Background: Little is known about the treatment outcomes of secukinumab in clinical practice, which differ from those in clinical trials. The effectiveness of biologics may differ in psoriasis patients with previous biologics exposure. The objective of this study was to investigate the real-world effectiveness and safety of secukinumab therapy and analyze subgroups stratified by reimbursement or prior biologic failure. Methods: This retrospective multicenter study collected data from a cohort of 118 consecutive patients who received secukinumab treatment between December 2015 and March 2018. Effectiveness was evaluated by degree of improvement in the Psoriasis Area and Severity Index (PASI) scores. Adverse events and reasons for discontinuation were also recorded. Results: The mean PASI improvement rate at weeks 4, 12, 24, and 36 was 63.5%, 77.7%, 78.7%, and 76.0%, respectively. Compared with reimbursed patients, nonreimbursed patients had a significantly lower baseline PASI and a shorter mean disease duration of psoriasis; they were more frequently biologic-naïve, had used less prior traditional antipsoriatic drugs and were more likely to be treated with secukinumab 150 mg. The effectiveness of secukinumab in nonreimbursed patients was superior despite higher discontinuation rates. Compared with patients without prior biologic failure, patients with prior biologic failure had a significantly lower mean PASI improvement at weeks 12, 24, 36, and 48. The decline in response rates to secukinumab tended to be more pronounced for patients who failed ustekinumab than tumor necrosis factor-α inhibitors. Moreover, the number of prior biologic failures was associated with a decreased response rate and increased likelihood of secondary loss of effectiveness of secukinumab therapy. Conclusion: In a real-life clinical setting, the characteristics of nonreimbursed patients receiving secukinumab treatment differed from those of reimbursed patients. The PASI improvement for secukinumab was substantial but lower than that in clinical trials. The number and classes of prior biologic failures impact the treatment response to secukinumab.

The association between vitiligo and hearing loss has been noted but the specific frequencies and degrees of hearing impairment remain unclear. The objective of this systematic review was to investigate the relationship between vitiligo and hearing thresholds at various specific frequencies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE and Embase for relevant studies from inception to 10th April 2021. Case-control studies, cross-sectional, or cohort studies that compared the frequency-specific hearing thresholds between vitiligo patients and age-matched non-vitiligo controls were included. There were neither language nor geographic limitations. We used the Newcastle-Ottawa Scale to assess the risk of bias of included studies.The DerSimonian and Laird random-effects model was utilized in meta-analyses due to expected clinical heterogeneity.We included 9 case-control studies with 371 vitiligo patients and 349 controls, which were rated with low or unclear risk.We found neither relevant cross-sectional nor cohort studies. The meta-analysis showed that when compared with controls, vitiligo patients had significantly higher pure-tone hearing thresholds at 2000, 4000, and 8000 Hz. In conclusions, vitiligo patients are prone to high-frequency sensorineural hearing loss.

The link between psoriasis and obstructive sleep apnea (OSA) has not been confirmed. We aimed to investigate the relationship between psoriasis and OSA. We conducted a systematic review and metaanalysis of case-control, cross-sectional, and cohort studies on the association between psoriasis and OSA. We searched MEDLINE and Embase for relevant studies on May 11, 2019. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of included studies. We performed random-effects model meta-analysis to calculate pooled odds ratio (ORs) with 95% confidence intervals (CIs) for case-control and cross-sectional studies as well as pooled incidence rate ratio (IRR) with 95% CIs for cohort studies in association between psoriasis and OSA. A total of 4 case-control or cross-sectional studies and 3 cohort studies with a total of 5,840,495 subjects were included. We identified a significantly increased odds for OSA in psoriasis patients (pooled OR 2.60; 95% CI 1.07-6.32), and significantly increased risk for psoriasis in OSA patients (pooled IRR 2.52; 95% CI 1.89-3.36). In conclusion, our study identified a bidirectional association between psoriasis and OSA. Sleep quality should be inquired in patients with psoriasis. Respirologist consultation or polysomnography may be indicated for those presenting with night snoring, recurrent awaking, and excessive daytime sleepiness. Psoriasis is a chronic inflammatory skin disease with characteristic feature of sharply circumscribed erythematous plaques with silvery scales on the trunk and limbs 1. The prevalence was estimated 0.5-11.4% in adults 2. Psoriasis is considered as a multisystemic disease involving proinflammatory cytokines such as tumor necrosis factor (TNF), interleukin (IL)-1, and IL-17 3,4. Various comorbidities have been linked to psoriasis including cardiovascular disease, metabolic syndrome, chronic kidney disease, uveitis, thyroid diseases, vitiligo, and inflammatory bowel disease 5-11. Obstructive sleep apnea (OSA), also called obstructive sleep apnea-hypopnea syndrome, is a chronic disorder of intermittent upper airway collapse during sleep resulting in recurrent hypoxia 12,13. OSA is characterized with night snoring, recurrent awaking, and excessive daytime sleepiness 14. The gold standard test for diagnosing OSA is polysomnography 15. The prevalence of OSA ranges from 3 to 17% 12. Risk factors of OSA include obesity, aging, male gender, anatomical predisposition, and alcohol consumption 12,13. OSA induces systemic inflammatory and increases the risk of hypertension, stroke, cardiovascular disease, and metabolic disorder, in particular of diabetes mellitus type 2 and metabolic syndrome regardless of the obesity 15-17. Psoriasis and OSA share a common pathogenesis of inflammatory and immune imbalance 18,19. The association between psoriasis and OSA has been examined in many studies but the results were limited and inconsistent 20-27. The objective of this study was to assess the evidence regarding the bidirectional association between psoriasis and OSA. Methods ...

Background: Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been unclear. Therefore, we aimed to investigate this association between AA and SNHL. Methods: We performed a systematic review and searched MEDLINE and Embase on July 25, 2022 for cross-sectional, case-control, or cohort studies that examined the association of AA with SNHL. The Newcastle–Ottawa Scale was used to evaluate their risk of bias. A random-effects model meta-analysis was performed to obtain the mean differences in frequency-specific hearing thresholds between AA patients and age-matched healthy controls and the pooled odds ratio for SNHL in relation to AA. Results: We included five case-control studies and one cohort study, with none of them rated with high risk of biases. The meta-analysis showed AA patients had significantly higher mean differences in pure tone hearing thresholds at 4000 Hz and 12000-12500 Hz. The meta-analysis also found increased odds for SNHL among patients with AA (OR 3.18; 95% CI 2.06-4.89; I2 = 0%). Conclusions: AA is associated with an increase of SNHL, especially at high frequencies. Otologic consultation may be indicated if AA patients present with hearing loss or tinnitus.

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Background The relation between psoriasis and hearing loss has been unclear. Objective To investigate the association of psoriasis with hearing loss. Methods We searched MEDLINE and Embase on 12th November 2022 for studies on the association between psoriasis and hearing loss. We conducted a random-effects model meta-analysis to calculate pooled mean difference (MD) in the pure tone thresholds, pooled odds ratio for sensorineural hearing loss, and pooled hazard ratio for sudden sensorineural hearing loss related to psoriasis. Results We included 12 case-control/cross-sectional and 3 cohort studies with 202,683 subjects. Psoriasis was associated with hearing loss at 500 Hz (pooled MD 2.21, 95% CI (CI) 0.13 to 4.29), 1000 Hz (pooled MD 2.97, 95% CI 1.01 to 4.93), 2000 Hz (pooled MD 5.13, 95% CI 2.45 to 7.82), 4000 Hz (pooled MD 9.3, 95% CI 5.1 to 13.51), and 6000 Hz (pooled MD 11.04, 95% CI 5.05 to 17.03). Patients with psoriasis had increased odds for sensorineural hearing loss (pooled odds ratio 3.85, 95% CI 1.07-13.9) and risk for sudden sensorineural hearing loss (pooled hazard ratio 1.45; 95% CI 1.22-1.71). Conclusion Psoriasis is associated with hearing loss, especially at high frequencies.

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