Optimising therapeutic strategy in psoriasis

Lead Research Organisation: King's College London
Department Name: Genetics and Molecular Medicine

Abstract

As global life expectancy and the prevalence of chronic diseases have increased, scientific research has delivered an expanding repertoire of treatments. An emerging challenge is ensuring the most effective, appropriate drug is selected early in each patient's journey.

Aim:
This study will determine whether a model that predicts response to treatments for psoriasis improves patient outcomes.

Background:
Psoriasis is a common, debilitating skin disease that affects between 2 and 4 in every 100 people worldwide. Patients develop red, scaly patches of skin that are itchy and painful. It is associated with heart and joint disease, can affect an individual's ability to work, and impacts on quality of life are comparable to heart disease or cancer. A third of patients report clinically significant anxiety and depression, and 1 in 10 have contemplated suicide.

Recent research has led to several 'biologic' treatments for psoriasis, however almost one third of patients fail to respond. Biologics are prescribed in a 'trial and error' manner until disease control is achieved. This process is expensive, since biologics cost ~£10,000/year/patient. Current practice also places patients at risk of long periods with poorly controlled disease and exposure to drug side effects. It is therefore vital to understand which patients will benefit from a particular biologic.

Since we now recognise that each patient has multiple unique characteristics (e.g. changes in their genetic code) that contribute to their psoriasis, there is an urgent need to use medications intelligently. The MRC-funded Psoriasis Stratification to Optimise Relevant Therapy (PSORT) study has uncovered markers of treatment response in psoriasis, however it is not known whether this knowledge will translate into better patient outcomes.

Methods:
Based on PSORT's findings, I will develop a model that predicts which biologic will be the most effective for a particular patient. The model will use information that is unique to the patient, including their genetic code ('DNA'; measured from a blood sample) and presence of arthritis. The model will then use blood tests (measuring drug levels) to guide dose adjustment during treatment.

I will evaluate the model's accuracy by analysing an independent, multicentre psoriasis database called BADBIR, which has periodically followed up patients receiving biologics, and recorded detailed genetic and clinical information. I will next design an innovative clinical trial to determine whether the model will lead to better outcomes for patients, including clearance of psoriasis and improved quality of life.

Patient and public involvement:
I sought patient and public involvement (PPI) in the development of this study through focus groups and surveys supported by my collaborators the Psoriasis Association (the UK's leading national charity and membership organisation for individuals affected by psoriasis). I will set up a patient and public advisory panel and meet with PPI focus groups six-monthly to provide progress updates and ascertain feedback.

Dissemination:
The results will potentially significantly impact on patients and national clinical-care pathways, so all relevant stakeholders will be updated with key findings. I will disseminate results at national and international conferences and through high-impact peer-reviewed papers. Results will be broadcast via university press offices and the information channels of the Psoriasis Association (website, social-media, magazine). I will also highlight the importance of this research to other medical specialties prescribing biologics such as rheumatology and gastroenterology. It will thus help a wide range of patients with chronic immune-mediated diseases maintain better control of their health, and save money for the NHS.

Technical Summary

Psoriasis affects 2-4% of the population and NHS costs are >£750 million/year, largely due to biologics costing £10,000/year/patient. NICE recommend 10 biologics targeting TNF or IL-23/T17 cytokines with equal first-line weighting. Real-world data suggest 20-30% of patients fail to respond, highlighting inter-individual variation in driver immune pathways. We thus urgently need to understand which biologic best suits each patient. Whereas biomarkers guide cancer care, such strategies are lacking in inflammatory diseases. Given research by the PSORT biomarker discovery programme, psoriasis presents an ideal disease model for this work.

Hypothesis: An algorithm which stratifies patients to receive TNF or IL-23/T17 inhibitors on the basis of genetic and clinical biomarkers, followed by dose optimisation using therapeutic drug monitoring (TDM), will improve real-world outcomes.

Aims:
1. Develop a treatment algorithm to personalise biologic use
2. Evaluate the algorithm's clinical utility in silico using a multicentre real-world observational pharmacovigilance dataset
3. Design a prospective biomarker-strategy trial to assess the algorithm against standard care

Methods: I will develop an algorithm, using PSORT's existing dataset and logistic regression, that stratifies patients to receive TNF or IL-23/T17 inhibitors based on established genetic (HLA-C*06:02) and clinical (e.g. psoriatic arthritis) biomarkers of response. TDM will prompt dose modification in those with supra/subtherapeutic drug levels. The algorithm's clinical utility will be determined in silico in an existing independent longitudinal outcome bioresource containing genetic, clinical and drug level data on patients receiving biologics, using area under the ROC curve. A trial will be designed to assess the algorithm.

By personalising treatment selection, this study will improve outcomes and cost efficiency of care and provide a blueprint for the management of other inflammatory diseases.

Planned Impact

This research will accelerate the introduction of personalised medicine into the management of chronic inflammatory diseases using psoriasis as an exemplar. It will develop and validate personalised data-driven biologic treatment selection for patients with psoriasis. It aims to find the right class of biologic for the right patient and provide an evidence-based alternative to current 'trial and error' prescribing. It will translate the results of a sustained biomarker discovery research programme (PSORT) into improved care pathways for psoriasis, thus delivering concrete health benefits for a high-need patient group.

While biologic treatments have shown exciting efficacy in trials, disease treatment remains challenging in real-world settings, owing to variable response rates and long-term toxicity. This reflects inter-individual variation in underlying driver immune pathways (TNF versus IL-23/T17) and drug pharmacokinetics (as indicated by serum drug levels). Patients thus often cycle through multiple biologics before remission is achieved, resulting in excess cost, morbidity and potential adverse events. Given the elevated incidence of psoriasis (the Psoriasis Association estimates >1.5 million individuals have psoriasis in the UK alone), the severity of associated co-morbidities (e.g. psoriatic arthritis, cardiovascular disease, depression) and increased mortality, there is an urgent need for the development of intelligent treatment strategies to enable targeting of the critical immune pathways that are deregulated in each individual. A personalised biologic algorithm that uses multi-dimensional biomarkers to predict response will optimise treatment, limit adverse effects and improve cost-effectiveness, thus impacting on many stakeholders including patients, health professionals and the public.

The research will benefit psoriasis patients and family members who are frequently involved in their care. 75% develop psoriasis before age 35 and biologic treatment can be lifelong. Finding the most effective biologic early in each patient's treatment journey will increase their quality of life, confidence in the healthcare system, and impact on co-morbidities. Inadequately treated disease leads to a greater burden on the NHS through increased visits to healthcare services. Further, the average sickness absence for a worker with moderate-severe psoriasis is 14 days/year, with total costs of >£1billion/year for absenteeism and reduced work productivity. Ensuring that each patient receives the correct biologic at the optimal dose will reduce their healthcare visits, and increase their employment prospects and ability to work, leading to wider gains to the NHS, society and the economy.

The findings will be applicable to patients receiving the same biologics for other diseases e.g. inflammatory bowel disease and rheumatoid arthritis, and enhance research efforts in these disciplines, such as that of the MATURA consortium. By developing more effective, efficient strategies to use expensive biologics in high-need patient populations, this work will inform evidence-based policy makers, professional bodies developing clinical guidelines (e.g. NICE), and lead to healthcare gains and cost savings.

This research, which will capitalise on recent genetic, clinical and pharmacological biomarker discoveries, is likely to generate considerable interest within the pharmaceutical industry, where the search for optimised biologic treatment strategies and algorithms to predict response is a very active field. Greater insights on the implementation of personalised medicine will inform the future learning of clinicians and researchers. The research will optimise trial methodology for evaluating personalised treatment algorithms in real-world settings. The proposed in silico evaluation of the algorithm's clinical utility is also highly generalisable given the pharmacovigilance datasets available in other diseases (e.g. rheumatoid arthritis).

Publications

10 25 50

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Catapano M (2020) IL-36 Promotes Systemic IFN-I Responses in Severe Forms of Psoriasis. in The Journal of investigative dermatology

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Corbett M (2022) Biomarkers of systemic treatment response in people with psoriasis: a scoping review. in The British journal of dermatology

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Dand N (2020) Psoriasis and Genetics in Acta Dermato Venereologica

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Freeman EE (2020) International collaboration and rapid harmonization across dermatologic COVID-19 registries. in Journal of the American Academy of Dermatology

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Freeman EE (2021) Dermatology COVID-19 Registries: Updates and Future Directions. in Dermatologic clinics

 
Title PsoProtect and PsoProtectMe manuscript infographics 
Description Infographics produced to summarise key findings from our scientific research papers, for dissemination via social media, patient organisations, newsletters, on websites. For infographics, please see; https://psoprotect.org/publications/ 
Type Of Art Image 
Year Produced 2020 
Impact Dissemination via social media, patient organisations, newsletters, on websites. 
URL https://psoprotect.org/publications/
 
Guideline Title The Green Book, COVID-19: chapter 14a
Description Informed COVID-19 vaccination policy for immunosuppressed individuals
Geographic Reach National 
Policy Influence Type Citation in clinical guidelines
Impact Our COVID-19 vaccine research is cited by the Green Book (COVID-19 Chapter 14) and has informed policy on the prioritisation of immunosuppressed individuals (i.e. those receiving drugs that affect the immune system) for COVID-19 vaccination boosters.
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1102...
 
Description Membership of British Association of Dermatologists (BAD) Biologics Guideline for Psoriasis committee
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact Informed national clinical practice for biologic therapy for psoriasis in UK, including when to dose escalate, when to switch treatment, pregnancy and vaccination considerations.
URL https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19039
 
Description Membership of European Dermatology Forum (EDF) EuroGuiDerm Guideline Committee for Psoriasis
Geographic Reach Europe 
Policy Influence Type Participation in a guidance/advisory committee
Impact The guidelines have influenced clinical practice including prescribing of treatments and special considerations with respect to management in pregnancy and vaccinations.
URL https://guidelines.edf.one/guidelines/psoriasis-guideline
 
Guideline Title IPC Statement on COVID-19 and Psoriasis, https://www.psoriasiscouncil.org/blog/COVID-19-Statement.htm
Description Shaping recommendations in psoriasis clinical care, International Psoriasis Council
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical guidelines
Impact International clinical guideline statement includes: 'Pending results of robust epidemiological studies, emerging data including from registries such as PsoProtect do not appear to provide supportive evidence for a meaningful adverse effect of psoriasis treatments on the risk of acquiring SARS-CoV-2 or of a poorer outcome to COVID-19'
 
Guideline Title National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2-Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments, https://www.jaad.org/article/S0190-9622(21)00016-5/fulltext
Description Shaping recommendations in psoriasis clinical care, National Psoriasis Foundation COVID-19 Task Force
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical guidelines
Impact The following is included in the guidance (ref 20 is our research paper, as above); 'New data confirm that age, male sex, and pre-existing comorbidities are also important drivers of poor COVID-19 outcomes in patients with psoriasis (ref 20)' 'Category 2: What are the effects of psoriasis or PsA treatment on SARS-CoV-2 infection and COVID-19 illness? The evolving literature reaffirms the TF conclusion that treatments for psoriasis and/or PsA do not appear to meaningfully alter the risk of acquiring SARS-CoV-2 infection or having worse COVID-19 outcomes; therefore, patients who are not infected with SARS-CoV-2 should continue their biologic or oral therapies for psoriasis and/or PsA in most cases (guidance 2.1 and 2.2). COVID-19 hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR, 2.8; 95% CI, 1.3-6.2) in a registry of 374 patients with psoriasis from 25 countries (ref 20)'
 
Description St John's DermAcademy
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact As Director of St John's DermAcademy, I lead the delivery of dermatology educational courses for clinicians including face-to-face events and webinars (see www.stjohnsdermacademy.com). These are attended by dermatologist consultants and trainees, junior doctors, medical students, nurses and pharmacists. Each course is attended by >100 delegates and receives excellent feedback. We have produced a series of educational podcasts (https://www.stjohnsdermacademy.com/podcasts) and dermatology surgery training videos (for launch 2023). We partner with industry (and received educational grants to support our activity) and charitable organisations (https://www.stjohnsdermacademy.com/partners). We organise industry education days on atopic dermatitis and psoriasis. We also organise PPI webinars for patients and the public in partnership with charities (e.g. Psoriasis Association, National Eczema Society and Ichthyosis Support Group).
 
Description Artificial Intelligence in Psoriasis (PI)
Amount £9,985 (GBP)
Organisation National Institute for Health Research 
Department NIHR Biomedical Research Centre (Guy's, St Thomas' and KCL)
Sector Hospitals
Country United Kingdom
Start 02/2021 
End 02/2022
 
Description British Skin Foundation Fellowship Award (PI).
Amount £62,000 (GBP)
Funding ID 024_F_19 
Organisation British Skin Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 02/2020 
End 02/2021
 
Description COVID-19 and immune-mediated inflammatory diseases [IMIDs] - using patient-reported data to identify determinants of outcome (Co-investigator)
Amount £58,000 (GBP)
Organisation National Institute for Health Research 
Department NIHR Biomedical Research Centre (Guy's, St Thomas' and KCL)
Sector Hospitals
Country United Kingdom
Start 04/2020 
End 05/2021
 
Description Identifying biomarkers of remission in psoriasis (PI)
Amount £3,950 (GBP)
Organisation National Institute for Health Research 
Department NIHR Biomedical Research Centre (Guy's, St Thomas' and KCL)
Sector Hospitals
Country United Kingdom
Start 09/2020 
End 10/2021
 
Description MRC Clinical Academic Research Partnership Award
Amount £123,866 (GBP)
Funding ID MRC-MR/T02383X/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 01/2020 
End 01/2022
 
Description Maintaining skin remission using treat-to-target - changing paradigms in psoriasis care
Amount £759,218 (GBP)
Funding ID NIHR302258 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 08/2022 
End 08/2026
 
Description PhD Studentship (1st supervisor, PI)
Amount £85,500 (GBP)
Organisation The Psoriasis Association 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2021 
End 10/2024
 
Description PsoProtectMe (Co-PI)
Amount £10,000 (GBP)
Organisation The Psoriasis Association 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2020 
End 04/2024
 
Title PsoProtect and PsoProtectMe research registries (COVID-19 pandemic outcomes in psoriasis) 
Description I am co-director of PsoProtect and PsoProtectMe global online research registries, which seek to better understand the impact of the pandemic on people with psoriasis. Data is entered via clinicians and patients online via secure online REDCap platform. Psoprotect has had >1000 cases submitted, and PsoProtectMe >3600 to date. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2020 
Provided To Others? Yes  
Impact We have published the findings of this research in the Journal of Allergy and Clinical Immunology and the British Journal of Dermatology. I also presented this research at the Annual BAD Meeting 2020, UK Consultant's Course 2020 and International Psoriasis Council Think Tank 2020 (as plenary session oral presentations). I will present further research findings from PsoProtectMe at the Annual BAD Meeting 2021 (plenary session). The research has informed international clinical guidance statements (see impact section) and involved numerous national and international PPI activities (see engagement section). 
URL http://psoprotect.org
 
Title ProProtect and PsoProtectMe global research registries 
Description I am co-director of the PsoProtect and PsoProtectMe global online research registries. They collect data from individuals and healthcare professionals to better understand the impact of the COVID-19 pandemic on people living with psoriasis. PsoProtect has >1000 clinician-reported cases of psoriasis and COVID-19, and PsoProtectMe has >3600 self-report surveys completed by people with psoriasis to date (7/3/21). 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? Yes  
Impact Publications - see full list at https://psoprotect.org/publications/: • Mahil SK, Yates M, Langan SM, (), Brown MA, Galloway JB, Smith CH; PsoProtect and CORE-UK study groups; Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey. Br J Dermatol 2020; doi: 10.1111/bjd.19755. • Mahil SK, Dand N, Mason KJ, (), Griffiths CE, Barker JN, Smith CH, PsoProtect study group; Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry based study. J Allergy Clin Immunol 2020; doi: 10.1016/j.jaci.2020.10.007. • Bechman K, Cook ES, Dand N, (), Smith CH, Galloway JB, Mahil SK; PsoProtect study group; Vaccine hesitancy and access to care in the COVID-19 pandemic: findings from a global patient-reported cross-sectional survey. Br J Dermatol 2022; doi 10.1111/bjd.21042. • Izadi Z, Brenner E, Mahil SK, Dand N (), Smith CH, Yazdany J, Kappelman M, SECURE-IBD/GRA/PsoProtect study groups; Association between tumour necrosis factor inhibitors and the risk of hospitalization or mortality among patients with immune-mediated inflammatory disease and COVID-19. JAMA Network Open 2021;4:e2129639. • Mahil SK, Yates M, Yiu ZZN, (), Brown MA, Galloway JB, Griffiths CM, Barker JN, Smith CH; PsoProtect study group; Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study. J Eur Acad Dermatol Venerol 2021;35:e636-640. • Mahil SK, Yiu ZZN, Mason KJ, (), Barker J, Irvine AD, Smith CH; Secure-AD and PsoProtect study groups. Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic. Br J Dermatol 2020;183:404-406. • Freeman EE, McMahon DE, Hruza GJ, Irvine AD, Spuls PI, Smith CH, Mahil SK, Castelo-Soccio L, Cordoro KM, Lara-Corrales I, Naik HB, Alhusayen R, Ingram JR, Feldman SR, Balogh EA, Kappelman MD, Wall D, Meah N, Sinclair R, Beylot-Barry M, Fitzgerald M, French LE, Lim HW, Griffiths CEM, Flohr CJ. International collaboration and rapid harmonization across dermatologic COVID-19 registries. J Am Acad Dermatol 2020;83:e261-e266. Please also see impact section for details on influence on guidelines/policy and engagement section for PPI activities. 
URL https://psoprotect.org/publications/
 
Description Collaboration with Dr Mark Corbett, Centre for Reviews and Dissemination, University of York 
Organisation University of York
Country United Kingdom 
Sector Academic/University 
PI Contribution We are currently undertaking a systematic review of deep learning image analyses in dermatology. The study team comprises academic dermatologists (Dr Mahil, Prof Smith, Prof Barker), machine learning experts (Dr Lynch), experts in systematic reviews (Dr Corbett) and medical students and junior doctors. This work has been informed through a valuable collaboration with Dr Corbett (and follows a prior collaboration with Dr Corbett on recent scoping reviews led by Prof Smith).
Collaborator Contribution Dr Corbett's expertise in systematic review methodology has informed this work at all stages - design, literature searches, interpretation of data and write up.
Impact Poster presentations of systematic review at ESDR and BSID annual meetings. The paper is currently in progress.
Start Year 2021
 
Description Councillor of the International Psoriasis Council 
Organisation International Psoriasis Council
Country United States 
Sector Charity/Non Profit 
PI Contribution I presented at the IPC Think Tank 2020 and will continue to be involved in International Psoriasis Council events
Collaborator Contribution as above
Impact as above
Start Year 2021
 
Description Guy's and St Thomas' NIHR Biomedical Research Centre (BRC) School of Translational and Experimental Medicine (STEM) Cluster Board member 
Organisation National Institute for Health Research
Department NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas
Country United Kingdom 
Sector Public 
PI Contribution The STEM cluster board comprises members across Guy's and St Thomas' and King's College London to provide integration and mentorship of the training platforms available for clinical and non-clinical trainees. The board has oversight of the NIHR Biomedical Research Centre's Clinical and Research Training Fellowships and PhD Studentships. I attend regular board meetings and help contribute to the strategy for provision of research training to trainees.
Collaborator Contribution I have developed links with other members of the research and supervisory community at King's College London through membership of the board.
Impact -
Start Year 2021
 
Description Member of British Association of Dermatologists Biologics Guideline Development Group 
Organisation British Association of Dermatologists (BAD)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I am a member of British Association of Dermatologists Biologics Guideline Development Group and co-author of the British Association of Dermatologists' guidelines for biologic therapy for psoriasis 2020 - a rapid update, Br J Dermatol 2020;183:628-637.
Collaborator Contribution As above
Impact Publication: • Smith CH, Yiu ZZ, Bale T, Burden AD, Coates LC, Edwards W, MacMahon E, Mahil S, McGuire A, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Uthman OA, Woolf RT, Manounah L, Ezejimofor MC, Exton LS, Mohd Mustapa MF; British Association of Dermatologists' Clinical Standards Unit. British Association of Dermatologists' guidelines for biologic therapy for psoriasis 2020 - a rapid update. Br J Dermatol 2020;183:628-637.
Start Year 2019
 
Description Member of European Academy of Dermatology and Venereology (EADV) Psoriasis Task Force 
Organisation European Academy of Dermatology and Venereology
Country Switzerland 
Sector Charity/Non Profit 
PI Contribution I am a member of the European Academy of Dermatology and Venereology (EADV) Psoriasis Task Force (established in 2021)
Collaborator Contribution First projects to commence in 2021
Impact as above
Start Year 2021
 
Description Member of European Dermatology Forum (EDF) EuroGuiDerm Psoriasis Guideline Group. 
Organisation European Dermatology Forum (EDF)
Country Switzerland 
Sector Charity/Non Profit 
PI Contribution I am a member of European Dermatology Forum (EDF) EuroGuiDerm Psoriasis Guideline Group and co-author of the following 2 guideline: • Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, De Jong E, Garcia-Doval I, Gisondi P, Kaur-Knudsen D, Mahil S, Mälkönen T, Maul JT, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt KM, Sator PG, Schmitt-Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C; EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venerol 2020;34:2461-2498. • Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, De Jong E, Garcia-Doval I, Gisondi P, Kaur-Knudsen D, Mahil S, Mälkönen T, Maul JT, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt KM, Sator PG, Schmitt-Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C; EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 2: specific clinical and comorbid situations. J Eur Acad Dermatol Venerol 2021;35:281-317.
Collaborator Contribution as above
Impact as above
Start Year 2020
 
Description PsoProtect and PsoProtectMe Partners 
Organisation The Psoriasis Association
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution During this award, and as part of the response to the COVID-19 pandemic, I led on setting up the PsoProtect and PsoProtectMe global psoriasis COVID-19 registries. These registries seek to better understand the impact of the COVID-19 pandemic in people with psoriasis, and in the context of the immunosuppressant treatments prescribed for psoriasis. I am co-director of these registries and they have >25 global professional and patient partner organisations who support our work e.g. European Society for Dermatological Research, Psoriasis Association, International Psoriasis Council, International Federation of Psoriasis Associations. Please see full list of partners at https://psoprotect.org/partners/ and https://psoprotectme.org/who-we-are/ We are also actively collaborating with other IMID registries to facilitate cross-disease meta-analyses i.e. Global Rheumatology Alliance and SECURE-IBD. Following completion of a data sharing agreement, we transferred PsoProtect data to the Global Rheumatology Alliance team at UCSF (USA) in Feb 2021 in order to conduct the first cross-disease analysis.
Collaborator Contribution Our global partners encourage participation of both international clinicians and patients in the registries. We feedback research findings (including publications) to our partners, who disseminate this to their members and supporters via their newsletters and social media. I led on writing plain language summaries and designing infographics to summarise our scientific research papers. We collaborate with other IMID registries to enable cross-disease meta-analyses, as above.
Impact Several publications (in which I am joint first author) and also impact on policy. Our data informed the consensus guideline from the National Psoriasis Foundation task force on management of patients with psoriasis in the pandemic (i.e. optimising outcomes and informing decisions on continuing immunosuppressants during the pandemic) and also guidance statements from the International Psoriasis Council. I have also participated in multiple PPI engagement activities as part of this project including webinars (for IFPA, Psoriasis Association), video interviews (IFPA, Psoriasis Association, International Psoriasis Council), podcasts (National Psoriasis Foundation, The Psoriasis Geek) and have led on writing blogs (British Skin Foundation) and press releases (please see engagement section).
Start Year 2020
 
Description 'Best of BRC' presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact I was invited to present my research in a 'Best of BRC' themed cross-specialty meeting, which was live streamed across KCL/GSTT. Each invited presenter presented 2 slides over 2 minutes in order to summarise their research to a general academic audience.
Year(s) Of Engagement Activity 2020
 
Description 2 podcasts for the National Psoriasis Foundation 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I recorded 2 podcasts for the 'Psound Bytes' series of podcasts for the National Psoriasis Foundation on the PsoProtect and PsoProtectMe studies.

http://psoundbytes.npf.libsynpro.com/ep-86-psoprotect-your-patients-the-search-for-answers-in-a-pandemic

http://psoundbytes.npf.libsynpro.com/ep-85-how-do-i-psoprotectme
Year(s) Of Engagement Activity 2020
URL http://psoundbytes.npf.libsynpro.com/ep-86-psoprotect-your-patients-the-search-for-answers-in-a-pand...
 
Description Blog for the British Skin Foundation 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact We wrote and published a blog for the British Skin Foundation on our recent PsoProtectMe paper, https://www.britishskinfoundation.org.uk/Blog/shielding-behaviour-in-people-with-psoriasis-or-a-joint-condition-during-the-covid-19-pandemic-diffe
Year(s) Of Engagement Activity 2021
 
Description Blog for the British Skin Foundation 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I wrote a blog for the British Skin Foundation on our recent paper, https://www.britishskinfoundation.org.uk/Blog/shielding-behaviour-in-people-with-psoriasis-or-a-joint-condition-during-the-covid-19-pandemic-diffe
Year(s) Of Engagement Activity 2021
 
Description Deep learning image analyses in dermatology: a systematic review of deep learning studies 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Poster presentations of systematic review of deep learning image analyses in dermatology at the European Society for Dermatological Research Annual Meeting 2022 (Amsterdam) and British Association of Dermatologists Annual Meeting 2022 (Glasgow). The posters were presented by Shern-Ping Choy, medical student at King's College London. Senior authors Dr Mahil and Prof Smith.
Year(s) Of Engagement Activity 2022
 
Description Dissertation supervisor on King's College London MSc Clinical Dermatology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact I have been a dissertation supervisor for students on the King's College London MSc Clinical Dermatology since 2021. This involves supervising 1 student per year on a dissertation involving inflammatory skin disease e.g. the influence of diet on acne, paradoxical psoriasis.
Year(s) Of Engagement Activity 2021,2022,2023
 
Description Global PPI live webinars - International Federation of Psoriasis Associations (IFPA) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I presented at 2 global webinars for IFPA on our research findings. Target audiences for the 2 live webinars were patients and public in Europe and Africa. The webinars had excellent feedback from attendees, with many reporting an improved understanding of risk factors for severe COVID-19, particularly in the context of their own psoriasis treatments. IFPA have subsequently invited me to present at a further global webinar at end March 2021.
Year(s) Of Engagement Activity 2020,2021
 
Description Global PPI webinars - International Federation of Psoriasis Associations (IFPA) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Mahil presented our research findings at 2 global webinars for IFPA. Target audiences for the 2 live webinars were patients and the public in Europe and Africa. The webinars received excellent feedback from attendees, with many reporting an improved understanding of risk factors for severe COVID-19, particularly in the context of their own psoriasis treatments. IFPA have subsequently invited us to present at a further global webinar at end March 2021.
Year(s) Of Engagement Activity 2020
 
Description Industry preceptorships on atopic dermatitis and psoriasis 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact As director of St John's DermAcademy, I lead the organisation of multiple industry preceptorships on atopic dermatitis and psoriasis. Each preceptorship includes talks from expert consultants and psychologists, nurse consultants in our severe eczema and psoriasis service, and also a session with patients. Face to face event in Feb 2020 (atopic dermatitis), multiple virtual live webinars in 2021 (atopic dermatitis and psoriasis), and face to face events in 2022 (x1 atopic dermatitis, x1 psoriasis). All events received excellent feedback from delegates.
Year(s) Of Engagement Activity 2020,2021,2022,2023
 
Description International Federation of Psoriasis Associations (IFPA) Newsletter Dec 2020 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I wrote a research update for the December 2020 edition of the IFPA Newsletter

https://ifpa-pso.com/wp-content/uploads/2020/12/Quarterly-December-2020.pdf
Year(s) Of Engagement Activity 2020
URL https://ifpa-pso.com/wp-content/uploads/2020/12/Quarterly-December-2020.pdf
 
Description Key note speaker at The Psoriasis Association Annual Conference 2022: 'COVID-19, vaccines and psoriasis: bringing research closer to you' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact I was a key note speaker at the The Psoriasis Association Annual Conference 2022. My talk was 'COVID-19, vaccines and psoriasis: bringing research closer to you' and I summarised our COVID-19 research, including the findings from PsoProtectMe.
Year(s) Of Engagement Activity 2022
URL https://www.psoriasis-association.org.uk/news/conference-2022
 
Description Lecture on Inflammatory skin diseases and stratified medicine for MSc in Genomics Medicine, King's College London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact I deliver an annual lecture on Inflammatory skin diseases and stratified medicine for students enrolled in the MSc in Genomics Medicine at King's College London/St George's London. I have consistently received good feedback for my talk and am invited back to deliver this talk on an annual basis for the MSc.
Year(s) Of Engagement Activity 2020,2021,2022,2023
 
Description Lecture on personalised medicine in psoriasis to medical school audiences (UCL in Jan 2020 and Cambrdidge University in Feb 2020) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact I delivered a presentation on personalised medicine approaches in psoriasis to medical students interested in dermatology at both UCL (Jan 2020) and Cambridge University (Feb 2020).
Year(s) Of Engagement Activity 2020
 
Description Live PPI webinar with Psoriasis Association 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I led the organisation of a PPI webinar in collaboration with the Psoriasis Association entitled 'Psoriasis, COVID-19 and Me'. This covered the impact of the pandemic on people with psoriasis and I presented our research findings and participated in the interactive Q&A session. The webinar received excellent feedback and we plan to hold annual PPI webinars with Psoriasis Association.
Year(s) Of Engagement Activity 2020
 
Description Live PPI webinar with Psoriasis Association - 'Pso let's talk research' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact PPI webinar focused on research during the pandemic. I delivered a talk on PsoProtectMe: https://www.stjohnsdermacademy.com/event-3rd-nov-2021. The event was attended by >100 patients/members of the public and received excellent feedback.
Year(s) Of Engagement Activity 2021
URL https://www.stjohnsdermacademy.com/event-3rd-nov-2021
 
Description Live PPI webinar with Psoriasis Association - Psoriasis, COVID-19 and Me 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact PPI webinar organised by St John's DermAcademy in collaboration with the Psoriasis Association entitled 'Psoriasis, COVID-19 and Me'. This covered the impact of the pandemic on people with psoriasis and included research presentations and an interactive Q&A session. The webinar received excellent feedback and we plan to hold annual PPI webinars with the Psoriasis Association.
Year(s) Of Engagement Activity 2020
 
Description Oral presentation at 51st European Society for Dermatological Research (ESDR) Annual Meeting 2022 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Luc Francis (PhD student) delivered an oral presentation at the 51st European Society for Dermatological Research (ESDR) Annual Meeting 2022 in Amsterdam, at the International Psoriasis Council symposium. The talk was titled 'Using single-cell transcriptomics to characterise early mechanisms of disease remission in psoriasis' and described his scRNA-seq analysis.
Year(s) Of Engagement Activity 2022
 
Description Oral presentation at British Society for Investigative Dermatology (BSID) Annual Meeting 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Luc Francis (PhD student) delivered an oral presentation at the British Society for Investigative Dermatology (BSID) Annual Meeting 2023 in Glasgow. The talk was titled 'Using single-cell transcriptomics to characterise early mechanisms of psoriasis resolution'.
Year(s) Of Engagement Activity 2023
 
Description Podcast on psoriasis research 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Prof Smith and Dr Mahil recorded a podcast on psoriasis COVID-19 research (PsoProtect and PsoProtectMe), for which the target audience was patients and the public - https://www.thepsoriasisgeek.com/covid/
Year(s) Of Engagement Activity 2020
 
Description Presentation of COVID-19 vaccine immunogenicity research at scientific meetings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I presented my work on COVID-19 vaccine immunogenicity in individuals receiving therapeutic immunosuppression for psoriasis at the following conferences:
- European Congress of Clinical Microbiology & Infectious Diseases 2021
- American College of Rheumatology Congress 2021
- Psoriasis Gene to Clinic Conference 2021
Year(s) Of Engagement Activity 2021
 
Description Presentations of COVID-19 registry research (PsoProtect, PsoProtectMe) at scientific meetings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The research findings from PsoProtect and PsoProtectMe have been presented at the following clinical/scientific meetings:
- International Psoriasis Council Think Tank 2020 and 2021
- Annual UK Dermatology Consultants Course 2020
- 'Best of BRC' presentation - research highlights from 2020 for Guy's and St Thomas' NIHR Biomedical Research Centre
- British Association of Dermatologists Annual Conference 2020 and 2021
- International Congress of Dermatology 2021 (Keynote speaker)
- European Society for Dermatological Research Annual Conference 2021
- International Federation of Psoriasis Associations World Conference 2021
- Fondation Rene Touraine Scientific Day 2021
- BAD/RCP Conference May 2022 ('Celebrating the skin we are in: what does the future hold?')
Year(s) Of Engagement Activity 2020,2021,2022
 
Description Presentations of research findings at international scientific meeting - International Psoriasis Council Think Tank 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was invited to present our research findings from PsoProtect at the International Psoriasis Council Think Tank 2020 (attended by clinicians, scientists who are members of the International Psoriasis Council). This generated valuable discussions and the talk received excellent feedback.
Year(s) Of Engagement Activity 2020
 
Description Presentations of research findings at national conference - Annual UK Dermatology Consultants Course 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact I was invited to present our research findings from PsoProtect at the Annual UK Dermatology Consultants Course 2020 (attended by clinicians) and received excellent feedback.
Year(s) Of Engagement Activity 2020
 
Description Presentations of research findings at national meeting - British Association of Dermatologists Annual Conference 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact I presented our research findings at the British Association of Dermatologists Annual Conference 2020 (attended by clinicians and academics). The talk generated valuable discussions in the Q&A at the end of the presentation and received excellent feedback.
Year(s) Of Engagement Activity 2020
 
Description Press release and plain language summary for publication in J Allergy Clin Immunol entitled 'Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry based study' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I wrote a plain language summary for our research publication, which was disseminated to members and supporters of the Psoriasis Association, The summary (and accompanying infographic) was also disseminated via the Guy's and St Thomas' NIHR BRC and IFPA.
Year(s) Of Engagement Activity 2020
 
Description Press release and plain language summary for publication in British Journal of Dermatology entitled 'Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey'' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I wrote a plain language summary for our publication in British Journal of Dermatology ('Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey'). This was disseminated (with an accompanying infographic) via Psoriasis Association, IFPA and also the Guy's and St Thomas' NIHR BRC.
Year(s) Of Engagement Activity 2021
 
Description Press release and plain language summary for publication in British Journal of Dermatology entitled 'Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey'' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact We disseminated a plain language summary of our publication in British Journal of Dermatology ('Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey'). This was disseminated (with an accompanying infographic) via Psoriasis Association, IFPA and also the Guy's and St Thomas' NIHR BRC.
Year(s) Of Engagement Activity 2021
 
Description Press release and plain language summary for publication in J Allergy Clin Immunol entitled 'Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry based study' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We disseminated a plain language summary for our research publication (and accompanying infographic) to members and supporters of the Psoriasis Association, IFPA and the Guy's and St Thomas' NIHR BRC.
Year(s) Of Engagement Activity 2020
 
Description Press release and plain language summary for publication in JAMA Dermatology entitled 'Mental health status is associated with discordance between patient and physician psoriasis ratings: a repeated cross-sectional study.' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Dissemination of plain language summary of research paper entitled 'Mental health status is associated with discordance between patient and physician psoriasis ratings: a repeated cross-sectional study' via Psoriasis Association and NIHR BRC.
Year(s) Of Engagement Activity 2021
 
Description Press release and plain language summary for publication in JEADV entitled 'Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Lay summary and infographic for the above research paper, see https://www.psoriasis-association.org.uk/news/findings-from-psoprotectme-burden-of-covid19-pandemic
Year(s) Of Engagement Activity 2021
URL https://www.psoriasis-association.org.uk/news/findings-from-psoprotectme-burden-of-covid19-pandemic
 
Description PsoProtect newsletters 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We regularly summarise our research outputs in our newsletters, which are emailed to all contributors and partner organisations so that they can disseminate via their networks. We have produced 3 newsletters to date (last in Jan 2021).
Year(s) Of Engagement Activity 2020,2021
 
Description Recording of a podcast on psoriasis research 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I recorded a podcast on psoriasis COVID-19 research with Prof Smith, with the target audience of patients and the public - https://www.thepsoriasisgeek.com/covid/
Year(s) Of Engagement Activity 2020
 
Description St John's DermAcademy newsletters 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We regularly produce newsletters summarising our educational activities, and forthcoming courses. This is disseminated to healthcare professional networks, e.g. trainee networks, mailing list. We have produced 3 newsletters to date (last Dec 2020).
Year(s) Of Engagement Activity 2020,2021
 
Description Video interviews (x4) - Psoriasis Association, International Federation of Psoriasis Associations, and International Psoriasis Council 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Prof Smith and Dr Mahil have participated in 3 recorded video interviews on psoriasis research for patients - 2 interviews for the Psoriasis Association (June 2020 and March 2021) and 1 for International Federation of Psoriasis Associations (June 2020). We have also been interviewed by the International Psoriasis Council (primary audience is clinicians). These video interviews have been disseminated via social media and are accessible via the websites of the organisations.
Year(s) Of Engagement Activity 2020,2021
 
Description Video interviews (x4) for Psoriasis Association, IFPA and International Psoriasis Council 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I have participated in 3 recorded video interviews on psoriasis research for patients - 2 interviews for the Psoriasis Association (June 2020 and March 2021) and 1 for International Federation of Psoriasis Associations (June 2020). I have also been interviewed by the International Psoriasis Council (primary audience is clinicians). These video interviews have been disseminated via social media and are accessible via the websites of the organisations.
Year(s) Of Engagement Activity 2020,2021
 
Description Websites and Social media - PsoProtect and PsoProtectMe 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact We set up study websites (psoprotect.org, psoprotectme.org), Twitter (#psoprotect) and Instagram accounts for our psoriasis research project, PsoProtect and PsoProtectMe. Patients and clinicians have engaged well with these platforms - the social media channels have more than 600 followers. We update our social media several times per week with new posts and update the 'Data summary' pages on the PsoProtect and PsoProtectMe websites with summary statistics at the beginning of each month.
Year(s) Of Engagement Activity 2020,2021