Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper

Abstract

Psoriasis is an immune-mediated inflammatory disease (IMID) which may have a major impact on a patient's life, especially when the disease is moderate to severe. There is evidence that treatment of psoriasis during the first years is conservative and frequently based on topical agents which rarely clear lesions. Treatment with systemic agents including biologics is often undertaken only when topical agents have proved unsuitable, even in patients with moderate to severe disease. However, there is evidence that in other IMIDs (rheumatoid arthritis and Crohn's disease), targeted systemic treatment given early in the treatment pathway may improve long-term patient outcomes. We hypothesize that a patient-centered therapeutic approach, undertaken early in the psoriasis treatment pathway (''early intervention'') with the goal of complete clearance, may improve control of cutaneous symptoms and may also modify disease course and burden. Critical points to address when designing an early intervention study would include: the definition of psoriasis disease activity; patient selection; intervention selection; and dosing strategies.

Secukinumab treatment in new‐onset psoriasis: aiming to understand the potential for disease modification – rationale and design of the randomized, multicenter STEPIn study

“…In addition, IL ‐17A induces the expression of IL ‐6 and IL ‐1ß which in turn trigger the differentiation of new IL 17+ effector cells in secondary lymphoid organs. This feed‐forward‐loop shifts the balance of the skin‐resident T‐cell population, increasing the pool of IL ‐17+ effector and IL ‐17+ T RM cells in the skin which then drive chronic and relapsing psoriasis …”

The effect of phototherapy on systemic inflammatory process in patients with plaque psoriasis

“…Produced both in the skin lesions and by circulating leukocytes, they mediate skin and systemic inflammation. Regarding psoriasis as chronic systemic inflammatory disease, therapeutic strategies should aim to achieve clearance of the skin lesions and a reduction of systemic inflammation in order to prevent the development of systemic psoriatic comorbidities [1,2,6]. It is still unclear, however, if systemic inflammation in psoriasis results from a spillover of inflammatory cytokines and activated immune cells from the skin into the circulation, or represent a psoriasis-related systemic inflammatory process of its own from genetic susceptibility or other factors.…”

“…Therefore, it is postulated that treatment of psoriasis should aim not only at a clearance of skin lesions but also reduce systemic inflammation. Early therapeutic intervention in patients with psoriasis may be beneficial and prevent the development of above mentioned systemic consequences [3,6].…”

A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

“…However, real‐life data show that time to optimal treatment is still too long and that persistence of the newest biologics is unexpectedly low and the complexity of psoriasis makes it a multimorbid condition, making management challenging. The hit‐hard‐and‐early strategy has been discussed . As a systemic inflammatory disease, psoriasis is plagued by comorbidities, including psoriatic arthritis and cardiovascular diseases that may reduce life expectancy .…”