Safer, More Effective Psoriasis Drugs Emerging By Jennifer Warner

Nearly a million people with psoriasis may be not getting the treatment they need and may be missing out on new, more effective psoriasis treatments. Researchers say recent developments in biotechnology are yielding a new generation of treatments for people with the chronic skin condition.

Researchers say up to 7 million people in the U.S. suffer from psoriasis, which typically strikes young people between the ages of 15 and 35. The disease causes scaling and inflammation of the skin and can vary in severity from small patches of irritation on the elbows, knees, and scalp to potentially disabling flare-ups that affect large portions of the body.

"Psoriasis is probably one of the most misunderstood diseases because most of what we learn is mainly from commercials on TV talking about the heartbreak of psoriasis or using a shampoo to get rid of a few flakes in your scalp," says Kenneth B. Gordon, MD, associate professor of medicine in the division of dermatology at Loyola University Medical Center in Maywood, Ill.

"Psoriasis is a disease that's driven by the immune system. It's a disease where you see the physical manifestations are in the skin. In many cases, however, it's the blood cells -- the immune cells -- that drive the skin changes you see," says Gordon, who spoke at an American Medical Association briefing on inflammatory diseases in New York City.

Old Psoriasis Treatments Limited

Researchers say that new understanding of the role the immune system plays in triggering psoriasis has led to targeted psoriasis treatments that block the chain of events that cause inflammation.

Until now, psoriasis treatments were limited to topical steroid creams applied to affected areas of the skin, phototherapy using ultraviolet light, and drugs such as Accutane, methotrexate, and cyclosporine. Although these traditional psoriasis treatments can be effective in many patients, researchers say they are limited by their significant long-term side effects.

"Psoriasis for me is characterized by frustration about the limited options available," says Michael Paranzino, who has suffered from severe psoriasis for several years and now serves as patient advocate for the National Psoriasis Foundation. "It was slim pickings all through the '90s."

Paranzino says the fear of running out of options and the lack of choices are major issues that prompt many people with psoriasis to give up on finding effective psoriasis treatments.

New Drugs Arriving

But researchers say many new drugs are now available or in development that target the specific elements of the immune system involved in psoriasis and can provide lasting relief with fewer side effects than conventional psoriasis treatments.

*Amevive became the first biologic agent approved by the FDA in January 2003 to treat moderate to severe psoriasis and works by suppressing the hyperactive immune system response involved in psoriasis.
*Enbrel, which is commonly used in treating rheumatoid arthritis, was also recently approved for the treatment of psoriatic arthritis and is showing promise in treating psoriasis. Enbrel works by targeting a protein in the body called tumor necrosis factor alpha (TNF-alpha), which is a key player in the inflammatory process.
*Remicade and Humira are TNF-alpha-inhibiting drugs that are available for the treatment of rheumatoid arthritis and are also being studied as psoriasis treatments.
*Raptiva is under development and pending FDA approval as a psoriasis treatment. It also works by targeting the inflammatory processes involved in psoriasis.

"There are multiple different ways to go and attack the immune system in psoriasis and induce the changes we want to see," says Gordon.

But, for now, the downside is that these new drugs must be given by injection, either under the skin, into the muscle, or through an IV (intravenous) infusion. They are also significantly more expensive than conventional psoriasis treatments, but researchers say some drug companies are offering them at reduced costs to needy individuals.

"The good news is that we might have greater safety for longer periods of time," says Gordon about this new generation of psoriasis drugs. "But also as we develop these medications, new targets are coming out that hopefully over the next five, 10, 15 years will develop into even better medications."