1. Welcome to Hyatt Regency Bethesda Saturday, June 27, 2015
www.psoriasis.org Triggers, Treatments & You
2. This activity is supported by an educational donation
provided by: www.psoriasis.org The National Psoriasis Foundation is
solely responsible for all content and development of this program.
AbbVie, Inc. Amgen, Inc. Celgene Corporation Janssen BioTech, Inc.
Novartis Pharmaceuticals, Inc.
3. Reminders www.psoriasis.org Cell phones Restrooms Questions
Evaluation form
4. Our mission: to drive efforts to cure psoriatic disease and
improve the lives of those affected Improve access to care Expand
knowledge of psoriatic diseaseNationalPsoriasisFoundation 2015:
$1.6 million Increase research www.psoriasis.org
5. Psoriatic Arthritis (PsA) Project www.psoriasis.org Largest,
most comprehensive realignment and expansion of its psoriatic
arthritis program since the Foundation began Goals include: Reduce
the average time of diagnosis Improve PsA outcomes for people with
the disease Expand the PsA research community
6. Advocacy and Government Relations Priorities Learn more at:
psoriasis.org/advocacy Promote federal research efforts and ensure
individuals living with psoriatic diseases have fair and affordable
access to needed treatments. The 2015 advocacy agenda priorities:
Growing the federal investment in psoriatic disease research
Building on the psoriasis and psoriatic arthritis public health
efforts at the CDC Reducing treatment barriers (including cost)
Ensuring affordable access to new treatments
7. Join us Team NPF Walk Washington, D.C. occurs Sunday,
September 27th at Lincoln Memorial Reflecting Pool
www.psoriasis.org Visit: www.teamnpf.org/DCwalk
8. Join us Team NPF Cycle Inaugural Ride Saturday, August 15,
2015 Unionville Vineyards, Ringoes, NJ www.psoriasis.org For more
information contact: Robert Grabel at [email protected]
9. What You Will Learn Today About common psoriasis and
psoriatic arthritis triggers The latest research to help reduce
itch, pain and swelling Treatment strategies and how to determine
the best options for you www.psoriasis.org
10. Triggers, Treatments & You Ronald Prussick, M.D.,
F.R.C.P.C., F.A.A.D. www.psoriasis.org Medical Director, Washington
Dermatology Center Rockville and Frederick, MD Assistant Clinical
Professor of Dermatology George Washington University Washington,
D.C.
11. Disclosures Dr. Prussick www.psoriasis.org The National
Psoriasis Foundation is solely responsible for all content and
development of this program. I have the following financial
relationships to disclose: Consultant: Immunotec, Inc., Medimetriks
Pharmaceuticals, Inc. Speakers Bureau: AbbVie, Inc., Celgene
Corporation, Janssen Biotech, LOreal/Galderma Laboratories, L.P.
Volunteer Member: Medical Board, National Psoriasis Foundation
12. Psoriatic Disease: What We Know www.psoriasis.org Chronic,
inflammatory disease of the skin and/or joints Causes rapid
turnover of skin cells (10 times faster than normal) Periods of
intense flares of the disease causing pain and itch May cause
persistent warmth and swelling (inflammation) around a joint
Related inflammation is associated with other health
conditions
13. Why does psoriatic disease occur? www.psoriasis.org Reason
not entirely known Known players: Dendritic cells Mast cells
TNF-alpha proteins Interleukin (IL) 17 Interleukin (IL) 12/23
Current model of psoriasis pathogenesis Journal of the American
Academy of Dermatology
http://www.jaad.org/article/S0190-9622(14)01001-9/pdf
14. Current Research: Why You Flare www.psoriasis.org Dendritic
cells (DCs) are a type of immune cell that play a role in psoriatic
disease One kind of DCs, Plasmacytoid dendritic cells might trigger
new psoriasis flares Plasmacytoid DCs are increased in psoriatic
skin A different kind of DC, Langerhan cells are decreased in
psoriatic skin. This decrease allows pro-inflammatory cytokines to
increase
15. Current Research: Why You Itch www.psoriasis.org Itch is
present in between 70 and 90 percent of people with psoriasis Itch
is associated with receptors that send a signal through fibers in
the skin to your spinal cord and to the brain Identified itch
receptors include: NGF (Nerve growth factor) TrkA (Tyrosine protein
kinase) TRPV1 (Transient receptor potential vaniliod 1)
16. Triggers of psoriatic disease www.psoriasis.org
17. Psoriasis Triggers www.psoriasis.org Medications: Lithium
Inderal, ACE inhibitors, beta-blockers Antimalarials Acute
withdrawal of systemic or potent corticosteroids Prednisone
18. Psoriasis Triggers www.psoriasis.org Infections: Strep
throat Respiratory infections Staph Thrush (yeast infection in the
mouth) Yeast Earache AlexanderRaths,123RFStockPhoto
19. Triggers: What You Can Do www.psoriasis.org Medications: If
you suspect a medication is irritating your skin, talk with your
provider about other treatment options Infections: Obtain treatment
for the infection to help calm or keep your psoriasis in
control
20. Psoriasis Triggers www.psoriasis.org Injury to the skin
(Koebner Response): Cuts, scrapes, scratches Poison ivy or poison
oak Bruises Sunburns Bug bites Tattoos Vaccinations or acupuncture
Constant pressure and rubbing Injury -> inflammation and
psoriatic arthritis
21. Triggers: What You Can Do www.psoriasis.org Injury to the
skin: Be careful when you know your psoriasis is active Treat
injuries quickly. Dont pick or scratch bites or scabs Use sunscreen
Talk with your provider prior to receiving a vaccine
22. Psoriasis Triggers www.psoriasis.org Alcohol Smoking
Hormones Psoriasis severity fluctuates with hormonal changes May
improve during pregnancy but become worse after pregnancy Frequency
peaks during puberty and menopause ArveBellum,123RFStockPhoto
23. Triggers: What You Can Do www.psoriasis.org Stop or limit
use of alcohol Stop smoking Hormonal changes may mean talk with
your provider about changing your psoriasis treatment options
IvanMateev,123RFStockPhoto
24. Psoriasis and Psoriatic Arthritis Triggers
www.psoriasis.org Stress Cause onset or aggravate psoriasis
symptoms Itch Pain Weather Cold, dry weather causing dry skin and
inflammation
25. Triggers: What You Can Do www.psoriasis.org Stress Try
meditating, mindfulness therapy or Tai Chi to relax Spa therapy
Connect with others who understand Weather Stay warm, place heating
pads over painful joints, wear gloves Try non-weight-bearing
exercises to improve joint function
CathyYeulet,123RFStockPhoto
26. Lifestyle Changes: What You Can Do www.psoriasis.org Eat a
balanced diet and watch your weight Helps decrease your risk of
serious health conditions Losing weight reduces pressure on joints
Eat plenty of fruits, vegetables, whole grains and fiber Decrease
amounts of processed or refined carbohydrates Choose foods low in
added sugar Be active with at least 30 minutes of moderate
exercise, five times a week
27. Treat Your Psoriasis and Psoriatic Arthritis
www.psoriasis.org
28. Purpose of treatment www.psoriasis.org Alleviate symptoms
Reduce inflammation Reduce risk of psoriatic arthritis and other
health conditions Slow progression of psoriatic disease Help
improve self image Decrease commorbidities
TracyHebden,123RFStockPhoto
29. Factors that impact treatment choices www.psoriasis.org
Disease severity in relation to: Body surface area Psoriasis area
and severity index (PASI) Duration Quality of life Treatment is
considered effective if achieving PASI reduction of 75 percent or
more
30. Assessing Severity of Psoriasis www.psoriasis.org
31. Factors that impact treatment choices www.psoriasis.org
Prior treatments Potential side effects Individual preferences and
treatment strategies Joint involvement (i.e. psoriatic arthritis)
Access to treatment, cost and insurance coverage If needed -
financial assistance programs, discount cards, co-pay assistance
programs are available to help For resources:
www.psoriasis.org/financial-assistance
32. Factors that impact treatment choices www.psoriasis.org
Other health risks: Cardiovascular disease Metabolic syndrome (i.e.
diabetes, high blood pressure, high cholesterol) Family history of
cancer/lymphoma History of liver disease, tuberculosis
Atherosclerosis
33. Ultimately treatment choices www.psoriasis.org Are
individualized What works for you may not work for another What
used to work stops and a change may be needed Take time to work
Need consistency with use and follow-up with a provider Reduce
inflammation and symptoms
35. Your treatment options www.psoriasis.org Topicals Light
therapy Oral Biologics PDE4 Biosimilars Alternative choices
ChristineLanger-Pueschel,123RFStockPhoto
36. www.psoriasis.org Topicals: What they do Slow growth of
skin cells Flatten lesions Remove scale Reduce itch and
inflammation
37. www.psoriasis.org Over-the-counter topicals Options include
products with: Salicylic acid (keratolytic or peeling agent) Coal
tar Moisturizers or emollients -Lotions and creams (lightest) (shea
butter, aloe vera, glycerin, lanolin, beeswax, colloidal oatmeal
-Ointments (thickest) -Oils (more effective but messy)
38. www.psoriasis.org Prescription Topicals Vitamin D
Derivatives Dovonex, Calcitrene (calcipotriene) Vectical
(calcitriol) Taclonex (calcipotriene and betamethasone
dipropionate) Vitamin A Derivatives Tazorac (tazarotene)
39. www.psoriasis.org Corticosteroids Anti-inflammatory agents
that reduce itch, swelling and redness of lesions Topical steroid
medications bind to steroid receptors in the skin and immune cells
Over 80 different formulations Available in various strengths from
least potent (class 7) to super potent (class 1)
40. www.psoriasis.org Topical Steroids: Side effects and
precautions Possible side effects: Thinning of the skin Changes in
pigmentation Easy bruising Stretch marks Redness and dilated
surface blood vessels Precautions: Systemic absorption
Tachyphylaxis If pregnant or nursing Use in children Do not use
strong steroids on the face or genitals Avoid applying on healthy
skin Dont discontinue use abruptly
41. www.psoriasis.org Occlusion Covering a topical to increase
effectiveness and absorbency into the skin Topical is applied to
the skin and then covered with impermeable materials such as
plastic wrap, cellophane, waterproof dressing, or a nylon suit
Check with your provider before occluding a topical
42. www.psoriasis.org Using multiple topical treatments Make
sure your health care provider clarifies the order you should apply
your topicals (including moisturizer) Give each topical enough time
to absorb before applying the next layer
43. www.psoriasis.org Upcoming Treatments: Topicals Aerosal
Foam (LEO 90100) Calcipotriol plus Betamethasone Dipropionate Once
daily for treatment of plaque psoriasis Submitted for FDA approval
Current research for youth Taclonex Scalp Topical Suspension for
ages 12-17 (LEO 80185 Phase II trials) Calcipotriene Foam (Sorilux)
for mild to moderate psoriasis use in ages 2 11 (GlaxoSmithKline
STF 115469 Phase III)
44. www.psoriasis.org Light Therapy Penetrates the skin to slow
growth of skin cells Involves exposing the skin to a light source
Consistency key
45. www.psoriasis.org Light Therapy Light therapy is a good
choice for: Children and adults Individuals who: Have thin plaques
(minimal scale buildup) or guttate psoriasis Plaques occur in areas
that are easy to expose Are responsive to natural sunlight
Combination therapy
46. www.psoriasis.org Source: Sunlight Natural sunlight UVA and
UVB Short, multiple exposures Be cautious with tanning beds
LjupcoSmokovski,123RFStockPhoto
47. www.psoriasis.org Source: Ultraviolet light B (UVB)
Options: Broad-band Narrow-band Clinic or home use Targeted
treatment used when less than 5-10 percent of body surface is
covered Whole-body treatment used when more than 5 percent of body
surface area is covered
48. www.psoriasis.org Source: PUVA Administered in a providers
office Ultraviolet A used with the light-sensitizing medication
psoralen (oral or applied to skin) Recommended for adults with:
Moderate-to-severe psoriasis Stable plaque psoriasis Guttate
psoriasis Psoriasis of the palms and soles Timing is critical
49. www.psoriasis.org Source: Excimer (Xtrac) laser
High-intensity beam of ultraviolet light administered in a clinic
Targets select areas of skin Used to treat mild-to- moderate plaque
psoriasis
50. www.psoriasis.org Risks Associated with Light Therapy Risks
include: Sunburn Skin cancer (www.aad.org) Premature aging
Cataracts (PUVA) if eyes are not protected (controversial) Tell
your provider what medications, treatments and dietary supplements
you take
51. www.psoriasis.org Systemics: What they do Work throughout
the body to: Most agents suppress the hyperactive immune system
Decrease activity of certain immune cells to slow the growth of
skin cells Reduce inflammation
52. www.psoriasis.org Methotrexate Take once a week Used to
treat severe psoriasis and psoriatic arthritis See improvement in
three to six weeks. May take six months for complete clearance Use
folic acid to decrease side effects Sometimes used to rotate with
other treatments Can be used with biologics to prevent resistance
and increase response
53. www.psoriasis.org Cyclosporine Take daily Take consistently
Use to treat psoriasis Use no longer than one year (according to
FDA preference). International Guidelines allow continuous,
uninterrupted use for two years at a time. Avoid grapefruit,
potassium-rich diet, St. Johns Wort, certain medications interact
Protect your skin while in the sun OK to use with topical
corticosteroids, vitamin D treatments
54. www.psoriasis.org Soriatane Oral retinoid Take once a day
with food Psoriasis may worsen before clearing After eight to 16
weeks of treatment, skin lesions improve. May take six months to
reach peak effect. Works slowly for plaque psoriasis Used to treat
severe psoriasis Rarely clears psoriasis alone Works best with
phototherapy Dont donate blood
55. www.psoriasis.org Risks Associated with Systemics Risks
include: Liver disease Kidney function High blood pressure Lymphoma
Precautions: Preconception and pregnancy Alcohol use
56. www.psoriasis.org Biologics: What they do Target and block
specific immune cells and proteins key to the development of
psoriasis and psoriatic arthritis Reduce inflammation Inhibit joint
damage in psoriatic arthritis SergeyNivens,123RFStockPhoto
57. www.psoriasis.org What are Biologics? Protein-based drugs
derived from living cells grown in a culture Action of biologics
mimic the natural function of the body Taken by injection or IV
infusion
58. Why does psoriatic disease occur? www.psoriasis.org Reason
not entirely known Known players: Dendritic cells Mast cells
TNF-alpha proteins Interleukin (IL) 17 Interleukin (IL) 12/23
Current model of psoriasis pathogenesis Journal of the American
Academy of Dermatology
http://www.jaad.org/article/S0190-9622(14)01001-9/pdf
60. www.psoriasis.org Interleukin 12/23 Inhibitor Binds to p40
protein found in IL-12 and IL-23 to inhibit inflammation that
triggers psoriasis and psoriatic arthritis Current treatment:
Stelara (Ustekinumab) - Janssen
61. www.psoriasis.org New: Interleukin 17-A Inhibitor Binds to
protein IL-17A to inhibit inflammation and immune responses that
trigger psoriasis Current treatment: Cosentyx (Secukinumab) -
Novartis -Prescribed for moderate to severe plaque psoriasis -Given
by injection at week 0, 1, 2, 3, 4 and then every 4 weeks Inhibitor
blocks
62. www.psoriasis.org Upcoming IL-17 Inhibitor Ixekizumab
(ILY2439821) Eli Lilly Monoclonal antibody against IL-17A protein
cells Treatment of psoriasis and psoriatic arthritis Phase III
trials
63. www.psoriasis.org Upcoming IL-23 Inhibitors Guselkumab
(CNTO1959) Janssen Monoclonal antibody to IL-23 Treatment of
psoriasis Phase III trials Tidrakizumab (MK-322) - Merck Monoclonal
antibody to IL-23 Treatment of psoriasis Phase III trials
64. www.psoriasis.org Risks Associated with Biologics Common
side effects: Respiratory infections Flu-like symptoms Injection
site reactions Headache Rare side effects: Nervous system disorders
Blood disorders Certain types of cancer Cautions: Pregnancy
Compromised immune system Congestive heart failure Surgery
65. www.psoriasis.org Phosphodiesterase-4 Inhibitor Inhibits
enzyme phosphodiesterase-4 (PDE4) which controls most of the
inflammatory action found in immune cells Current treatment: Otezla
(Apremilast) - Celgene -Prescribed for psoriasis and psoriatic
arthritis -Oral agent available as a 30mg tablet -Take
continuously
66. www.psoriasis.org Upcoming Oral Agents Tofacitinib
(CP-690,550) Pfizer Baricitinib (Ly3009104/INCB280501)-Eli Lilly
JAK (Janus Kinase) Inhibitors Reduces production of
pro-inflammatory cells Treatment of psoriasis and/or psoriatic
arthritis Phase III trials Adenosine CF101 (Can-Fite BioPharma) A3
Receptor inhibitor for treatment of psoriasis Phase III trials
67. www.psoriasis.org Biosimilars Biosimilars are not
chemically identical to biologics Offer potentially affordable
treatments NPF biosimilar recommendations: FDA designates
biosimilars are interchangeable with prescribed biologics Have
unique nonproprietary names Notification of substitution is
made
68. www.psoriasis.org How Treatment Can Be Used Topicals
Corticosteroids Tar Vitamin D analogs Emollients Phototherapy PUVA
UVB Methotrexate Cyclosporine Retinoids Biologics PDE4
Systemic
69. www.psoriasis.org Rotational Therapy Used to reduce the
cumulative toxicity of treatments Treatments are rotated on
intervals of one to two years Example: Methotrexate rotates with
other treatments PUVA, cyclosporine or a biologic
70. www.psoriasis.org Complementary Medicine Herbs/Natural
remedies Aloe Vera Apple Cider Vinegar Capsaicin Dead Sea Salts
Turmeric Fish Oil Vitamin D Acupuncture or acupressure
71. Tips to help maximize your treatment options
www.psoriasis.org
72. What You Can Do www.psoriasis.org Prepare for your
appointment with your provider Write down symptoms Make a list of
all medications (prescription and over-the-counter) Write down your
questions Keep track of your triggers Learn more about treatment
options Ask about side effects vs benefits to help find a treatment
that works for you Talk with your provider and give feedback
73. Continue to learn: NPF Webcasts www.psoriasis.org
74. Access support: One to One Program www.psoriasis.org Voice
concerns and get answers to your questions about psoriasis and
psoriatic arthritis To request a mentor visit
www.psoriasis.org/one-to-one Improve your health with a support
system
75. Participate in Research Efforts www.psoriasis.org To learn
more visit: http://services.psoriasis.org/clinical-trials/
DmitriyShironosov,123RFStockPhoto Clinical trials: Help develop new
and better treatments Help gain a better understanding of psoriatic
disease and related health conditions
76. Stay current: New Treatments and Research www.psoriasis.org
Advance Enews (www.psoriasis.org/enews) Receive the latest news in
research, treatment and healthy living tips Team NPF Enews
(www.psoriasis.org/enews) Stay current on upcoming events and how
to be involved Psoriasis Advance www.psoriasis.org/advance
Quarterly publication the premier source for the latest news in
psoriatic disease
77. Small Group Discussion www.psoriasis.org 11:40 a.m. to
12:00 p.m.
78. Q & A Session www.psoriasis.org with Dr. Prussick 12:00
p.m.
79. Join us and Connect with others Visit:
www.teamnpf.org/DCwalk www.psoriasis.org Team NPF Walk Washington,
D.C. occurs Sunday, September 27th at Lincoln Memorial Reflecting
Pool
80. Join us and Connect with others Team NPF Cycle Inaugural
Ride Saturday, August 15, 2015 Unionville Vineyards, Ringoes, NJ
www.psoriasis.org For more information contact: Robert Grabel at
[email protected]
81. www.psoriasis.org Our thanks to: Dr. Prussick All of you
for attending Our sponsors: Amgen, AbbVie, Celgene, Janssen
Biotech, Novartis Pharmaceuticals Please Complete Your Evaluation
Form