Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Ryan Livingston

A recent nested matched cohort study indicated that patients with 

 have a longer duration of symptoms before referral and a longer interval between presentation to a general practitioner and diagnosis than those with 

Previous research has indicated that, despite similar disease impact and physical function at diagnosis, patients with PsA had a longer delay to diagnosis. Additionally, patients with PsA are less likely to receive combination treatment and may have increased disease burden 3 months after presentation.

“This study aimed to gain a greater understanding of delay to diagnosis and compare the time from general practitioner presentation to diagnosis, for patients with PsA with that of patients with RA,” wrote William Tillett, PhD, department of rheumatology, Royal National Hospital for Rheumatic Diseases, and colleagues. “The study also aimed to compare disease activity and impact of disease, as well as treatment initiation, including treat-to-treat and [disease-modifying antirheumatic drug (DMARD)] therapy, between the PsA and RA cohorts.”

Tillett and colleagues utilized data collected for the 2018 British Society for Rheumatology National Early Inflammatory Arthritis Audit (NEIAA); included patients were ≥16 years and attending specialist Rheumatology Centres in England and Wales for suspected inflammatory arthritis for the first time. A total of 4240 patients were considered eligible: 2120 with RA and 2120 with PsA.

Eligible patients with PsA were then randomly matched to an RA patient based on age and sex. Patients with a diagnosis of RA or inflammatory polyarthritis (affecting ≥5 joints) were eligible for follow-up, and patient-reported outcomes were collected at baseline and 3- and 12-month follow-up periods.

The time between first symptoms and referral was compared between patients in each cohort: 40% of patients with RA and PsA were referred to a specialist within 3 working days (

 = .145). However, patients with PsA experienced a longer duration of symptoms before referral and a longer duration between first presentation and receiving a diagnosis (

 <.001). Once referral had been received by secondary care, there was another similar delay (adjusted hazard ratio [aHR], 0.87: 95% CI, 0.79-0.96, 

 <.007 and aHR, 0.86: 95% CI, 0.80-0.95, 

Tillett and colleagues also noted that considerably fewer DMARDs were prescribed at baseline to patients with PsA compared with their matched RA comparators (54% and 69%, respectively; 

 <.001). These results were consistent at the 3-month follow-up, when percentages of those who had initiated DMARD rose to 73.9% and 87.5%, respectively (

 <.001). Based on the collective DMARD initiation in the first 3 months, patients with PsA were found to be started more often on a single DMARD, while those with RA were started on multiple.

Patient-reported outcomes were available for roughly 40% of patients at baseline and 20% at 3-month follow-up. A total of 502 patients with PsA and 505 patients with RA had completed the form at baseline, and 258 patients with PsA and 270 with RA at the follow-up. Restricting data to patients with both data sets indicated a greater improvement in the RA cohort than the PsA cohort.

These data suggest that patients with PsA experienced longer delays in diagnosis, are less likely to receive DMARD therapy, and have little improvement during their first 3 months of care. According to investigators, however, much of this knowledge is nothing new. Instead, the team is leveraging the data to call for earlier diagnosis and treatment.

“These findings highlight the need for education both of patients and the clinical team, to support earlier diagnosis and treatment, thus improving longer-term outcomes,” wrote Tillett and colleagues.

Charlton RA, Gates E, Coates LC, et al. Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: A study nested within an English and Welsh audit data set. 

. Published online March 29, 2025. doi:10.1016/j.ard.2025.02.020

Holland R, Davis A, Green A, et al. FRI0514 psoriatic arthritis is associated with diagnostic delay and worse outcome at three months when compared to rheumatoid arthritis: Results from the UK national audit for inflammatory arthritis. 

. 2017;76:685. doi:10.1136/annrheumdis-2017-eular.5066

Articles

Patients with psoriatic arthritis (PsA) experience longer delays in diagnosis and treatment initiation compared to those with rheumatoid arthritis (RA). Despite similar disease impact at diagnosis, PsA patients face extended intervals between symptom onset and specialist referral, and fewer receive disease-modifying antirheumatic drugs (DMARDs) at baseline. This discrepancy persists at the 3-month follow-up, with PsA patients more often started on a single DMARD. The study underscores the need for improved education and strategies to facilitate earlier diagnosis and treatment, aiming to enhance long-term outcomes for PsA patients.

Investigators call for faster diagnosis and better treatment for psoriatic arthritis to avoid unnecessary complication and suffering.

Study Finds Diagnostic Delay, Less Intensive Therapy Use in PsA than RA

New research is shedding light on the potential utility of mobile apps for improving medication adherence among patients with 

The systematic review included 9 studies comprising 1023 participants at various stages of CKD management, including hemodialysis, peritoneal dialysis, and post-kidney transplant. Results highlight statistically significant improvements in medication adherence with use of different mobile apps, but low evidence and short intervention duration necessitate further research.

According to the American Kidney Fund, an estimated 35.5 million people in the US have kidney disease, approximately 815,000 of whom are living with kidney failure. Kidney disease is the fastest-growing noncommunicable disease in the US, and it is not reversible, it is treatable – when caught and treated early, it is often possible to slow or stop the progression of kidney disease and avoid serious complications.

Medication adherence is a critical aspect of disease management for patients with CKD, but complex medication regimens, forgetfulness, lack of understanding about the importance of adherence, and limited patient-provider communication can all lead to nonadherence and subsequent poor outcomes.

“Despite the growing body of research on the efficacy of mobile apps in fostering medication adherence for various chronic diseases, there is a noticeable gap in the literature regarding their application in CKD management,” Ganesh Sritheran Paneerselvam, a senior lecturer at Taylor's University in Malaysia, and colleagues wrote.

 “The unique challenges and complexities of CKD warrant a specialized investigation into the role of mobile apps in enhancing medication adherence among this specific patient group.”

To evaluate the effectiveness of mobile apps for improving medication adherence among patients with CKD, investigators systematically searched Scopus, Cochrane, PubMed, and EBSCOhost databases for quantitative studies involving patients with CKD. The primary intervention of interest was mobile apps specifically designed for managing medication adherence in patients with CKD, but investigators included apps with additional functionalities if they addressed this focus.

Out of 231 relevant articles, 9 studies were selected for systematic review. Of these studies, 4 were conducted in the United States, 2 were conducted in South Korea, and 1 study each was performed in Australia, Iran, and Taiwan. Most (n = 3) were randomized controlled studies, 2 were prospective cohort studies, 2 were quasi-experimental studies, and 2 were observational studies.

Investigators noted the sample size of the included studies ranged from a minimum of 67 participants to a maximum of 214 participants. Among the total 1023 participants included in the analysis, the mean age was 52.65 (standard deviation, 5.93) years.

Mobile apps examined in the studies included Transplant Hero, Perx, Smartphone Medication Adherence Saves Kidneys (SMASK), Adhere4U, My Dialysis, Kidney Love, and iCKD, all of which used various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring.

Of the 9 selected studies, 7 used objective measures of adherence, such as pill counting, coefficient of variability for immunosuppressants, electronic monitoring, and adherence scales. Subjective measures were utilized in 2 studies with self-report questionnaires. One study used 2 objective measures along with self-reporting, while another combined both subjective and objective measures.

Overall, 5 out of the 9 studies demonstrated ≥ 1 statistically significant (

<.05) measure of medication adherence in patients with CKD due to the intervention of a mobile app. However, investigators called attention to methodological diversity, variations in-app functionalities, and outcome measurement approaches between the studies.

“The findings of this review underscore the potential of mobile apps to improve medication adherence among patients with CKD, though the impact on clinical outcomes remains an area for further exploration,” investigators concluded.

Paneerselvam GS, Lua PL, Chooi WH, et al. Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review. 

American Kidney Fund. Quick kidney disease facts and stats. February 11, 2025. Accessed April 18, 2025. 

https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

New research highlights the potential of mobile apps to enhance medication adherence in chronic kidney disease (CKD) patients. A systematic review of nine studies involving 1,023 participants across various CKD management stages showed significant improvements in adherence with app use. Despite promising results, the evidence remains low, and further research is needed. CKD is a growing noncommunicable disease in the US, affecting millions. Medication adherence is crucial for CKD management, yet challenges persist. The review emphasizes the need for specialized investigation into mobile app efficacy for CKD patients.

Several mobile apps effectively improved medication adherence in patients with CKD, posing important implications for their impact on clinical outcomes.

Mobile Apps Show Promise for Improving CKD Medication Adherence

A recent survey study conducted in South Korea indicated that menopause has a neutral to negative effect on the course of 

Estrogen, which sharply declines over the 30-year post-menopausal period, has been indicated in several past studies to have a protective effect on the skin. Although no direct causal relationship has been proven, research has shown an association between the use of transepidermal estrogen and an improved skin barrier function.

Notably, psoriasis is associated with a compromised skin-barrier function.

“We conducted surveys in North America and East Asia to understand the patient-reported impact of menopause and HRT on women with an existing diagnosis of psoriasis,” wrote Bo Young Chung, MD, department of dermatology, Kangnam Sacred Heart Hospital, Hallym University, and colleagues. “Our results provide patient-centred data that may help clinicians counsel women with psoriasis as they make the menopausal transition.”

The online survey consisted of 35 questions, gathering demographic, social history, menopausal history, and psoriasis history and severity data. Eligible participants must have been formally diagnosed with psoriasis and have gone through menopause, which was defined as having no menstrual bleeding for ≥1 year. Respondents were recruited from outpatient dermatology clinics at the University of California, San Francisco, and Hallym University Kangnam Sacred Heart Hospital in Seoul, South Korea.

In total, 139 participants took part in the survey – 110 from the US and 29 from South Korea. The mean age at menopause onset was 46.45 in the US group and 50.10 in the South Korean group. Together, natural menopause was reported in 71.2% of respondents, surgical menopause in 22.3%, and medical menopause in 2.2%.

In the combined group, 10.1% of women said menopause caused their psoriasis, 33.1% said it worsened the condition, 2.2% said it improved it, and 41.7% said it had no effect. Investigators noted differences between the two groups, however, such as the frequency of psoriasis causation with menopause being higher in the US group (

 = .043) while no change with menopause was more common among the Korean group (

A collective total of 29 participants reported receiving hormone replacement therapy (HRT) – 62.1% of the combined group received estrogen only, 3.4% received progestin only, 20.7% received a combination of both, and 13.8% were unsure. Regarding HRT’s effect on psoriasis, 62.1% of the combined group reported it had no effect, 3.4% that menopause caused psoriasis, 3.4% that it had worsened psoriasis, and 13.8% that it improved psoriasis.1

After subgroup analysis, Chung and colleagues indicated that the most significant factors associated with menopause worsening psoriasis were obesity (odds ratio [OR] 2.66: 95% CI, 1.14-6.22, 

 = .024), alcohol consumption history (OR, 0.41, 95% CI, .19-.92, 

 = .030), older age (OR, 0.95, 95% CI, 0.90-0.995, 

 = .030), and Asian race (OR, 0.39: 95% CI, .16-.94, 

 = .036). However, after multivariate analysis, only alcohol consumption history remained significant (OR, 0.19: 95% CI, .06-.59, 

“In summary, this study showed that menopause is likely to have a neutral to negative effect on psoriasis, with very few women reporting improvement of psoriasis after menopause,” Chung and colleagues wrote. “However, despite the worsening of psoriasis in some women with menopause, the large majority of women did not need to modify their psoriasis treatment plan after menopause.”

Chung BY, Johnson C, Park JS, et al. Patient-reported Impact of Menopause and Hormone Replacement Therapy on Psoriasis. 

. 2025;105:adv42843. Published 2025 Apr 9. doi:10.2340/actadv.v105.42843

Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 2: skin disorders. 

. 2022;47(12):2117-2122. doi:10.1111/ced.15308

A survey study in South Korea and North America explored the impact of menopause and hormone replacement therapy (HRT) on psoriasis. The study found that menopause generally has a neutral to negative effect on psoriasis, with few women reporting improvement. The survey included 139 post-menopausal women with psoriasis, revealing that 33.1% experienced worsening symptoms post-menopause. Factors such as obesity, alcohol consumption, and age were linked to worsening psoriasis, but only alcohol consumption remained significant after multivariate analysis. Most women did not need to alter their psoriasis treatment post-menopause.

Without estrogen, the skin barrier weakens, leading to more severe and symptomatic psoriasis.

Menopause May Worsen Symptoms of Psoriasis, New Study Reveals

Image Credit: US Food and Drug Administration

 has issued a Complete Response Letter (CRL) to the supplemental Biologic License Application (sBLA) for an extended 24-week dosing duration for aflibercept 8 mg (EYLEA HD) in the treatment of 

wet age-related macular degeneration (AMD)

Announced by Regeneron on April 18, 2025, the CRL did not identify issues with aflibercept 8 mg in its already approved dosing regimens or its indications for wet AMD, DME, or DR. However, the FDA disagreed with the company's proposal to add extended dosing intervals greater than 16 weeks, the current maximum according to the label.

Aflibercept 8 mg is a longstanding treatment for various ophthalmic diseases, including wet AMD and DME. It was initially approved for the treatment of both diseases in August 2023, based on the data from the PULSAR and PHOTON trials.

The dosing extension plan was first announced during Regeneron’s presentation at the J.P. Morgan Healthcare Conference in January 2025. At the time of presentation, the FDA was already reviewing the application.

The sBLA submission was based on positive results from the PULSAR (wet AMD) and PHOTON (DME) trials, which indicated durable vision gains at extended dosing intervals. The PULSAR and PHOTON trials were double-masked, active-controlled trials evaluating the non-inferiority of aflibercept 8 mg dosing regimens to an 8-week aflibercept 2 mg treatment regimen for treating wet AMD and DME, respectively. Participants receiving aflibercept 8 mg received 3 initial monthly doses in both trials, while those receiving aflibercept 2 mg received 3 initial monthly doses in PULSAR and 5 in PHOTON.

In both studies, most aflibercept 8 mg recipients sustained visual gains and anatomic improvements achieved by the end of the second year, while also achieving longer treatment intervals. Those who switched from aflibercept 2 mg to aflibercept 8 mg at the beginning of the third year also exhibited and maintained anatomic and vision improvements with longer dosing intervals and fewer injections.

During the first year, patients could have their dosing intervals shortened to an every 2-month interval if specific criteria were observed; intervals could not be extended until the second year. Both trials were followed up with an optional extension study beginning at week 96, which saw participating patients initially randomized to aflibercept 2 mg switched to 8 mg at the start of the extension and assigned a 3-month dosing interval.

The safety profile for aflibercept 8 mg in both trials was similar to aflibercept 2 mg and remained consistent throughout the three years. The endpoints of both trials were reached, and on February 8, 2025, Regeneron announced the positive results.

"Regeneron is evaluating the FDA's decision and will determine a path forward in due course," the company wrote in its April 18 announcement.

Regeneron. "Regeneron Provides Update on EYLEA HD® (aflibercept) Injection 8 mg Supplemental Biologics License Application". Regeneron. April 18, 2025. Accessed April 18, 2025. 

https://investor.regeneron.com/news-releases/news-release-details/regeneron-provides-update-eylea-hdr-aflibercept-injection-8-mg

P. Aflibercept 8 mg (eylea HD) approved by FDA for wet AMD, DME, and Diabetic retinopathy. HCP Live. August 23, 2023. Accessed April 18, 2025. 

https://www.hcplive.com/view/aflibercept-8mg-eylea-hd-approved-by-fda-for-wamd-dme-and-diabetic-retinopathy

Regeneron provides business updates and highlights from Broad Clinical Pipeline at the 43rd Annual J.P. Morgan Healthcare Conference. Regeneron Pharmaceuticals Inc. January 13, 2025. Accessed April 18, 2025. https://investor.regeneron.com/news-releases/news-release-details/regeneron-provides-business-updates-and-highlights-broad.

Regeneron. Three-Year Results for EYLEA HD (aflibercept) Injection 8 mg in Patients with Wet Age-Related-Macular Degeneration Demonstrate Continued Durable Vision Gains and Anatomic Improvements with Extended Dosing Intervals. Regeneron. February 8, 2025. Accessed April 16, 2025. 

https://investor.regeneron.com/news-releases/newsA-release-details/three-year-results-eylea-hdr-aflibercept-injection-8-mg-patients

The FDA issued a Complete Response Letter to Regeneron's supplemental Biologic License Application for extending aflibercept 8 mg dosing intervals to 24 weeks for wet AMD, DME, and DR. The FDA disagreed with extending dosing beyond the current 16-week maximum, despite positive trial results showing durable vision gains and anatomic improvements. Aflibercept 8 mg, approved in 2023, demonstrated non-inferiority to the 2 mg regimen in trials. Regeneron is assessing the FDA's decision and planning future steps.

The FDA identified no issues with the safety or efficacy of aflibercept 8 mg in any of its already approved dosing regimens or indications.