Biologics combined with conventional systemic agents or phototherapy for the treatment of psoriasis: real-life data from PSONET registries.

BACKGROUND Biologics have greatly improved psoriasis management. However, primary and secondary non-response to treatment requires innovative strategies to optimize outcomes. OBJECTIVE To describe the use of combined treatment of biologics with conventional systemic agents or phototherapy in daily clinical practice. METHODS We collected data on frequency of use, demographics, treatment characteristics and drug survival of biologics combined with conventional systemic agents or phototherapy in five PSONET registries. RESULTS Of 9922 biologic treatment cycles, 982 (9.9%) were identified as combination treatment. 72.9% of treatment cycles concerned concomitant use of methotrexate, 25.3% concerned concomitant UVB therapy, acitretin or cyclosporin and 1.8% concerned combined treatment with PUVA, fumaric acids or a second biologic. Substantial variation was detected in type and frequency of combination treatments prescribed across registries. Patients initiated on combined treatment had generally severe disease and were affected with psoriasis for many years. The extent to which patients had been priory treated with biologic monotherapy and the proportion of patients affected with psoriatic arthritis differed between registries. Survival rates for etanercept, adalimumab, infliximab and ustekinumab with methotrexate ranged between 43 and 92%, 28 and 83%, 65 and 87% and 53 and 77%, respectively, across registries after one year with no consistent superior survival for a particular biologic. Longest survival on a biologic combined with methotrexate, acitretin or cyclosporin was 103, 78 and 34 months, respectively. CONCLUSION Methotrexate was the most commonly used concomitant treatment for patients on a biologic. Wide geographical variations in treatment selection and persistence of combination treatment exist. Data derived from ongoing studies may help to determine whether combined treatment is superior to biologic monotherapy

Cumulative exposure to biological therapy and risk of cancer in patients with psoriasis: a meta-analysis of Psonet studies from Israel, Italy, Spain, the U.K. and Republic of Ireland.

Cancer risk following long-term exposure to systemic immunomodulatory therapies in patients with psoriasis is possible. To assess a dose-response relationship between cumulative length of exposure to biological therapy and risk of cancer. Four national studies (a healthcare database from Israel, and prospective cohorts form Italy, Spain and the U.K. and Republic of Ireland) collaborating through Psonet (European Registry of Psoriasis) participated in these nested case-control studies, including nearly 60 000 person-years of observation. 'Cases' were patients who developed an incident cancer. Patients with previous cancers and benign or in situ tumours were excluded. Four cancer-free controls were matched to each case on year of birth, sex, geographic area and registration year. Follow-up for controls was censored at the date of cancer diagnosis for the matched case. Conditional logistic regression was performed by each registry. Results were pooled using random-effects meta-analysis. A total of 728 cases and 2671 controls were identified. After matching, differences between cases and controls were present for the Charlson Comorbidity Index in all three registries, and in the prevalence of previous exposure to psoralen-ultraviolet A and smoking (the British Association of Dermatologists Biologic Interventions Register only). The risk of first cancers was not significantly associated with cumulative exposure to biologics (adjusted odds ratio per year of exposure 1·02, 95% confidence interval 0·92-1·13). Results were similar if squamous and basal cell carcinomas were included in the outcome. Cumulative length of exposure to biological therapies in patients with psoriasis in real-world clinical practice does not appear to be linked to a higher risk of cancer after several years of use

An Inventory of Vertebrate Roadkill in the Greater Mapungubwe Transfrontier Conservation Area, South Africa

Using a standard protocol, we conducted vertebrate roadkill surveys in the Greater Mapungubwe Transfrontier Conservation Area (GMTFCA), South Africa, which is a World Heritage Site. A total of 991 roadkill were recorded on the paved roads and 36 roadkill on the unpaved roads. Identifiable roadkill comprised 162 species from 24 orders and 65 families. Ninety-three roadkill could not be identified to species level. Roadkill counts were strongly influenced by road type and season. More roadkill was recorded on the paved than the unpaved roads. Irrespective of road type, the proportion of roadkill was greatest in the hot/wet season (4.3 paved roadkill/km/day paved and 1.3 roadkill/km/day unpaved) and lowest in the cold/dry season (2.0 roadkill/km/day paved and 0.1 roadkill/km/day unpaved). The high numbers of vertebrates identified as roadkill suggests that road traffic has the potential to directly and negatively affect biodiversity conservation in this part of South Africa. We recommend continued roadkill data collection across South Africa to assist with creating an inventory of species most likely to be at risk from roads. This will, in turn, better inform the implementation of potential mitigation measures.This research was initiated by the Endangered Wildlife Trust, with funding from Bridgestone South Africa.http://www.sawma.co.zaam201