World Psoriasis Day

October 27, 2023

Psoriasis is a chronic inflammatory skin disease that affects millions of people around the world.

According to the latest research data, the estimated number of people suffering from psoriasis exceeds several million.

In Central Asia, the incidence of psoriasis is approximately 0.7% of the population [1]. It is expected that in 2023 the incidence rate in Kazakhstan will reach ~ 296,485 patients, among which the total number of patients is ~6,242, with 5,062 adults. Psoriasis therapy is a very long and complex process that is the subject of discussion in the medical community. Recent studies are devoted to biological therapy in the treatment of psoriasis. Biological agents are indicated in patients with moderate and severe psoriasis as part of standard therapy, up to 55% ~ 2,747 patients.
A real revolution in the treatment of psoriasis was made by the appearance of genetically engineered biological drugs (GIBP), which are specially created immunoglobulins. The use of GIBP in psoriasis therapy has led to significant changes that have led to a significant improvement in the prognosis of the disease and the survival of therapy, which significantly improves the quality of life of the able-bodied population of the Republic of Kazakhstan[2]. In Kazakhstan, 6242 patients with a diagnosis of psoriasis have been officially registered, about 30% of them have a moderate and moderate form of the disease.3
Psoriasis is associated with a significant deterioration in the quality of life of patients. Skin rashes can cause physical and emotional discomfort and negatively affect self-esteem and psychological well-being. Social stigmatization in society often creates obstacles in obtaining accurate diagnosis and proper treatment. This can lead to a delay in the start of treatment and an increase in symptoms, so it is extremely important to pay special attention to education and informing the public about psoriasis. Additional research is also needed to better assess the problem and develop effective psoriasis treatment strategies to help patients effectively manage this chronic disease.
In Kazakhstan, since 2020, psoriasis has been included in the List of ALO and is funded under compulsory medical insurance. Currently, patients can receive genetically engineered biological therapy for free. The possibilities of biological therapy allow patients to remove all the unpleasant symptoms of the disease, cleanse the skin from the manifestations of psoriasis, as well as prevent the progression of joint damage, and thereby improve their quality of life.
Today, biological therapy with ustekinumab is used in Kazakhstan, more than 1,500 patients are already receiving therapy thanks to the state. The lives of these people have changed dramatically, young able-bodied people can now create families, work, continue to study and achieve success in their activities. Visiting public places no longer burdens them with thoughts of what they will think about them.
Medicine does not stand still, and we see that every year there are new innovative drugs in the treatment of psoriasis. Kazakhstan has already registered drugs that can help patients completely cleanse the skin and prevent the progression of the disease. Such a drug is guselkumab (iIL-23). The main cytokines in the pathogenesis of psoriasis (IL 23, IL17, TNF) are divided into regulatory and effector. IL-23 is responsible for regulating and maintaining the pool of Th17 cells (guselkumab regulatory cytokine), while IL-17 and TNF mediate the effector functions of innate (TNF) and adaptive (TNF, IL-17) immune cells. Guselkumab acts at earlier stages of the inflammatory cascade, supporting the pool and phenotype of Th17 cells and plays the role of a regulator of further stages of the immuno-inflammatory process, which involves effector cytokines – IL-17, TNF.
The drug Tremfea (guselkumab) demonstrates significant results of therapy in patients with psoriasis, according to studies, 80% of patients retain PASI 90 (almost completely clean skin) for 5 years of therapy, while on methotrexate therapy, patients achieve PASI 50, secukinumab only 70% of patients [3,4]. Tremfea demonstrates stable efficacy regardless of body weight, and does not require an increase in dose, more than 80% of patients treated with Tremfea achieved PASI 90 regardless of body weight at 48 weeks of therapy [3]. And the safety profile is comparable to placebo, no cases of malignant neoplasms and cardiovascular events were detected [4]. According to the survey results, 88% of patients who started guselkumab therapy continued it for 2 years[5].
According to comparative clinical studies, Tremfea therapy is 2 times more effective than ustekinumab therapy in achieving PASI 90 by 52 weeks, 52% of patients achieved PASI 90, while ustekinumab PASI 90 in 24% of patients. The transfer from the drug Stelara to the drug Tremfea will allow you to get excellent skin cleansing already at week 16 of therapy [6-8], achieve a pronounced effect on articular manifestations [9], provide the patient with a quality of life that allows him to enjoy every day, offer a convenient therapeutic option to patients who need correction of therapy [10,11].
Patients with psoriatic arthritis, dactylitis and enteritis on guselkumab therapy showed an improvement in symptoms at week 8 of therapy, a significant difference in comparison with placebo counts of enteritis (LEI) and dactylitis at weeks 16 and 24. The proportion of patients with the absence of dactylitis and enthesitis by week 52 reached 75% for dactylitis and 58% for enthesitis[12].
To get complete information about the treatment of psoriasis, it is necessary to consult a doctor, only a qualified doctor can make the correct diagnosis and prescribe therapy.
O.Smirnova is a graduate of the RSE at the PCV "KNCDIZ" of the Ministry of Health of the Republic of Kazakhstan in the specialty "Dermatovenerology, including children's" since 2018, she has been treating psoriasis and vitiligo. In 2018, she independently registered lamps and booths for the phototherapy of psoriasis and vitiligo. Over these 5 years, lamps and cabins for the phototherapy of psoriasis and vitiligo have appeared in Almaty, Astana, Karaganda, Shymkent, semi-cabins - in Aktau, Almaty, Shymkent, local devices have been installed in Astana, Atyrau, Karaganda, Kyzylorda, Uralsk, Shymkent. The total number of patients was about 500 people.

List of used literature
1. Parisi R, Iskandar I Y K, Kontopantelis E, Augustin M, Griffiths C E M, Ashcroft D M et al. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study BMJ 2020; 369 :m1590 doi:10.1136/bmj.m1590
2. Griffiths et al. Poster Presentation Coastal Dermatology Symposium 2020, October 15-16th
3. Armstrong A et al. Poster presented at: EADV; 9–13 October 2019; Madrid, Spain. P1631
4. RahmanP, etal. Long-termsafetyofGuselkumab(Tremfya®) inpatientswithactivepsoriaticarthritis: pooledresultsfrom3 randomizedclinicaltrialsthroughupto2 years. ACR2021, AbstractID: 1050675.
5. McInnesIB, etal. Long-termEfficacyandSafetyofGuselkumab, a MonoclonalAntibodySpecifictothep19 SubunitofInterleukin-23, Through2 Years: Resultsfroma Phase3, Randomized, Double-blind, Placebo-controlledStudyConductedin Biologic-naïvePatientswithActivePsoriaticArthritis. ArthritisRheumatol. 2021.
6. Blauvelt A, et al. J Am Acad Dermatol 2017;76:405–417
7. Reich K, et al. Br J Dermatol 2021; doi:10.1111/bjd.20568
8. Diels J, et al. Br J Dermatol 2020;183:276–284
9. Diels, J., et al. Comparing efficacy of guselkumab versus ustekinumab in patients with psoriasis arthritis: an adjusted comparison using individual patient data from DISCOVER 1&2 and PSUMMIT trials. 2021.
10. Presented at ACR 2021 van Ee I, et al. J Eur Acad Dermatol Venereol 2021; doi: 10.1111/jdv.17829.
11. Ferris LA et al. J Dermatolog Treat 2020; 31: 152–159 7. Langley RG, et al. Br J Dermatol 2018;178:114–123
12. McGonagle et al. Presented at the EULAR e-Congress, June 2020. Abstract 0836

S. Ospanova, Head of the Department of Postgraduate Education of the KNCDIZ of the Ministry of Health of the Republic of Kazakhstan

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