The Canadian Association of Psoriasis Patients is pleased to announce the winners ofhe 2019 studentships in psoriatic disease. Congratulations to all of you!
Alexandra Finstad, University of Toronto
Primary Supervisor: Dr. Raed Alhusayen
Project Title: Investigating the Risk of Malignancy in Elderly Patients with Psoriasis: Does Treatment Choice Affect One’s Future Risk of Malignancy?
Psoriasis is a chronic inflammatory multisystem disease that affects the regeneration of skin cells. It commonly presents on the elbows, knees, and scalp, but can occur anywhere on the human body. Affecting approximately 2-3% of the world’s population (World Health Organization), psoriasis is not just a physical disease, but also has an important emotional impact on those whom it affects. As there currently exists no cure, effective treatment is critical. However, there is still much research that needs to be done in regard to the long-term effects of different psoriasis treatment options, including the potential risk of malignancy. This, coupled with research that has shown that immune-suppressive treatment can be associated with an increased risk of malignancy, led us to explore the potential connection between psoriasis treatment and increased risk of malignancy. As there are many different treatment options for psoriasis, the purpose of our study is to investigate and identify those that may carry an increased risk of future malignancy in order to protect psoriasis patients and to provide the best care possible. Thus, our research question is: Does psoriasis treatment affect one’s future risk of malignancy? Due to data restrictions, our study will focus on outcomes in the elderly population (defined as those 70 years and older). In order to explore our research question, we will be conducting a retrospective cohort study looking at the risk of malignancy in elderly patients with psoriasis compared to the general population, and we will be conducting subgroup analysis based on psoriasis treatment and the presence of psoriatic arthritis. We will also conduct further analysis by exploring the risk of specific types of malignancies in psoriasis patients including selective solid organ and hematologic malignancies. Through conducting this study, we hope to explore and uncover the potential association between psoriasis and its different treatments on the subsequent risk of developing a malignancy, with the hope of reducing this risk.
Amy Du, University of Alberta
Primary Supervisor: Dr. Robert Gniadecki
Title: 3D Body Imaging of Psoriatic Lesions
Psoriasis is a chronic, relapsing skin disease that affects as much as 11.4% of adults in some countries. It can have a significant negative impact on both the physical
and psychosocial well-being of affected patients. With its ever-increasing incidence and prevalence in the world, the need for high quality, standardized monitoring and treatment of psoriasis is immense.
The landscape of the human skin takes a very complex form, with its properties depending on a variety of patient factors (e.g. age, gender, body morphology) and its location on the body (e.g. abdomen vs. underarm vs. hand). While a crucial part of psoriasis treatment is tracking lesion progression in a consistent and standardized manner, the aforementioned qualities of skin can make it difficult for dermatologists to achieve this in an objective manner. Traditionally, psoriasis progression has been monitored by the Psoriasis Area and Severity Index (PASI) score, a measurement tool that can be subject to variability between raters and even within the same rater. In literature, more objective photographic techniques to estimate the region of skin conditions have been proposed. While these techniques are simple, they are not reliable for mapping large or irregular skin lesions.
As such, our study aims to use novel machine learning techniques and algorithms (i.e. artificial intelligence) to detect, map, and measure the surface area of skin lesions on a 3D model of the entire human body in the context of psoriasis. New techniques in model-based human pose and shape estimation, as well as 3D reconstruction of the body will be applied to create an accurate body skin map.
Christine Eun Byeol Jo, University of Ottawa
Primary Supervisor: Dr. Jensen Yeung
Project Title: Is it worth a second chance? Efficacy and safety of certolizumab pegol for moderate-to-severe plaque psoriasis after previous failure of another anti-TNF-α
With heightened understanding of the pathogenesis of psoriasis, many biologics have been introduced to market and are now considered the mainstay treatment. One of the earliest classes of biologics that have significantly improved patient management are anti-TNF-α. However, as individual patient response to different biologics varies, not everyone responds adequately to all biologics. Therefore, biologic switching has become a common practice. Deciding on the next optimal biologic agent remains a clinical challenge with no guidelines currently available. In the case of anti-TNF-α, while some studies state it is unnecessary to switch to a different mechanism of action, others warn of a lower response rate of a second anti-TNF-α in patients who were previously unresponsive. Certolizumab pegol (CZP) is the newest anti-TNF-α that has been approved for moderate-to-severe psoriasis by Health Canada in August 2018. Surprisingly, randomized controlled trials (RCT) showed equal efficacy between anti-TNF-α naive and experienced patients, proving CZP to be a promising option even after previous anti-TNF-α failure. However, this information is limited to RCT results which due to strict inclusion and exclusion criteria may lack generalizability to the real world. For the first time ever, our team will examine the real-world efficacy and safety of switching to CZP for treatment of moderate-to-severe plaque psoriasis at two academic sites in Toronto (Women’s College Hospital and Sunnybrook Health Sciences Centre). Results from the study will significantly help patients and physicians in real-world practice by providing greater understanding of its expected outcome for patients placed in this potentially challenging clinical situation.
Clare Sheen, University of Toronto
Primary Supervisor: Dr. Dafna Gladman
Project Title: Understanding the Regulation of Inflammatory Proteins in Psoriasis Patients Who Develop Psoriatic Arthritis
Psoriatic arthritis (PsA) is an inflammatory arthritis associated that develops in approximately one third of psoriasis patients. Currently, it is difficult for family physicians and dermatologists to recognize PsA, and as a result, 30-40% of individuals who have the disease are undiagnosed. The difficulty in recognizing PsA stems from the lack of a diagnostic test to identify which psoriasis patients have it, or predict which are susceptible to developing it in the future. A blood biomarker test is urgently needed to help physicians identify PsA at an early stage, so that patients can be treated in an appropriate and timely manner.
Our laboratory has done extensive work to identify the blood protein CXCL10 as a potential biomarker of PsA in patients with psoriasis. We found that blood CXCL10 levels are higher in PsA patients compared to psoriasis patients without arthritis. Moreover, CXCL10 levels are higher in psoriasis patients who later develop PsA compared to patients who never develop PsA. CXCL10 is involved in attracting immune cells to the joints.
In other diseases, it is known that CXCL10 levels in the blood is influenced by genes. The hypothesis of this study is that these genes will be found more frequently in PsA patients compared to psoriasis patients, and that the presence of certain genes will correlate with blood CXCL10 levels. This study will use laboratory and computational methods to examine how the genes are related to CXCL10 levels. This knowledge will help us understand CXCL10’s role in the development of PsA and whether the genes regulating its levels can also serve as blood biomarkers of future PsA onset.
Khalad Maliyar, University of Toronto
Primary Supervisor: Dr. Melinda Gooderham
Project Title: Efficacy, safety, and treatment alterations of guselkumab monotherapy for moderate-to-severe plaque psoriasis: A Canadian retrospective study.
Psoriasis is a common, chronic, inflammatory skin disease that affects approximately 3% of individuals living in Western countries. Patients with psoriasis suffer from a myriad of health sequelae such as psoriatic arthritis, gastrointestinal diseases, and cardiometabolic diseases. Furthermore, psoriasis has a profoundly detrimental effect on patient’s quality of life, psychological well-being, mental health, and work productivity. There are a wide range of genetically inherited, environmental, endocrine, and immunological factors that contribute to the incidence and severity of psoriasis in each patient. Sadly, there is currently no definitive cure for psoriasis. There are therapies available that can help attenuate the gravity of the symptoms, but due to the idiosyncratic variation amongst patients, not all treatments are equally as efficacious.
Recently, a new medication called TremfyaTM (guselkumab) was approved for the treatment of moderate to severe plaque psoriasis. TremfyaTM is the first biologic treatment that selectively inhibits interleukin-23 (IL-23), one of the main pro-inflammatory proteins believed to mediate the inflammatory processes seen in plaque psoriasis. The development of this new targeted therapy offers patients an auxiliary option to manage their plaque psoriasis. Results of recent clinical trials that have led to the approval of TremfyaTM by Health Canada, have demonstrated that it is both safe and provides significant improvement in skin lesions. Notwithstanding encouraging results, there is currently a paucity in the scientific literature of how safe and effective guselkumab treatment is in real-world clinical practice. Accordingly, the aim of this study is to measure the safety, efficacy, and treatment changes of guselkumab in the treatment of moderate to severe psoriasis in an outpatient, community dermatologic clinic. The ultimate goal of this study is to guide physicians as to how to appropriately prescribe and monitor TremfyaTM. The results of the study have the possibility of situating TremfyaTM as an efficacious staple drug used for the treatment of plaque psoriasis.
CAPP is so grateful for the support of our 2019 sponsors, without whom these Studentships would not be possible.