to 12 % increase ( HR = 1.115 , p < 0.001 ) when narrowly defined . The proportional hazards assumption appeared to hold in each survival analysis . A substantial portion , but not all , of psoriasis patients ’ risk of depression onset was attributable to comorbidities , and sociodemographic factors did not appear to affect the estimates of association between depression and psoriasis . Major differences were found between antidepressant- and diagnosis-based definitions of depression , while inclusion of psoriatic arthropathy did not affect the results . No unmeasured confounding was identified . Conclusions : Due to the elevated risk of depression in psoriasis patients , treating physicians should ensure patients ’ psychological well-being is addressed , especially in those presenting with additional risk factors , to break the cyclical relationship between depression and psoriasis and improve patients ’ quality of life . Contemporary , holistic management of psoriasis patients should encourage routine screening for depression .
P016 EFFICACY OF ADALIMUMAB PLUS METHOTREXATE IN PATIENTS WITH MODERATE TO SEVERE PLAQUE
PSORIASIS Ghasem Rahmatpour Rokni , Mohamad Goldust Mazandaran University of Medical Sciences
Background : Adalimumab , a high-affinity monoclonal antibody that selectively targets tumor necrosis factor alpha , is efficacious in treating moderate-to-severe plaque psoriasis . Currently there are some reports regarding drug resistance to adalimumab ( 1,2 ). Objective : This study aimed at evaluating the efficacy of adalimumab plus methotrexate in patients with moderate to severe plaque psoriasis . Methods : In this cross sectional study , 23 patients suffering from moderate to severe psoriasis were recruited . Patients received adalimumab 80 mg week 0 , 1 and then 40 mg every 2 weeks and methotrexate up to 25 mg / week . The primary outcome measure was the difference in Psoriasis area and severity index ( PASI-
75 ) response after 12 weeks . The secondary outcomes included PASI 75 at week 6 ( onset of action ) and week 12 , Investigator ’ s Global Assessment ( IGA ), Patient Global Assessment , impact on quality of life ( Skindex-17 and SF-36 ), Treatment Satisfaction Questionnaire of Medication , duration of remission , maintenance treatment and safety . Results : In the study group , 86.9 % ( 20 out of 23 patients ) reached PASI-75 at week 12 . The longitudinal analysis showed a PASI reduction of 6.42 % per week . The onset of action was achieved in 65.2 %. At week 12 , IGA ‘ clear or almost clear ’ was observed in 91.3 % ( p < 0 · 01 ). Skindex-17 symptom score was significant with combination therapy ( p < 0 · 01 ). Maintenance treatment achieved PASI 75 for 82.6 % ( p < 0 · 01 ). Mild adverse events were reported in 79.5 %. Conclusion : Combination therapy of adalimumab plus methotrexate is a highly effective , well-tolerated , maintenance therapy in patients with moderate to severe plaque psoriasis . References : 1 . Mease P , Hall S , FitzGerald O et al . Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis . N Engl J Med 2017 Oct 19 . 377 ; 1537-1550 . 2 . Papp K , Bachelez H , Costanzo A et al . Clinical similarity of biosimilar ABP 501 to adalimumab in the treatment of patients with moderate to severe plaque psoriasis : A randomized , double-blind , multicenter , phase III study . J Am Acad Dermatol 2017 Jun . 1976 ; 1093-1102 .
P018 ATTAINMENT OF REMISSION AND MINIMAL DISEASE ACTIVITY AFTER STARTING METHOTREXATE
SUBCUTANEOUS THERAPY Elena Loginova , Tatiana Korotaeva , Elena Gubar , Svetlana Glukhova , Eugeny Nasonov Nasonova Research Institute of Rheumatology , Moscow
Introduction : Methotrexate ( MTX ) is the first-choice therapy in psoriatic arthritis ( PsA ). There is limited data concerning efficacy of early administration and rapidly dose escalation of MTX subcutaneous ( s / c ) in early ( E ) PsA patients ( pts ). Objective : to study attainment of remission ( REM ) or minimal disease activity ( MDA ) after starting MTX s / c therapy in EPsA pts treated according to treat-to-target ( T2T ) strategy . Methods : 77 ( M-37 / F-40 ) pts with active EPsA , according to the CASPAR criteria were included . Mean age 37.4 ± 10.8 years ( yrs .), PsA duration 11 ± 10 months ( mon .), psoriasis duration 86 ± 96.1 mon ., DAPSA 32.45 ± 12.7 . At baseline all pts started MTX s / c therapy . The dose of MTX s / c was escalated by 5 mg every 2 weeks from 10 mg / wk to appropriate dose 20 – 25 mg / wk according to the drug intolerance . If the patient did not achieve remission or MDA on MTX mono-therapy , biological ( b ) DMARDs was added . At baseline and every 3 mon . of study ( till 24 mon .) all pts underwent assessment of PsA activity by DAPSA and MDA criteria ( tender joint count ≤ 1 , swollen joint count ≤ 1 , PASI ≤ 1 or BSA ≤ 3 , patient pain global assessment VAS ≤ 15 , patient ´ s global disease activity VAS ≤ 20 , HAQ ≤ 0.5 , enthesitis count ≤ 1 ). The proportion of pts who achieved REM by DAPSA ≤ 4 and MDA ( 5 of 7 cutpoints ), the timing of REM / MDA , the mean dose of MTX during the study were performed . M ± SD , Me [ Q75 ; Q50 ], (%), W-test were calculated . All p < 0.05 were considered to indicate statistical significance . Results : 36 out of 77 pts ( 46.75 %) did not achieve REM or MDA in MTX therapy within 7 ± 5 mon . and bDMARDs were added . 5 out of 77 pts ( 6.5 %) stopped MTX therapy due to intolerance within 6 ± 2 mon . 36 out of 77 pts ( 46.75 %) went on taking MTX-monotherapy . In 22 out of 36 pts , who had mean DAPSA 27.7 ± 10.0 at baseline , data was available by the 24 mon . of study . At baseline median dose of MTX s / c was 15 [ 10 ; 20 ], Min 10 – Max 20 mg / wk . At the third mon . of study median dose of MTX s / c was escalated to 20 [ 20 ; 20 ], Min 0 – Max 25 mg / wk . After attainment of REM / MDA the dose of MTX was decreased . At the end of the study median dose of MTX s / c was 7.5 [ 0 ; 15 ], Min 0 – Max 20 www . medicaljournals . se / acta