M.A.M. Berends

Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: Fibrotest predicts the presence and Fibroscan predicts the absence of significant liver fibrosis.

Background: Methotrexate (MTX) use is associated with hepatic fibrosis in psoriasis patients. To monitor this serial liver biopsies were performed. The Fibroscan® and the Fibrotest are two novel, non‐invasive methods that might be able to assess MTX‐induced hepatic fibrosis.

Liver injury in long-term methotrexate treatment in psoriasis is relatively infrequent.

Methotrexate‐induced liver damage in psoriasis has led to dermatologic guidelines that stipulate monitoring of liver injury by means of serial liver biopsies. Recent literature data suggest that methotrexate may be considerably less hepatotoxic than previously assumed.

Comparison of the 1- and 5-year effectiveness of adalimumab, etanercept and ustekinumab in patients with psoriasis in daily clinical practice: results from the prospective BioCAPTURE registry

The efficacy of etanercept and ustekinumab in psoriasis has been compared in one randomized controlled trial. Comparison of the long‐term effectiveness of biologics in daily‐practice psoriasis treatment is currently lacking.

Body mass index predicts discontinuation due to ineffectiveness and female sex predicts discontinuation due to side-effects in patients with psoriasis treated with adalimumab, etanercept or ustekinumab in daily practice: a prospective, comparative, long-term drug-survival study from the BioCAPTURE registry.

Predictors for successful treatment are important for personalized medicine. Predictors for drug survival of biologics in psoriasis have been assessed, but not split for different biologics or for the reason of discontinuation.

Relevance of compartmentalization of T‐cell subsets for clinical improvement in psoriasis: effect of immune‐targeted antipsoriatic therapies

Background  Therapies targeting the T cell‐mediated pathology of psoriasis have been found to achieve remarkable clinical improvement and have confirmed the crucial role of the immune system either in peripheral blood (PB) or in skin. No analyses of T‐cell counts in both compartments have been conducted in order to confirm or refute the hypothesized shifts between them.

Dermatologists’ Adherence to the Guideline of the Dutch Society of Dermatology and Venereology with Respect to the Treatment with Methotrexate for Severe Chronic Plaque Psoriasis: Results from a Dutch Survey

Background: In 2003, the Dutch guideline ‘Photo(chemo) therapy and systemic therapy for severe chronic plaque psoriasis’ was established. Objectives: To document how closely this guideline is followed in clinical practice with respect to the methotrexate (MTX) treatment and to formulate recommendations to adjust the guideline. Methods: A survey was conducted among Dutch dermatologists and residents in dermatology. The questionnaire assessed the knowledge of and the adherence to the guideline with respect to MTX treatment. Results: Fifty percent of the contacted dermatologists/residents responded. Fifty-two percent follow the guideline with respect to MTX. Liver biopsy and the frequency of blood investigations cause a discrepancy between guideline and reality. There is a lack of consensus between guidelines of the different specialisms concerning liver biopsy. Conclusion: The need for liver biopsies in combination with the frequent check-ups and the lack of consensus between rheumatologists, hepatologists and dermatologists seem to restrict the adherence to the guideline.

Good clinical response to anti-psoriatic treatment with adalimumab and methotrexate does not inflict a direct effect on compartmentalization of T-cell subsets: A pilot study

Objectives: The most recently introduced therapeutics for psoriasis are biologicals which can target the T‐cell‐mediated pathology of psoriasis in a direct or indirect manner. The present pilot study focuses on and compares the effect of a conventional systemic agent (methotrexate; MTX) with the effect of a TNF‐binding biological (adalimumab) on psoriasis‐associated T‐cell subsets in peripheral blood (PB) and lesional skin. Insight is provided in the hypothesized compartmentalization of these T‐cell subsets between PB and the cutaneous compartment. Methods: Immunohistochemical stainings of designated T‐cell subsets on psoriatic skin sections were performed and similar subsets were isolated from PB specimens by flow cytometry. These counts were correlated with clinical severity. Results: Results showed that adalimumab had a greater clinical effect than MTX treatment after 12 weeks. In the dermis, only the CD3+ T cells were significantly reduced after 12 weeks of adalimumab therapy, whereas for MTX only CD3+ T cells in the epidermis and CD45RO+ T cells in the dermis reduced significantly. However, PB T‐lymphocyte populations did not show significant shifts in quantification of T‐cell subsets. Conclusion: Therefore, recompartmentalization of psoriasis‐associated T‐cell subsets between PB and lesional skin was not induced in this study as a therapeutic principle. Consequently, recompartmentalization of T‐cell subsets does not seem an obligatory event in order to achieve good clinical response.

The journey of adult psoriasis patients towards biologics: past and present ‐ Results from the BioCAPTURE registry

A considerable disease period often precedes initiation of a biologic in patients with psoriasis. Little is known about this important period in patients’ lives. Evaluation of this ‘journey’ can reveal important insights and opportunities for physicians and healthcare decision makers.