BAD Highlights

British Academy of Dermatology (BAD) 2020: 100th Annual Meeting

The British Association of Dermatologists (BAD) was founded 100 years ago, just after the 1914–18 World War and the global Influenza Pandemic. It is therefore paradoxical that in 2020 the 100th Annual Meeting of BAD was delivered virtually due to the ongoing global COVID-19 pandemic.  

On the 1st September, the 2020 Virtual Annual Meeting was launched as an online event. The programme features a large number of psoriasis presentations and posters across a diverse range of topics; from analysis of biologic registry data to the rapid implementation of a virtual adult outpatient dermatology service due to the COVID-19 pandemic. 

Meeting highlights include the Arthur Rook Psoriasis Lessons presented by Keynote speaker Professor Chris Griffiths (Manchester, UK) who explains how research over the past several years has resulted in significant progress in our understanding of the key immune mechanisms underlying psoriasis which in turn have led to new, targeted therapies and the emergence of a stratified approach to management¹.

Clinicians are increasingly interested in real-world evidence and registry data. It is, therefore, encouraging that the 2020 Virtual Annual Meeting includes several presentations involving data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). Click on the link for more information about BADBIR: http://www.badbir.org

Drug survival of adalimumab, secukinumab and ustekinumab in psoriasis: does biological treatment history matter?

In this plenary presentation, Yiu Z, et al. (Manchester, UK) and members of the BADBIR Study Group report on the drug survival of adalimumab, ustekinumab and secukinumab, as an important proxy measure for effectiveness, in a real-world, prospective cohort study involving 9652 patients over 12 years. The authors conclude that secukinumab and ustekinumab had similarly higher 1-year drug survival in biologic-naïve as biologic-experienced participants. Furthermore, the 1-year drug survival of adalimumab was lower overall but showed little difference between biologic-naïve and biologic-experienced patients².

Real-world baseline characteristics of UK patients treated with guselkumab: the first descriptive analysis from the British Association of Dermatologists’ Biologics and Immunomodulators Register

BADBIR data presented by Hampton K, et al. (Janssen, UK) describe the baseline characteristics of patients treated with the novel IL-23 inhibitor guselkumab. As of October 2019, 199 patients in the UK had received ≥1 guselkumab dose and, these patients have a long disease history and severe disease at baseline with a notable proportion affected in difficult-to-treat areas. The authors note these data are the first to describe real-world use of guselkumab in psoriasis in the UK and will inform future efficacy and safety analyses³.

Real-world efficacy of guselkumab in the UK: 6-month data from the British Association of Dermatologists’ Biologics and Immunomodulators Register

BADBIR data in a second poster presented by Hampton K, et al. (Janssen, UK) describe the real-world efficacy guselkumab. Results from this real-world data set show robust 6-month skin clearance responses with 77% of guselkumab patients achieving a PASI 75 response. The authors note this evidence for guselkumab efficacy in a real-world setting is reflective of clinical trial data⁴.

Successful treatment of psoriasis with guselkumab in an individual with HIV–hepatitis B virus coinfection

Despite the availability of several new systemic agents for psoriasis treatment, choosing the right therapy in certain patient populations can be challenging, especially in the setting of chronic infections such as hepatitis and HIV. The poster presented by Timoney P, et al. (London, UK), describes the use of the IL-23 inhibitor guselkumab to successfully treat a psoriasis patient with HIV and hepatitis B virus coinfection⁵.

Factors associated with hospitalization due to COVID-19 in patients with psoriasis: insights from a global registry

Data from a global registry provide insights into the impact of COVID-19 on psoriasis patients and the effect of psoriasis therapies on the course of COVID-19. In this presentation, Mahil S, et al. (London, UK) report that most patients fully recovered from COVID-19 and that older age, being male and being of non-white ethnicity increased the risk of hospitalisation. Use of biologics, when compared with non-biological systemic therapies, was associated with reduced risk of hospitalisation. The authors highlight this requires further study owing to potential selection bias and unmeasured confounding such as a difference in risk-mitigating behaviours⁶.

Necessity is the mother of invention: implementing virtual assessment in specialist eczema and psoriasis services during a pandemic

This poster by Shah A, et al. (London, UK), describes the rapid implementation of a virtual adult outpatient dermatology service due to the COVID-19 pandemic in March 2020. A patient engagement exercise through semi-structured interviews highlighted that face-to-face review was not considered essential when skin disease was in remission, outpatient consultations were burdensome, and most patients (79%) favoured remote assessments. A ‘virtual assessment’ tool to evaluate patients’ progress and determine whether or not it was safe and clinically appropriate to continue systemic therapy was developed and at the onset of the coronavirus pandemic, all routine follow-up was converted to telephone review. Qualitative feedback from the clinical team has been positive⁷.

The use of narrowband ultraviolet B (NB-UVB) phototherapy in psoriasis: summary of the evidence in the updated British Association of Dermatologists’ NB-UVB guidelines

In this presentation, Babakinejad P, et al. (Newcastle, UK) summarise the evidence for clinical effectiveness, safety and tolerability of NB-UVB phototherapy when used for psoriasis, compared with conventional and biological systemic immunosuppression/modulation, placebo, other phototherapies, no treatment or combination treatment. The systematic review shows equivalent efficacy in terms of PASI 70 (³70% reduction in the Psoriasis Area and Severity Index) with narrow-band ultraviolet B (NB-UVB) and psoralen and ultraviolet A (PUVA). However, the number of sessions required for psoriasis clearance is significantly lower with PUVA than with NB-UVB, with a higher proportion of patients achieving remission with PUVA than with NB-UVB. The authors note that NB-UVB is the preferred initial treatment for psoriasis compared with PUVA and systemic immunosuppressants (whether conventional or biological) owing to the relative simplicity and safety of treatment. The authors also highlight that there is a paucity of evidence on the combination of NB-UVB and systemic treatments, and that this needs further study⁸.

The role of a multidisciplinary team in the management of complex psoriasis

In this poster, Sharif J, et al. (Salford, UK) describe how the care of psoriasis is increasingly complex, with a wide array of available therapies and multidisciplinary team (MDT) meetings support centres in providing high-quality, evidence-based care and enable patients to access high-cost medications appropriately. MDT meetings offer the opportunity to involve relevant specialists, guide evidence-based treatment, and afford patients therapeutic choice in scenarios where guidelines offer little assistance⁹.

References

1. Griffiths C. The Arthur Rook Oration. Psoriasis Lessons. Br J Dermatol. 2020;183 Suppl 1:3-212.
2. Yiu Z and BADBIR Study Group. Drug survival of adalimumab, secukinumab and ustekinumab in psoriasis: does biological treatment history matter? Br J Dermatol. 2020;183 Suppl 1:3-212.
3. Hampton K, Shann A, Chi J. Real-world baseline characteristics of U.K. patients treated with guselkumab: the first descriptive analysis from the British Association of Dermatologists’ Biologics and Immunomodulators Register. Br J Dermatol. 2020;183 Suppl 1:3-212.
4. Hampton K, Shann A, Chi J. Real-world efficacy of guselkumab in the UK: 6-month data from the British Association of Dermatologists’ Biologics and Immunomodulators Register. Br J Dermatol. 2020;183 Suppl 1:3-212.
5. Timoney SL, French P, Walker SL. Successful treatment of psoriasis with guselkumab in an individual with HIV–hepatitis B virus coinfection. Br J Dermatol. 2020;183 Suppl 1:3-212.
6. Mahil S, Dand N, Mason K, Yiu Z, Tsakok T, Meynell F, et al. Factors associated with hospitalization due to COVID-19 in patients with psoriasis: insights from a global registry. Br J Dermatol. 2020;183 Suppl 1:3-212.
7. Shah A, Paolino A, Vas V, Moorhead L, Guard S, Jabarzai W, et al. Necessity is the mother of invention: implementing virtual assessment in specialist eczema and psoriasis services during a pandemic. Br J Dermatol. 2020;183 Suppl 1:3-212.
8. Babakinejad P, Weatherhead S, Ibbotson S, Dawe R, Goulden V, Ling T, et al. The use of narrowband ultraviolet B (NB-UVB) phototherapy in psoriasis: summary of the evidence in the updated British Association of Dermatologists’ NB-UVB guidelines. Br J Dermatol. 2020;183 Suppl 1:3-212.
9. Sharif J, Stylianou K, Asfour L, Foulkes AC, Hunter HJA, Kleyn EC, et al. The role of a multidisciplinary team in the management of complex psoriasis. Br J Dermatol. 2020;183 Suppl 1:3-212.