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5 th World Psoriasis & Psoriatic Arthritis Conference 2018
non-switch discontinuation was experienced by 63.8 % of patients, switch to another biologic by 15.1 %, above label dosing by 11.5 %, and add-on treatment by 9.7 %. Overall, the mean time from initiation of 1st line treatment to IR event was 4.7 months, ranging from 4.3 months to add-on therapy and 5.7 months for patients switching to another biologic. Among patients switching to another biologic, 70.3 % of patients were persistent on the new biologic after three months versus 54.0 % after 6 months. The most frequent add-on therapies were immunosuppressive drugs( 63.8 %) followed by systemic corticosteroids( 20.6 %), and biologics( 15.5 %). Conclusions: IR in 1st line PSO biologic treatment is common with non-switch discontinuation being the most frequent. This highlights an opportunity to optimize treatment options currently available and better understand patients’ needs for successful therapy. Therapeutic options with improved durability may provide a clinically meaningful path to optimizing psoriasis management. Further analysis is necessary to identify underlying causes of IR and to guide more effective approaches to treatment. Acknowledgements: This study was supported by UCB Pharma.
P089 BARRIERS OF GUIDELINE-COMPLIANT CARE FOR PSORIASIS IN GERMANY – RESULTS OF THE
EUROPEAN STUDY PSOBARRIER Matthias Augustin, Anna Langenbruch, Marc Radtke, Nicole Zander University Medical Center Hamburg-Eppendorf
Introduction & Objectives: A series of nation-wide studies in Germany over the last years has focused on the quality of psoriasis care. It was found that a significant proportion of psoriasis patients is not treated according to the national guideline1. Similar underprovision of care has been identified in other countries as well, reflected by patients’ dissatisfaction with the management of their disease2. This study aims to identify these barriers of guidelinecompliant healthcare for psoriasis in Europe. Materials & Methods: The study assesses barriers and quality of health care in a multi-centre, cross-sectional study design. Participating centres in five European countries( Denmark, Poland, Spain, United Kingdom, and Germany) aim to represent the range of dermatological health care-providing outpatient facilities of the respective country. The current analysis includes the data collected in Germany from January 2016 to May 2017. Results: Data of n = 497 patients were analysed. Mean age was 49.7 years, 41.4 % were female. Mean PASI was 7.2 ± 9.2, 20.9 % had a PASI > 10. The mean DLQI was 6.2 ± 6.7. 27.0 % were currently treated with systemics( excluding biologics), 22.3 % with biologics. Since the diagnosis of psoriasis, the participants consulted on average 3.0 ± 2.3 different dermatologists( min 0 / max 27) and had 3.5 ± 3.7 therapy changes. For 32.0 % of the patients the time between the first skin changes and the first diagnosis of psoriasis was one year or longer. 7.6 % stated that their health insurance turned down a therapy, treatment or referral that was recommended by a physician at least once. Conclusions: The quite high numbers of consultations of different dermatologists, therapy changes and therapies turned down indicate that there might be barriers in psoriasis care. The generated data facilitate measures for an improved patient access to systemic drugs and biologics. The European comparison will allow for the first time the direct description of psoriasis care in a wide variety of European countries. The matching of patient-reported outcomes with data of the health care system and barriers from the physician’ s perspective is a novelty worldwide and the results will contribute to developing strategies to overcome these barriers. References: 1 Augustin M, Schäfer I, Reich K, Glaeske G, Radtke MA. Systemic treatment with corticosteroids in psoriasis--health care provision far beyond the S3-guidelines. J Dtsch Dermatol Ges. 2011; 9:833 – 38. 2 Dubertret L, Mrowietz U, Ranki A, van de Kerkhof, P C M, Chimenti S,
Lotti T, et al. European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey. Br J Dermatol. 2006; 155:729 – 36.
P090 INDIVIDUALISED THERAPY FOR PSORIASIS- CASE
SERIES Seema Mahesh 1, Viraj Shah 2, Mahesh Mallappa 1, George Vithoulkas 3 1
Centre For Classical Homeopathy, 2 Shah Homeopathic Clinic, 3 International Academy of Classical Homeopathy
Introduction: Psoriasis and its complications are still a challenge to clinicians. The autoimmune disorder though targeting the skin, involves the immune system as a whole. The inflammatory component in the pathogenesis of psoriasis has further established the role of aberrant immune system in the process [ 1, 2, 3 ]. Homeopathy addresses every individual’ s peculiar combination of genetic and epigenetic causative factors in the development of such auto immune diseases [ 4, 5 ]. Therefore it may be considered as a therapy where integrated approach is indicated. Case series: 5 cases of psoriasis are presented, two of which were in erythrodermic state [ one also with sepsis superimposed ]. Through monitoring of blood markers and documenting on photos and videos the effect of individualised homeopathic therapy on psoriasis and its complications is demonstrated. The theory of Levels of Health can explain the variety in the presentation of psoriasis and response to treatment in terms of the time taken and number of remedies required. The same theory also helps to assess the prognosis and comprehend the response to treatment [ LOH ]. With the help of the evidence of these cases we may formulate a larger study to ascertain the extent to which classical homeopathy may be employed in psoriasis. Conclusions: These cases depict the potential for homeopathy in alleviating the suffering of patients with psoriasis if applied as individualised therapy and give grounds to further conduct controlled studies to confirm the role of homeopathy in psoriatic therapy. References: 1. Boyd A, Menter A. Erythrodermic psoriasis. Journal of the American Academy of Dermatology. 1989; 21( 5): 985-991. 2. Chandra A, Ray A, Senapati S, Chatterjee R. Genetic and epigenetic basis of psoriasis pathogenesis. Molecular Immunology. 2015; 64( 2): 313-323. 3. Reich K. The concept of psoriasis as a systemic inflammation: implications for disease management. Journal of the European Academy of Dermatology and Venereology. 2012; 26:3-11. 4. Vithoulkas G, Tiller W. The science of homeopathy. Athens: International Academy of Classical Homeopathy; 2009. 5. Vithoulkas G. Levels of health. Alonissos: International Academy of Classical Homeopathy; 2017.
P091 A UNIQUE CLINICAL CASE OF PSORIATIC ARTHRITIS
AND RELAPSING POLYCHONDRITIS Elena Gubar, Alla Godzenko, Tatiana Korotaeva Nasonova Research Institute of Rheumatology, Moscow
Introduction: Relapsing polychondritis( RP) is a rare systemic autoimmune disorder affecting the cartilaginous structures of the body and resulting in their destruction. In the literature available we didn’ t find any references to RP occurring together with psoriatic arthritis( PsA). Objective: to demonstrate a rare clinical case of RP and PsA. Methods: Patient( pt)( female), 29 y. o., complained of pain, swelling, and hyperemia of both ears, pain in the joints, in heels and toes and pain in cervical spine. Scalp psoriasis( Ps) and Ps in the external ear canal occurred in April, 2017, nail Ps and dactilitis in October, 2017; in November, asymmetrical polyarthritis, pain in heels, pain and limitation of movement in cervical spine developed. Besides the pt noticed redness, swelling and pain in pinnas of both ears and impairment of hearing; conjunctivitis, stomatitis and subfebrile temperature developed. www. medicaljournals. se / acta