New Research Grants Awarded

Dr Zenas Yiu, the University of Manchester

Biologic therapies for psoriasis, which are targeted injection treatments made of manufactured antibodies, are very effective and have transformed the level of success patients with psoriasis can achieve in clearing the skin. These medicines are made using living cell lines and are costly.

Biosimilar is a term used to describe a me-too medicine designed to work in the body in the same way as a biologic medicine already available for use by patients, also called originators. Biosimilars do not need to go through as much testing; makers of biosimilars only need to show there are no major differences between their product and the originator. The costs of biosimilars are usually much lower, offering the NHS cost savings whilst opening opportunities to treat more people in the future.

However, biologics have complex chemical designs, and it is difficult to make a biosimilar that is exactly the same as the originator. Although trials have not shown any difference between biosimilars and originators, we do not yet know whether this is the same in routine clinical practice.

We designed a study using data from the British Association of Dermatologists Biologics and Immunomodulator Register, a large multicentre registry of patients with severe psoriasis based in the UK and the Republic of Ireland, with the objectives to firstly describe the current use of biosimilars for the treatment of psoriasis in the UK; and secondly to generate evidence to show whether biosimilars have the same effectiveness and safety compared to originators under routine clinical practice settings.

Dr Satveer Mahil, King’s College London

Psoriasis research has delivered powerful drugs (called biologics) which act by influencing the immune system. ‘Remission’ (achieving clear skin with no/low risk of psoriasis recurrence upon stopping therapy) is now achieved more frequently than ever before. However, biologics are still continued lifelong at standard doses. This is costly and burdensome, with regular injections, blood tests, risk of infections and side effects.

We therefore need to identify patients in remission, in whom clear skin could be maintained with less frequent dosing (‘dose tapering’) or by stopping treatment.

1. Identify the immune cell types driving remission.

• We obtained skin biopsies before and after biologic treatment in patients in remission. We will examine individual immune cells present in these samples, using an innovative technique called single-cell sequencing.

2. Confirm that these immune cells are also observed in publicly available studies.

• We will validate the above findings by comparing our individual cell data with results of traditional studies, comprising information from a mixture of cells.

3. Demonstrate the presence of these immune cells in skin and blood collected from a new group of patients receiving biologics.

• We will use experimental techniques to detect the immune cells defined in the previous stages of the study.

The above steps will define the cells driving remission in people receiving biologics. This will identify patients suitable for dose tapering, which may reduce the burden of long-term biologics use and improve outcomes in psoriasis.

Dr Thiviyani Maruthappu, Queen Mary University of London

The APPLE Study (Asking People with Psoriasis about their Lifestyle and Eating) aims to help address one of the commonest questions that people living with psoriasis ask, whether changes in diet may or may not be helpful for their skin. Therefore, developing evidence-based dietary guidance is a key priority. This study aims to address this unmet need by firstly, examining the current diet patterns of people living with psoriasis around the UK, in addition to lifestyle factors such as sleep and exercise. This questionnaire survey will enquire whether people with psoriasis have observed whether particular foods trigger their psoriasis or whether any dietary changes may have helped. Secondly, a small trial will compare two popular evidence-based diets – the Mediterranean diet and “Intermittent Fasting” to observe whether either of these are helpful in improving psoriasis and potentially associated risk factors for heart disease such as high blood pressure and cholesterol levels. By examining the amount of inflammation in the blood as well as the extent of skin involvement at the beginning and end of the study, we will be able to see if either of these diet affects inflammation. The study brings together a unique group of UK experts for the first time, dermatologists, scientists and nutritionists to provide a robust approach in exploring the relationship between diet and psoriasis. The PhD candidate will be a Registered dietician who, at the end of the study, will have developed expertise in the specific needs and challenges faced by people living with psoriasis.

Dr Stephanie Shoop-Worrall, the University of Manchester

Around one in 14 children with arthritis have juvenile psoriatic arthritis. This means that alongside their swollen and painful joints, they also experience features of psoriasis or one of their close family has psoriatic arthritis. Although arthritis and psoriasis can separately impact the quality of life and wellbeing of a child, it is not known how having both arthritis and psoriasis adds to this burden.

We want to explore if children with psoriatic arthritis have worse clinical outcomes, quality of life, wellbeing and mood than children with other kinds of arthritis. We will then see if having active psoriasis is important in this burden. This will help us understand the experiences of children with psoriatic arthritis, and whether they might need extra services or care from different kinds of healthcare professionals when they are first diagnosed with psoriatic arthritis.

The second part of this project will explore how disease impact changes over time in children with psoriatic arthritis compared with other types of childhood arthritis. In previous work, we have found six different patterns of disease impact in childhood arthritis based on three core outcomes for childhood arthritis. In some groups, arthritis seems to improve but wellbeing does not. We want to understand if children with psoriatic arthritis are more likely to be in those groups and whether this is linked to having psoriasis early in disease. This will help doctors predict how disease activity will change over time when children are diagnosed with psoriatic arthritis and talk with families about how they can expect their child’s disease to progress.

This project will use information from the biggest collection of children with arthritis when they are diagnosed: the Childhood Arthritis Prospective Study. This study includes a large volume of information on wellbeing, mood, quality of life and information from hospital notes. This means that we will have the biggest collection of children with psoriatic arthritis from diagnosis, to allow us to study these important questions.