Efficacy and safety of ustekinumab in the treatment of moderate to severe plaque psoriasis in Singapore.

Introduction: Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis. In this study, we assessed the efficacy and safety of patients receiving ustekinumab for psoriasis. Methods: This retrospective study included all adults with chronic plaque psoriasis who were prescribed ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. Efficacy end points included a proportion of patients achieving at least 50% and 75% improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at Weeks 4 and 16. Results: A total of 99 patients were prescribed ustekinumab; 69% of these were Chinese, followed by 15% Indians and 9% Malays. 31 patients had documented PASI scores and 55 patients had documented BSA improvements. In patients with recorded PASI scores, 29 (93.5%) of 31 patients achieved PASI 50, and 21 (67.7%) of 31 achieved PASI 75 at week 16. In patients with recorded BSA, 43 (78.2%) of 55 had at least 50% BSA improvement, and 31 (56.4%) of 55 achieved 75% BSA improvement at 16 weeks. Regarding safety, no patient experienced tuberculosis reactivation. A total of 11 (11%) of 99 patients had latent tuberculosis infection and were treated with prophylactic isoniazid. No patient experienced serious adverse events. No cardiovascular events, cutaneous malignancies or deaths were reported over six years. Conclusion: Ustekinumab is safe and efficacious in the treatment of patients with moderate to severe plaque psoriasis in a multiethnic Asian population.

Serum Adiponectin Levels and Their Association With Cardiometabolic Risk Factors in Patients With Psoriasis.

Background and objective Low adiponectin levels have been described in conditions with high cardiometabolic risk, including obesity, type 2 diabetes, insulin resistance, and hyperlipidaemia. Psoriasis is a chronic inflammatory skin disorder, and it is also associated with these conditions. In this study, we sought to assess the correlation between adiponectin levels and these risk factors including psoriasis severity. We investigated adiponectin value and its correlation with components of metabolic syndrome (MetS) and psoriasis severity. Methods Serum adiponectin levels were obtained from 215 psoriasis patients in a tertiary dermatology centre in Singapore. Psoriasis severity was measured with the psoriasis area and severity index (PASI), and cardiometabolic risk factors including obesity, hyperlipidaemia, insulin resistance, and waist circumference were measured. Patients answered a questionnaire regarding alcohol use, exercise, family history, smoking, and treatment history. Results Low adiponectin value was found in psoriasis patients with high body mass index (BMI) risk, high low-density lipoprotein (LDL), and low high-density lipoprotein (HDL). Patients with low HDL value had 25% lower adiponectin value compared to those with normal HDL. Adiponectin levels had a negative correlation with waist circumference. Psoriasis patients with MetS and a family history of cerebral vascular accidents (CVAs) had 17% and 18% lower adiponectin values than those without, respectively. There was no correlation between adiponectin level and PASI score. Conclusion Adiponectin levels were significantly decreased in psoriasis patients with obese-level BMI, MetS, increased abdominal girth, low HDL, high LDL, and a family history of CVA. Low adiponectin levels could play a role in predicting the development of MetS and possibly enable intervention to decrease the risk of cardiovascular mortality in psoriatic patients.

Two Episodes of Cutaneous Non-Tuberculous Mycobacterial Infection in a Patient with Psoriasis.

Non-tuberculous mycobacteria (NTM) are a group of environmental pathogens, which cause a broad spectrum of disease. The incidence of NTM infection is increasing, especially in immunocompromized patients. The past three decades also saw a rapid increase in the incidence of NTM infection involving otherwise healthy subjects. We report a case of cutaneous NTM infection in a 79-year-old Chinese woman, who was receiving methotrexate for psoriasis. Mycobacterial culture grew Mycobacterium abscessus, and the lesions cleared with a combination of oral clarithromycin, ciprofloxacin and doxycycline. Interestingly, she then developed a second episode of cutaneous NTM infection with Mycobacterium haemophilum over the same body region, five years after stoppage of methotrexate. Both episodes were separated in time and involved different species, indicating that they were independent from each other. We further discuss the risk factors for cutaneous NTM infection, treatment, and highlight the need for diagnostic vigilance.