Psoriasis therapy: problems and prospects
Annotation. Modern therapy of psoriasis is to contain the manifestations of the disease, the choice of treatment tactics depends on the severity of the course. However, the effectiveness of standardized complex therapy remains rather low and the results of treatment are unpredictable, which requires further study of ways to increase the effectiveness of psoriasis therapy. Aim – to evaluate the effectiveness of standard psoriasis therapy. An analysis of the effectiveness of standard therapy for psoriasis was carried out in 30 patients who were under the supervision of a dermatologist at the Vinnitsa Regional Clinical Dermato-Venereal Dispensary in 2019–2020. In addition to general clinical research methods, the patients were evaluated for the skin lesion index and the severity of the psoriatic process (PASI) and the quality of life was assessed – the dermatological index of quality of life (DLQI). Statistical processing of the study data was performed using the program Statistica® (StatSoft, Tulsa Oklahoma), using the Wilcoxon test, the difference between the mean m at p<0.05 was considered probable. The results obtained showed the existence of an empirical approach to therapy and the choice of topical and systemic drugs. The low efficiency of the used therapy tactics was also found, as indicated by the insignificant dynamics of the PASI and DLQI indicators. The PASI indicator decreased from 11.6 to 7.6 (p≥0.05), and the DLQI indicator decreased from 14 to 10 points (p≥0.05). In general, the indicators of the group corresponded to the average severity of the course of the disease when it is necessary to give preference to complex topical therapy with the addition of systemic drugs in some cases. However, the question of a rational combination of drugs that can enhance the basic therapy remains open. Thus, modern therapy of patients with psoriasis is insufficiently effective in controlling both the disease itself and in relation to the impact on the quality of life of patients. Insufficient effectiveness of existing treatment combinations requires further search for promising drugs.
2. Ministerstvo okhorony zdorovia Ukrainy. (2015). Nakaz MOZ Ukrainy vid 20.11.2015 r. № 762 “Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry psoriazi, vkliuchaiuchy psoriatychni artropatii” [Ministry of Health of Ukraine. (2015). Order of the Ministry of Health of Ukraine dated 20.11.2015 № 762 “On approval and implementation of medical and technological documents for standardization of medical care for psoriasis, including psoriatic arthropathy”]. Vziato z https://zakon.rada.gov.ua/rada/show/v0762282-15#Text.
3. Abrouk, M., Nakamura, M., Zhu, T. H., Farahnik, B., Koo, J., & Bhutani, T. (2017). The impact of PASI 75 and PASI 90 on quality of life in moderate to severe psoriasis patients. Journal of Dermatological Treatment, 28 (6), 488–491. DOI: 10.1080/09546634.2016.1278198.
4. Amatore, F., Villani, A. P., Tauber, M., Viguier, M., & Guillot, B. (2019). French guidelines on the use of systemic treatments for moderate‐to‐severe psoriasis in adults. J. Eur. Acad. Dermatol. Venereol., 33 (3), 464–483. doi: 10.1111/jdv.15340.
5. Arnold, T., Schaarschmidt, M‐L., Herrm, R., Fischer, J. E., Goerdt, S., & Peitsch, W. K.(2016) Drug survival rates and reasons for drug discontinuation in psoriasis. JDDG J. der Dtsch Dermatologischen Gesellschaft, 14 (11), 1089–1099. https://doi.org/10.1111/ddg.13152.
6. Arnone, M., Takahashi, M. D. F., Carvalho, A. V. E., Bernardo, W. M., Bressan, A. L., Ramos, A. M. C., … & Jaime, T. J. (2019). Diagnostic and therapeutic guidelines for plaque psoriasis – Brazilian Society of Dermatology. An. Bras. Dermatol., 94, 2 (1), 76–107. doi:10.1590/abd1806-4841.2019940211.
7. Augustin, M., & Radtke, M. A. (2019). Psoriasis: Epidemiology. In Harper's Textbook of Pediatric Dermatology. (pp. 343–349). https://doi.org/10.1002/9781119142812.ch27.
8. Burden‐Teh, E., Thomas, K. S., Ratib, S., Adaji, E., & Murphy, R. (2016). The epidemiology of childhood psoriasis: a scoping review. British Journal of Dermatology, 174 (6), 1242–1257. https://doi.org/10.1111/bjd.14507.
9. Egeberg, A., & Andersen, Y. M. F. (2020). Use of topical calcipotriol for identification of patients with psoriasis in administrative healthcare data – a validation study. Journal of the European Academy of Dermatology and Venereology, 34 (2), e90-e91. https://doi.org/10.1111/jdv.15991.
10. Gamble, C., Krishan, A., Stocken, D., Lewis, S., Juszczak, E., Doré, C., ... & Berlin, J. (2017). Guidelines for the content of statistical analysis plans in clinical trials. Jama, 318 (23), 2337–2343. doi:10.1001/jama.2017.18556.
11. Grine, L., de la Brassinne, M., Ghislain, P. D., Hillary, T., Lambert, J., Segaert, S., … & Lambert, J. (2020). A Belgian consensus on the definition of a treat-to-target outcome set in psoriasis management. Journal of the European Academy of Dermatology and Venereology: JEADV, 34 (4), 676–684. https://doi.org/10.1111/jdv.16104.
12. Ighani, A., Partridge, A. C. R., Shear, N. H., Lynde, C., Gulliver, W. P., Sibbald, C., & Fleming, P. (2019). Comparison of Management Guidelines for Moderate-to-Severe Plaque Psoriasis: A Review of Phototherapy, Systemic Therapies, and Biologic Agents. J. Cutan Med. Surg., 23 (2), 204–221. doi:10.1177/1203475418814234.
13. Kamiya, K., Kishimoto, M., Sugai, J., Komine, M., & Ohtsuki, M. (2019). Risk factors for the development of psoriasis. International Journal of Molecular Sciences, 20 (18), 4347. https://doi.org/10.3390/ijms20184347.
14. Korman, N. J. (2020). Management of psoriasis as a systemic disease: what is the evidence? The British journal of dermatology, 182 (4), 840–848. https://doi.org/10.1111/bjd.18245.
15. Michalek, I. M., Loring, B., & John, S. M. (2017). A systematic review of worldwide epidemiology of psoriasis. Journal of the European Academy of Dermatology and Venereology, 31 (2), 205–212. doi: 10.1111/jdv.13854.
16. Mikhaylov, D., Hashim, P. W., Nektalova, T., & Goldenberg, G. (2019). Systemic Psoriasis Therapies and Comorbid Disease in Patients with Psoriasis: A Review of Potential Risks and Benefits. The Journal of clinical and aesthetic dermatology, 12 (6), 46–54. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31360288/.
17. Poór, A. K., Brodszky, V., Péntek, M., Gulácsi, L., Ruzsa, G., Hidvégi, B., ... & Rencz, F. (2018). Is the DLQI appropriate for medical decision-making in psoriasis patients?. Archives of Dermatological Research, 310 (1), 47–55. https://doi.org/10.1007/s00403-017-1794-4.
18. Skutnik-Radziszewska, A., Maciejczyk, M., Fejfer, K., Krahel, J., Flisiak, I., Kołodziej, U., & Zalewska, A. (2020). Salivary Antioxidants and Oxidative Stress in Psoriatic Patients: Can Salivary Total Oxidant Status and Oxidative Status Index Be a Plaque Psoriasis Biomarker? Oxidative Medicine and Cellular Longevity, 2020, ID 9086024. https://doi.org/10.1155/2020/9086024.
19. Tsoi, L. C., Spain, S. L., Ellinghaus, E., & Elder, J. T. (2015). Enhanced meta-analysis and replication studies identify five new psoriasis susceptibility loci. Nature communications, 6, 7001. https://doi.org/10.1038/ncomms8001.
20. Wu, B., Muser, E., Teeple, A., Pericone, C. D., & Feldman, S. R. (2020). Treatment adherence and persistence of five commonly prescribed medications for moderate to severe psoriasis in a US commercially insured population. Journal of Dermatological Treatment, 1–8. DOI: 10.1080/09546634.2019.1687828.
21. Xiran Lin & Tian Huang. (2016). Oxidative stress in psoriasis and potential therapeutic use of antioxidants. Free Radical Research, 50 (6), 585–595. DOI: 10.3109/10715762.2016.1162301.
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