New developments in psoriasis therapy
73,000 people in Ireland have psoriasis. We have heard about exciting new treatments and how psoriasis is connected with other conditions.
Prof. van de Kerkhof from the Netherlands described how psoriasis treatment has improved during his thirty years as a dermatologist specialising in the disease. He told the meeting that a new “biologic” therapy, secukinumab, has recently been approved for psoriasis treatment in most countries, including Ireland.
Many research studies over several years, aimed at better understanding the biology of the disease, revealed that a protein called interleukin-17A was often a key molecule in psoriasis lesions. Secukinumab works as an antibody designed to block interleukin-17A, and clinical trials have shown promising results for many patients.
Clinical trials often measure improvements in psoriasis by using the Psoriasis Area and Severity Index (PASI) score, so that if the score improves by 75% after treatment, the response is classed as PASI-75. Over four-fifths of patients, Prof. van de Kerkhof said, had a PASI-75 response after secukinumab treatment. Though it took four months for the treatment to have its full effect, after a few weeks there was already a substantial improvement.
Prof. van de Kerkhof stressed the connection between psoriasis and other diseases
As well as therapeutic antibodies, Prof. van de Kerkhof spoke of some “small molecule” drugs being tested for the treatment of psoriasis: apremilast and tofacitinib. One recent clinical trial compared the effect of apremilast versus placebo. After four months of treatment, a third of patients had improved to reach PASI-75. Apremilast, he commented, was especially useful for patients with mild to moderate disease, where there have not been as many recent advances as in severe disease.
Prof. van de Kerkhof noted that unlike biologic therapies such as secukinumab, there was no need for blood tests (to check for possible side-effects such as immune suppression) during a course of apremilast treatment – a difference that made the treatment much more convenient for patients, along with the fact that it is taken as a pill.
He pointed out that tofacitinib, another small molecule drug tested for psoriasis treatment, appeared to have the unintended side-effect of increasing cholesterol, and cautioned that in deciding when or whether the drug should be used, as well as looking at the benefits, side-effects needed to be taken seriously. As patients with psoriasis are already at a high risk from cardiovascular disease, it is important that drugs do not add to this threat. He and other speakers remarked that the high cost of new targeted therapies was another important issue.
Prof. van de Kerkhof stressed the connection between psoriasis and other diseases which patients often experience alongside it. Some patients with psoriasis, for example, also suffer from metabolic syndrome, cardiovascular risk, or depression. These links, he said, were not well enough understood. When patients receive treatment for diabetes or atherosclerosis, does this make a difference to their psoriasis symptoms? On the other hand, do psoriasis therapies have any impact on cardiovascular risk and the metabolic syndrome?
Later, Prof. Chris Griffiths from Manchester mentioned a recent study confirming a link between major stressful life events and psoriasis symptoms. He went on to show that in an experiment where volunteers were put under artificial stress (having to make a public speaking performance at short notice), their skin showed signs of being more liable to inflammation, up to 24 hours later.
Prof. van de Kerkhof emphasised the need for better records of patient outcomes after treatment, collected over time as patients live with two or more chronic diseases. He pointed out the importance of including the patient’s view on the effects of the treatment,. Researchers are increasingly working to store this information in electronic formats, so that they can find it and use it more efficiently, while making sure to protect the privacy of patients’ personal information.
Prof. van de Kerkhof concluded that a “large portfolio” of new targeted therapies for psoriasis was emerging, and making a valuable impact on how patients across the spectrum from mild to severe disease could manage their symptoms better.
Summary by Dr Ruth Foley, Research Scientist and Copywriter
Talk given by Professor Peter van der Kerkhof at the Future in Dermatology Symposium in UCD on October 2nd and 3rd 2015.