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New research from a Taiwanese insurance database suggests that some commonly used therapies against psoriasis may increase the risk of herpes zoster, although 2 other therapies lowered the risk.

Although biologic agents are frequently prescribed for patients with psoriasis, the resulting suppression of cell-mediated immunity can increase the risks of bacterial and viral infections, according to the research published in Scientific Reports. These potential links have been unproven, however, despite earlier study findings that patients with psoriasis face higher risks of herpes zoster infection.

To investigate this question, researchers identified 92,374 patients in the Taiwan National Health Insurance Research Database who were diagnosed with psoriasis between 2001 and 2013. They followed these patients for a median of 6.8 years and noted anti-psoriasis therapeutics as well as herpes zoster infection diagnoses.

According to their findings, etanercept, adalimumab, and methotrexate plus azathioprine were all associated with an increased risk of herpes zoster infection. The investigators also studied ustekinumab and found that none of these patients were diagnosed with herpes zoster. However, they said this could be because ustekinumab was not approved for use in Taiwan until 2011, so there was a limited amount of follow-up time for these patients.

In total, 5.2% of the patients were diagnosed with herpes zoster during the follow-up period. Older age, female sex, hypertension, dyslipidemia, psoriatic arthritis, and a high Charleston comorbidity index score were all associated with an increased risk of herpes zoster diagnosis. Concurrent exposures to steroids and statins were also linked with a higher risk.

Similar to previous studies on general population or on diabetic patients, the use of statin is associated with higher risk of [herpes zoster], the authors wrote. The actual mechanisms of these associations have not [been] fully understood, but may involve the effect of statin on T cell function.

Notably, however, the 3 anti-psoriasis therapies identified as increasing risk of herpes zoster were each associated with a more than quadrupled risk of infection. Etanercept had a hazard ratio of 4.78; adalimumab had a hazard ratio of 5.52; and methotrexate plus azathioprine had a hazard ratio of 4.17.

In addition to finding that methotrexate in combination with azathioprine increased the risk of herpes zoster, the researchers added that methotrexate combined with any biologic agent increased the risk, although not to a statistically significant level.

Two other treatmentsphototherapy and acitretinwere associated with a lower risk of psoriasis, with hazard ratios of 0.76 and 0.39, respectively. The lower risk associated with acitretin could be attributable to the lower level of immunosuppression associated with this monotherapy. Similarly, the benefit associated with phototherapy could be caused by the increased level of vitamin D associated with UV exposure. Earlier research has suggested that vitamin D therapy could lower the risk of herpes zoster, the authors said.

Although the effect of UV light on the skin is mainly anti-inflammatory, this may not imply an overt immunosuppressive effect, the authors wrote. Upon exposure to UV light, the human skin generates vitamin D, a vital nutrient for skeletal health and a well-known immunoregulator.

Based on these findings, the investigators concluded that patients with moderate to severe psoriasis who are prescribed certain biologic agents may have a higher risk of herpes zoster infection. This risk should be considered, and other treatments may mitigate this risk while allowing for effective anti-psoriasis treatment.

REFERENCE

Ting SW, Ting SY, Lin YS, Lin MS, Kuo G. Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study. Scientific Reports. June 3, 2021. Accessed June 30, 2021. https://www.nature.com/articles/s41598-021-91356-3

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Study: Some Systemic Anti-Psoriasis Therapies Increase Risks of Herpes Zoster - Pharmacy Times

Patients on kidney dialysis who also have psoriasis are at increased risk of infection, and psoriasis treatment can reduce both the risk of infection and death, investigators report.

They looked at data on nearly 9,000 patients with both conditions in the United States Renal Data System, which has information on essentially all patients in the country on dialysis, says Dr. Wendy B. Bollag, cell physiologist in the Medical College of Georgia Department of Physiology and the studys corresponding author.

What they found indicates psoriasis treatment, which likely helps restore the natural frontline barrier protection of the skin, reduces infection rates and improves survival, indicating its potentially important role in better managing kidney failure, corresponding author Bollag and colleagues at MCG and the Charlie Norwood VA Medical Center in Augusta write.

Prospective studies are needed to further examine these associations, they note in The American Journal of the Medical Sciences.

We looked at all causes of mortality in this study and also the effect of treatment, says Dr. Stephanie L. Baer, infectious disease physician in the MCG Department of Medicine and chief of Infection Control and Epidemiology at the Charlie Norwood VA. The most important thing in this paper is that treatment helped.

They recommend that physicians taking care of patients who have both conditions be aware of their increased infection risk, and ensure psoriasis treatment as well as vaccination for herpes zoster.

Both psoriasis and kidney failure are known to increase the risk of infection with herpes zoster, the virus that causes shingles and chickenpox, infecting nerves where it can lie dormant for years. The investigators already had shown the virus presence is associated with increased death rates in patients in kidney failure. This time they found that this infection actually surfaced more frequently in the face of psoriasis treatment, which supports current recommendations that kidney failure patients get a herpes zoster vaccine, they say.

They suspect the increased risk of infection by herpes zoster and other invaders results from the common, compounding denominator of chronic inflammation caused by both conditions, and the subsequent wear and tear on the vascular and immune systems.

Patients on dialysis are known to be at increased risk of infection because of their typically multiple, weekly visits to a dialysis center and permanent intravenous access lines needed for dialysis, Bollag says, and the loss of barrier protection caused by psoriasis compounds that risk.

They also knew that cardiovascular disease is the leading cause of death in patients on dialysis, that kidney disease is a downstream effect of vascular disease and they suspected psoriasis could further complicate the scenario.

We know that psoriasis is a proinflammatory syndrome, and we knew that it could increase cardiovascular complications in the general population, says co-author Baer.

The U.S. Renal Data System is a good system for exploring these kinds of associations, Bollag says, so they decided to find out.

In addition to herpes zoster, they focused on eight other infections common in patients on dialysis, and found psoriasis likely increased their risk of most of them.

They looked for problems like bacteremia, a common bacterial infection in the bloodstream that can result from even a slight injury like vigorous tooth brushing or medical procedures; septicemia, or blood poisoning, the more serious, body-wide illness resulting from significant bacterial infections; conjunctivitis, or pink eye; and cellulitis, a common but potentially significant bacterial skin infection that can occur in inflamed skin.

The most common infections they found were septicemia and cellulitis, which occurred in about half of kidney failure patients with psoriasis, and systemic inflammatory response syndrome, or SIRS, an overwhelming, body-wide inflammatory response to something like a severe bacterial infection or trauma, in 42%.

They also looked at three categories of treatment patients received, which have procedure codes so they could search for them in the huge national database. These include treatments with a body-wide, or systemic, impact like biologics, therapies made from living material like the RNA vaccines in use against COVID-19, or in the case of psoriasis, drugs that specifically block drivers of the immune response called T cells or block proteins immune cells produce like tumor necrosis factor alpha, which promote inflammation. Other treatments included were localized ones like corticosteroid injections directly into a psoriasis lesion, and light-based therapy like ultraviolet therapy that inhibits the immune response in the skin.

The investigators noted that information was not included in the database for all treatments, like self-administered topical creams, and it has been reported that overall a significant percentage of even moderate to severe psoriasis is undertreated or untreated, and that inadequate treatment can worsen the disease.

In this case, they found the therapies that work to suppress the effect of an overzealous immune response were effective at reducing both infection and death.

Now the investigators are pursuing associations between psoriasis and stroke as well as heart attack.

Baer notes that psoriasis may seem like a more chronic, secondary problem in the face of kidney failure, but the reality is both conditions put patients at increased risk for infections and have inflammation and vascular damage as major factors.

The federally funded U.S. Renal Data System collects, analyzes and makes available information on patients who require dialysis because of chronic kidney disease or end stage renal disease. MCG and VA investigators looked specifically at all patients in the database ages 18 and older starting dialysis between 2004-11 a total of 8,911 individuals who also had a diagnosis of psoriasis.

About 1% of the patients in kidney failure also had psoriasis and they tended to be older, white, tobacco users and had higher rates of all nine infections the investigators looked at. The investigators noted that its highly likely more patients in the database have psoriasis but that diagnosis was not noted.

Other recent population database studies have indicated that having psoriasis increases the risk of kidney disease.

About 7.5 million Americans are living with psoriasis, and 10-20% of patients will also develop psoriatic arthritis, according to the Centers for Disease Control and Prevention.

The typically cyclical, but chronic condition causes patches of thick, red, flaky, sometimes painful skin, most often in places like the elbows, knees and face, but can even surface inside the mouth and on the face, lips and soles of the feet.

Psoriasis is characterized as an immune-mediated disease, in which an overactive immune response dramatically accelerates skin cell growth, according to the National Psoriasis Foundation. While skin cells turn over comparatively rapidly, they go from being produced and shed in about a month to just a few days, which causes the raised pileup that looks distinctive from the rest of the skin.

More than half of patients report the disease to be a major problem in everyday life, the foundation says, and patients are known to be at increased risk for problems like heart attack, stroke and diabetes, in which inflammation also is a major factor.

The research was supported in part by a VA Merit Award (#CX001357).

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Psoriasis treatment reduces infections, death in patients on dialysis with the skin condition - Jagwire Augusta

HIGH POINT, N.C., June 29, 2021 (GLOBE NEWSWIRE) -- vTv Therapeutics Inc. (Nasdaq: VTVT) a clinical-stage biopharmaceutical company focused on the development of orally administered treatments for type 1 diabetes and psoriasis, today announced that it will be presenting data from the clinical development of HPP737 as a treatment for psoriasis in a poster presentation at the 6th World Psoriasis & Psoriatic Arthritis Conference held virtually June 30 July 3, 2021 in Stockholm, Sweden.

Poster Details:

Poster Title: Pharmacokinetics and Pharmacodynamics of the Phosphodiesterase 4 (PDE4) Inhibitor HPP737 Following Single-dose Oral Administration in Healthy Subjects

Presenting author: Aaron Burstein, PharmD

ID: 35201

Topic: 4. Current and new therapeutic modalities

The poster will be added to vTvs website following the presentation and will be available at: https://vtvtherapeutics.com/pipeline/hpp737/.

About HPP737

HPP737 is a novel, potent, orally administered PDE4 inhibitor discovered by vTv Therapeutics. PDE4 is a validated therapeutic target for the treatment of a variety of disorders including psoriasis. In the phase 1 single ascending dose study presented here and a subsequent multiple-ascending dose study, HPP737 was well tolerated, with little or no gastrointestinal adverse events, such as nausea, vomiting or diarrhea, across the range of doses tested. HPP737 has evidence supporting target engagement from an ex vivo LPS stimulation TNF-alpha production assay and has demonstrated very potent activity in the Th17 skin resident immune cell activation (sRICA) assay, in which HPP737 was 10-100 fold more potent than apremilast in inhibiting the generation of cytokines/chemokines, depending upon the analyte. HPP737 is currently being tested in an on-going multiple ascending dose phase 1 study that is expected to complete during the third quarter.

About vTv TherapeuticsvTv Therapeutics Inc. is a clinical-stage biopharmaceutical company focused on developing oral, small molecule drug candidates. vTv has a pipeline of clinical drug candidates led by programs for the treatment of type 1 diabetes (T1D) and psoriasis. vTvs development partners are pursuing additional indications in type 2 diabetes, chronic obstructive pulmonary disease (COPD), renal disease, and primary mitochondrial myopathy.

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For more information, please visit http://www.vtvtherapeutics.com or follow us on Twitter: @vTvTherapeutics.

Forward-Looking StatementsThis release contains forward-looking statements, which involve risks and uncertainties. These forward-looking statements can be identified by the use of forward-looking terminology, including the terms anticipate, believe, could, estimate, expect, intend, may, plan, potential, predict, project, should, target, will, would and, in each case, their negative or other various or comparable terminology. All statements other than statements of historical facts contained in this release, including statements regarding the timing of our clinical trials, our strategy, future operations, future financial position, future revenue, projected costs, prospects, plans, objectives of management and expected market growth are forward-looking statements. These statements involve known and unknown risks, uncertainties and other important factors that may cause our actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements. Important factors that could cause our results to vary from expectations include those described under the heading Risk Factors in our Annual Report on Form 10-K and our other filings with the SEC. These forward-looking statements reflect our views with respect to future events as of the date of this release and are based on assumptions and subject to risks and uncertainties. Given these uncertainties, you should not place undue reliance on these forward-looking statements. These forward-looking statements represent our estimates and assumptions only as of the date of this release and, except as required by law, we undertake no obligation to update or review publicly any forward-looking statements, whether as a result of new information, future events or otherwise after the date of this release. We anticipate that subsequent events and developments will cause our views to change. Our forward-looking statements do not reflect the potential impact of any future acquisitions, merger, dispositions, joint ventures or investments we may undertake. We qualify all of our forward-looking statements by these cautionary statements.

Contacts

Investors:

Corey DavisLifeSci AdvisorsCDavis@LifeSciAdvisors.com

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Media:

PR@vtvtherapeutics.com

Source: vTv Therapeutics Inc.

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vTv Therapeutics to Participate at the 6th World Psoriasis & Psoriatic Arthritis Conference with Poster Presentation on HPP737 - Yahoo Finance

People can have dry skin anywhere on their body, including the scalp. Although dry scalp and dandruff have similar symptoms, they have different causes and treatments.

This article will describe what a dry scalp is and how it differs from dandruff. It will also look at some of the common causes of dry scalp, some available treatments, and a few prevention strategies.

People can have dry skin anywhere on the body, including the scalp. Dry skin occurs when the skin loses water too quickly.

A person with dry skin on the scalp may notice:

There are many potential causes of dry skin, such as low humidity or indoor heating. In fact, the American Skin Association notes that dry skin is not usually anything to worry about.

Sometimes, however, an underlying skin condition might be the cause of a dry scalp. When this is the case, a person might need medical treatment.

The American Academy of Dermatology (AAD) says that some people are more at risk of dry skin than others. These people include:

Lots of different things can lead to dry skin and a dry scalp. Some examples include:

Sometimes, underlying health conditions can also lead to a dry scalp. These might include the following.

Atopic dermatitis is the most common form of eczema.

In children, atopic dermatitis causes dry, itchy rashes anywhere on the body. In adults, rashes are less common, and a person may have skin that is extremely dry and easily irritated.

Contact dermatitis, which is another form of eczema, happens when the skin has an allergic reaction to something it comes into contact with.

On the scalp, hair care products, hair dye, and hair accessories can all lead to contact dermatitis. Contact dermatitis can cause itching and burning or blistering of the skin.

Around 50% of people with psoriasis experience flare-ups on the scalp. A person may also experience:

Learn more about scalp psoriasis here.

The best treatment for a dry scalp will depend on what is causing it.

In many cases, making healthy lifestyle choices will help. Some examples include:

Other causes may need additional treatment. If contact dermatitis is the cause, a person may require corticosteroids.

Treatments for other medical conditions that can cause a dry scalp include the following.

Doctors recommend that people with atopic dermatitis avoid triggers, or things that make the condition worse. Triggers are different for everyone, but some common ones include:

Sometimes, people may need medical treatment. Doctors might recommend special shampoos or biologic medications that help control the immune system.

Learn more about how to treat atopic dermatitis here.

Over-the-counter products can sometimes help treat scalp psoriasis.

According to the National Psoriasis Foundation, people should try to look for shampoos that contain salicylic acid or coal tar.

In more severe cases, doctors might recommend phototherapy, which uses UV light to slow skin cell growth, or biologic drugs, which help control the inflammation.

Dandruff is a common skin condition. It causes gray or white flakes of skin to appear on the scalp and in the hair.

Dandruff only affects the scalp, but people with a dry scalp tend to experience dry skin on other parts of the body as well.

According to the AAD, researchers are unsure of the exact cause of dandruff. However, it may be the result of other skin conditions, such as:

The above conditions can also lead to dry skin on the scalp.

Learn more about the difference between dry scalp and dandruff here.

A person can use medicated shampoos to treat dandruff.

Learn more about how to treat dandruff here.

There are lots of things that people can do to help prevent developing dry skin on the scalp. These include:

Anyone who suspects that they have an underlying skin condition should talk with a doctor. This is especially true if the symptoms are interfering with their everyday life.

The doctor will assess the persons skin and recommend the best treatment or course of action for them.

A person with a dry scalp may experience itching and flaking skin. Although it may look like dandruff, a dry scalp is different. The two conditions have different causes and different treatments.

Many dry scalp cases resolve on their own with a few lifestyle changes. These changes include drinking plenty of water and avoiding harsh shampoos and hair care products.

Sometimes, a dry scalp may be a symptom of an underlying skin condition. When this is the case, a person can talk with a doctor. They will be able to assess the skin and recommend the best course of action.

Link:
Dry scalp: Causes and treatment options - Medical News Today