October 29 – World Psoriasis Day

 

October 29, 2022

Psoriatic disease refers to pathological conditions with unknown etiology, therefore, it is currently not possible to talk about the possibility of a complete cure for this pathology. On the other hand, the appearance in recent years of targeted drugs for the treatment of patients suffering from this dermatosis has allowed us to achieve impressive results both in terms of cleansing the skin from rashes during exacerbations and for prolongation of remission.

The era of genetically engineered biological therapy is marked by the expansion of the list of nosologies with indications for the use of GIBP, the emergence of new drugs and a significant increase in the number of patients who need GIBP for a long time and even be committed throughout their lives.

These are such common and severe diseases as psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, the pathogenesis of which is based on a chronic multifactorial, autoimmune process and can progress rapidly, leading to a worsening of the disease, disability, and often to a decrease in the life expectancy of patients, which is due to both the severity of the disease itself, and the undesirable effects of drug treatment.

The accumulated experience of exposure to immune inflammation – glucocorticoids, cytotoxic drugs in monotherapy, in various combinations and combinations, can provide reliable remission of diseases, prevent permanent disability and significantly improve the quality of life of patients. At the same time, side effects, drug intolerance and addiction to them dictate the need to find other methods and means of therapy.

An important area of research on the pathogenesis of psoriasis, PsA was the study of immune mechanisms and led to the development of genetically engineered biotechnologies, which allowed us to revise the therapy of severe forms of psoriasis and PsA. Anticytokine therapy with biological agents, which is considered as the therapy of the XXI century, is based on a deep understanding of the pathogenesis of diseases.

Psoriatic arthritis is a typical representative of the group of seronegative spondyloarthritis associated with psoriasis, characterized by a chronic systemic progressive course with a predominant localization of the pathological process in the tissues of the musculoskeletal system. The primary target in PA is not the synovial membrane, but bone tissue and inflamed entheses and in the clinical picture in the development of paraarticular phenomena, dactylitis, periostitis, various types of bone destruction, and above all intra-articular osteolysis, paraspinal infections. In PA, there is an increase in mortality compared to the population (in men by 59% and in women by 65%). The main causes of deaths are metabolic disorders and obstructive vascular diseases of the heart and brain caused by them, chronic renal failure as a consequence of amyloid nephropathy, respiratory diseases, malignant tumors, as well as complications of therapy (gastric bleeding, hemocytopenia, liver failure).

Chronic, continuously recurrent, severe course of dermatosis, low effectiveness of the treatment methods used, intolerance to therapy, severe itching and discomfort significantly reduce the quality of life of patients. The ineffectiveness of psoriasis treatment may be due to low adherence to the treatment and also in a third of patients systemic immunosuppressive drugs are ineffective and can cause serious adverse events, which limits their use. The appearance of systemic drugs with a convenient administration mode, high efficiency and a favorable safety profile allows increasing patient adherence to treatment and achieving controlled results. To date, these requirements are more consistent with genetically engineered biological drugs. Anti-cytokine therapy or biological therapy, or also called targeted therapy, or "target therapy", which are represented by cytokines.

Currently, biological drugs have been registered in the Republic of Kazakhstan for the treatment of psoriasis and PA: infliximab, etanercept, ustekinumab, golimumabiadalimumab. According to the WHO report, the prevalence of psoriasis in the general population worldwide is 2-3%. In different countries, these indicators vary from 0.09 to 11.4%, depending on the age of patients, region of residence and genetic factors.The incidence of psoriasis in the Republic of Kazakhstan is 33.4 per 100 thousand population, that is, there are 6254 patients in Kazakhstan. The ALO List now includes the nosology Psoriasis, including drugs for biological therapy. Nosology is included in the list of diseases subject to dynamic monitoring within the framework of consultative and diagnostic assistance (Order of the Ministry of Health of the Republic of Kazakhstan dated July 28, 2015 No. 626 "On approval of the Rules for the provision of consultative and diagnostic assistance")

Up to 30% of patients with psoriasis have moderate to severe severity of the disease, this is about 1876 patients. Every third patient with psoriasis develops psoriatic arthritis, which is accompanied by a decrease in the quality of life of patients as a result of progressive damage to the bone and joint apparatus, and due to skin manifestations, which are often accompanied by depression. According to statistics, every 5th patient with severe psoriasis and psoriatic arthritis has suicidal thoughts and suicide attempts. Progressive disability over time leads to an additional financial burden on the budget due to the need to pay social benefits and provide benefits to these patients.

The number of patients with moderate and moderate psoriasis in the country, taking into account its prevalence, reaches 1,876 people. At the same time, up to 40% of patients with moderate to severe forms of psoriasis have contraindications to standard systemic therapy and phototherapy, are resistant to it, or they have adverse events against the background of its use.

According to Kazakhstan and international clinical guidelines, this group of patients (about 750 patients) is indicated for the appointment of genetically engineered biological drugs (GIBP). However, it should be noted that these data are the maximum, taking into account 100% of the diagnosis and detection of all patients. This situation is possible provided that all patients would be registered at the dispensary and regularly applied to medical organizations. Often, the actual number of patients applying to medical organizations due to various social, household factors differs 3-5 times from the number of patients according to statistical data.

Ustekinumab is included in the Kazakhstan National Form regulated by the Order of the Minister of Health of the Republic of Kazakhstan dated April 25, 2019 No. KR DSM-51 "On amendments to the Order of the Ministry of Health of the Republic of Kazakhstan" dated December 8, 2017 No. 931 "On approval of the KNF". The drug Ustekinumab has proven clinical efficacy and safety according to clinical studies, is registered in countries with a strong regulatory system, including the United States and the European Union, is included in the British and Kazakh national formularies, in international and local clinical treatment protocols.

With. Ospanova, dermatovenerologist, Head of the Department of Postgraduate Education of KNCDIZ

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