Psoriasis Research Today is a free monthly online journal that collates and summarizes the latest research about Psoriasis, including details on treatment, prevention, medication, causes.

Efficacy of ISA247 in plaque psoriasis: a randomised, multicentre, double-blind, placebo-controlled phase III study.

Papp K, Bissonnette R, Rosoph L, Wasel N, Lynde CW, Searles G, Shear NH, Huizinga RB, Maksymowych WP

Probity Medical Research, Waterloo, ON, Canada. kapapp@probitymedical.com

BACKGROUND: The use of systemic calcineurin inhibitors for the treatment of patients with psoriasis is limited by toxicity, particularly nephrotoxicity. ISA247, a novel inhibitor, was effective and well tolerated in a phase II study of patients with plaque psoriasis. Therefore its efficacy was assessed in this phase III study. METHODS: 451 patients aged 18-65 years with plaque psoriasis involving at least 10% of the body surface area were randomly assigned in equal proportions to receive placebo or ISA247 at 0.2 mg/kg, 0.3 mg/kg, or 0.4 mg/kg orally twice a day in dermatology clinics. The primary endpoint was a 75% reduction in the psoriasis area and severity index (PASI 75) score at week 12. Treatment allocation was concealed from patient and physicians doing the assessments by use of sealed envelopes. The method of analysis was by modified intention to treat. The trial is registered at ClinicalTrials.gov, number NCT00244842. FINDINGS: 107, 113, and 116 patients were assigned to the ISA247 0.2 mg/kg, 0.3 mg/kg, and 0.4 mg/kg groups, respectively, and 115 to the placebo group. At week 12, PASI 75 scores were achieved in the ISA247 0.2 mg/kg, 0.3 mg/kg, and 0.4 mg/kg groups by 14 (16%; 95% CI 9-24) of 105, 26 (25%; 17-24) of 111, and 44 (47%; 27-57) of 113 patients, respectively, and in the placebo group by 4 (4%; 0-8) of 113 patients. Efficacy was maintained during 24 weeks. Mild to moderate glomerular filtration rate reductions were noted in seven patients in the ISA247 0.4 mg/kg group and in one in the ISA247 0.3 mg/kg group. ISA247 blood concentrations showed a strong correlation with mean percentage reduction in PASI. INTERPRETATION: ISA247 was safe and effective in the treatment of patients with moderate to severe psoriasis during 24 weeks, with the highest dose providing the best efficacy. The strong correlation between ISA247 concentrations and efficacy might allow for accurate dosing of patients compared with existing calcineurin inhibitors.

Published 21 April 2008 in Lancet, 371(9621): 1337-42.
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Articles on Psoriasis published 28 March 2008:

Perioperative management of medications for psoriasis and psoriatic arthritis: a review for the dermasurgeon.   Dermatol Surg, 34(4): 446-59.

BACKGROUND: Psoriasis affects an estimated 3% of the world's population. Many are on chronic immunosuppressive therapy for the cutaneous and joint manifestations of this disorder. The management of these medications in the perioperative period is controversial. Psoriasis and psoriatic arthritis medications can affect wound healing, hemostasis, and infection risk during cutaneous surgery. OBJECTIVES: The objective of this article is to provide a critical review of various medications used for ... [Abstract] [Full-text]

Articles on Psoriasis published 26 March 2008:

Botulinum toxin type-A for the treatment of inverse psoriasis.   J Eur Acad Dermatol Venereol, 22(4): 431-6.

OBJECTIVE: To evaluate the efficacy of botulinum toxin type-A (BoNTA) for the treatment of inverse psoriasis. BACKGROUND: The use of BoNTA in inverse psoriasis would be a novel approach compared with conventional treatments and may act at the neuroglandular junction level to reduce local sweating with its consequent skin maceration and secondary infection and at the extra-junction level to inhibit the liberation of neuropeptides and other pro-algogenic substances responsible for inflammation, ... [Abstract] [Full-text]

Haptoglobin from psoriatic patients exhibits decreased activity in binding haemoglobin and inhibiting lecithin-cholesterol acyltransferase activity.   J Eur Acad Dermatol Venereol, 22(4): 417-25.

OBJECTIVE: The aim of this work was to assess whether psoriasis is associated with phenotype prevalence and altered activity of haptoglobin (Hpt). BACKGROUND: Hpt is a plasma acute-phase glycoprotein, displaying in humans three phenotypes. Phenotype prevalence or structure modification of Hpt was associated with several diseases. The Hpt main function is to bind and carry to the liver free haemoglobin for degradation and iron recycling. Hpt was recently found able to bind the apolipoprotein A-I ... [Abstract] [Full-text]

Peripheral blood eosinophilia in association with generalized pustular and erythrodermic psoriasis.   J Eur Acad Dermatol Venereol, 22(4): 451-5.

BACKGROUND: In recent studies, it has been documented that the eosinophil cells play active role in many kinds of inflammatory disorders. Measurements of the mediators released by eosinophils and cell counts in serum and skin have provided some evidence indicating the role of eosinophils in psoriasis. OBJECTIVE: To evaluate the blood eosinophil cell count in patients with erythrodermic psoriasis and generalized pustular psoriasis. METHODS: In this study, 48 patients with histopathologically ... [Abstract] [Full-text]

Articles on Psoriasis published 24 March 2008:

Histopathologic study of scalp psoriasis: peculiar features including sebaceous gland atrophy.   Am J Dermatopathol, 30(2): 93-100.

In a study on scalp psoriasis of 19 patients (11 males and 8 females, 15-64 years of age, psoriasis area severity index partial score of the head ranging from 0.5 to 2.8), we came to notice that, apart from the classical criteria for the diagnosis of psoriasis which were present in all cases, in a majority of patients, sebaceous glands were extremely reduced in size. We compared findings of follicular counts and sebaceous glands with a nonpsoriatic group of individuals (n = 26). Ten cases from ... [Abstract] [Full-text]

Articles on Psoriasis published 20 March 2008:

Etanercept.   Expert Opin Biol Ther, 8(4): 491-502.

BACKGROUND: In some patients with psoriasis the inflammatory process fueling skin lesions also afflicts their joints in a condition called psoriatic arthritis. TNF-alpha has been shown to play a central role in the pathogenesis of both cutaneous and joint disease. Etanercept is a soluble fusion protein that binds TNF-alpha, rendering the molecule inactive and making etanercept an effective, targeted therapeutic option for many TNF-mediated inflammatory diseases. OBJECTIVE: To review the key ... [Abstract] [Full-text]

Articles on Psoriasis published 17 March 2008:

An open-label study evaluating the efficacy and tolerability of alefacept for the treatment of scalp psoriasis.   J Am Acad Dermatol, 58(4): 609-16.

BACKGROUND: Almost 50% of patients with psoriasis also have scalp psoriasis. Although alefacept is safe and effective for the treatment of generalized plaque psoriasis, its efficacy specifically for treating scalp psoriasis has not been formally evaluated. OBJECTIVE: We sought to evaluate the efficacy and tolerability of alefacept in treating scalp psoriasis. METHODS: Patients (n = 30) with psoriatic plaques covering 30% or more of scalp surface received 15 mg of intramuscular alefacept once ... [Abstract] [Full-text]

Oral curcumin in the treatment of moderate to severe psoriasis vulgaris: A prospective clinical trial.   J Am Acad Dermatol, 58(4): 625-31.

BACKGROUND: There is a need for safe, inexpensive, and effective psoriasis therapies. Many anecdotal accounts of patients' successful treatment with the alternative medicine curcumin exist. OBJECTIVE: We sought to determine the safety and efficacy of oral curcumin in patients with psoriasis. METHODS: We conducted a phase II, open-label, Simon's two-stage trial of 4.5 g/d of oral curcuminoid C3 complex in patients with plaque psoriasis. End points included improvement in Physicians Global ... [Abstract] [Full-text]

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