Description: Background The burden of psoriasis across many world regions is high and there is a recognised need to better understand the epidemiology of this common skin disorder. Objectives To examine changes in the prevalence and incidence of psoriasis, and mortality rates over a 15 year period. Methods Cohort study involving analysis of longitudinal electronic health records between 1999 and 2013 using the UK Clinical Practice Research Datalink (CPRD). Results The prevalence of psoriasis increased steadily from 2.3% (2297 cases per 100,000) in 1999 to 2.8% (2815 per 100,000) in 2013, which does not appear to be attributable to changes in incidence rates. We observed peaks in age-bands characteristic of early (type I) and late-onset (type II) psoriasis, and changes in incidence and prevalence rates with increasing latitude in the UK. All-cause mortality rates for the general population and for patients with psoriasis have decreased over the last 15 years. However, the risk of all-cause mortality for psoriasis patients remains elevated compared to people without psoriasis (hazard ratio (HR) 1.21; 95% CI 1.13-1.3) and we found no significant change in this relative excess mortality gap over time. Conclusions We found an increasing population living longer with psoriasis in the UK which has important implications for healthcare service delivery and for resource allocation. Importantly, early mortality in patients with psoriasis remains elevated compared to the general population and we found no evidence of change in this premature mortality gap. This article is protected by copyright. All rights reserved.

Description: We would like to thank Drs Amin, No and Wu for their interest in our recent publication. 2 We are pleased to note, in particular, how much we agree on one fundamental point - there is a need for future well-designed studies that involve larger numbers of patients and longer durations of treatment exposure in order to better assess the impact of biologic therapies on the risk of major adverse cardiovascular events (MACEs) in patients with psoriasis. This article is protected by copyright. All rights reserved.

Description: Psoriasis is associated with considerable physical and psychological morbidity. Optimal use of psoriasis treatments can limit the physical manifestations of psoriasis and help improve quality of life, but non-adherence is common. Smoking, obesity and excessive alcohol consumption are prevalent in this population. A systematic review of adherence to medication and recommendations for lifestyle change in psoriasis was undertaken, with a critical appraisal of the quality of selected studies. Electronic searches from inception to March 2012 (PubMed, Web of Science and EMBASE) were conducted. Twenty nine studies were included, however, none examined adherence to advice about lifestyle change. Studies using a dichotomous classification of adherence tended to report sub-optimal adherence, with 21.6% - 66.6% of patients classed as adherent. No consistent pattern of results emerged for socio-demographic, disease and lifestyle factors as determinants of adherence. However, some treatment factors were associated with adherence. Whilst mixed findings were reported for quality of life as a determinant of adherence, psychological factors (psychological distress and patient satisfaction with care / therapy) were associated with adherence. Only tentative conclusions can be made for determinants of adherence because the methodological quality of many of the included studies limits conclusions. There is a need for improved research quality and reporting in this area and this review provides a platform from which future research within this area should progress with suggested research recommendations.

Description: Background Medication non-adherence is known to limit the effectiveness of available therapies, however little is known specifically about medication adherence in people with psoriasis. Medicines self-management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing non-adherence to medication as an outcome of limited personal coping resources and conflicting goals may help explain medication non-adherence Objective To explore individuals’ perspectives of their psoriasis, medication and its management. Methods Twenty people with psoriasis were recruited from community samples in England and interviewed in-depth about their perceptions of their psoriasis, medication, and adherence to medication and self-management advice. Data were analysed using Framework Analysis. Results Participants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self-reported adherence which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants’ self-management difficulties was viewed as an additional source of stress and distress. Conclusions Adhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of non-adherence to psoriasis medication as rational attempts by individuals to minimise distress and to gain control over their life. This article is protected by copyright. All rights reserved.

Description: Background Concerns have been raised regarding an increased risk of major adverse cardiovascular events (MACEs) (myocardial infarction, cerebrovascular accident, or cardiovascular death) in patients treated with anti-interleukin (IL)-12/23 agents for moderate-to-severe psoriasis. Objective To examine the risk of MACEs in adult patients with plaque psoriasis that are exposed to biologic therapies via a meta-analysis of randomised controlled trials (RCTs). Methods (i) Data sources: Systematic searches were performed in the Cochrane Library, MEDLINE and EMBASE, US Food and Drug Administration, European Medicines Agency, individual pharmaceutical companies online search platforms and 5 trials registers (until 31 March 2016). (ii) Study selection: RCTs reporting adverse events in adults with plaque psoriasis receiving at least one licensed dose of biologic therapy, conventional systematic therapy or placebo (iii) Data synthesis: Peto odds ratios (OR) with 95% confidence intervals (CI) were calculated and I 2 statistics were used to assess heterogeneity using RevMan5.3. Results Overall, 38 RCTs involving 18,024 patients were included. No MACEs were observed in 29 studies, while 9 RCTs reported 10 patients experiencing MACEs. There was no statistically significant difference in risk of MACEs associated with the use of biologic therapies overall (OR 1.45, 95%CI 0.34–6.24); tumour necrosis factor α inhibitors (adalimumab, etanercept and infliximab) (OR 0.67, 95%CI0.10–4.63); anti-IL-17A agents (secukinumab and ixekizumab) (OR1.00, 95CI% 0.09-11.09) or ustekinumab (OR4.48, 95%CI0.24–84.77). No heterogeneity was observed in these comparisons. Conclusions The limited existing evidence suggests that licensed biologic therapies are not associated with MACEs during the short randomised controlled periods in clinical trials. This article is protected by copyright. All rights reserved.