June 25, 2001 -- It's been advertised as the heartbreak of psoriasis, those patches of red, raised areas of skin covered with a flaky white buildup called plaques. For many though, that heartbreak may soon go away because there are many upcoming treatments for this often disabling and disfiguring condition.
Psoriasis is thought to be an autoimmune disease, meaning that a malfunction of the body's own immune system causes an alteration in normal skin growth. The condition usually starts in early adulthood and can last, off and on, for the rest of a person's life. The disease may run in families, but it's not contagious. According to the National Psoriasis Foundation, about seven million Americans suffer from psoriasis.
Mild and moderate psoriasis can be managed fairly well with various creams. But severe psoriasis is typically treated with one or both of two very effective drugs, methotrexate and cyclosporine. The problem is these and other drugs only work in some people some of the time and can have serious, even life threatening side effects.
Expert Alice Gottlieb, MD, PhD, director of the Clinical Research Center and professor of medicine at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J., says that, "psoriasis is a disease that is exceedingly life impacting ... 10% of patients who are aged 17 to 34 [who have severe psoriasis] are actively suicidal. ... The impact on life of this disease is the same as cancer, diabetes, hypertension, and major depression."
There is thus a real need for better options for people suffering from psoriasis.
Fortunately, in the pipeline there are several new drugs, new treatments, and new uses for drugs approved for other conditions. Many of these options were described by experts, including Gottlieb, on Thursday at a press conference of the USA World Conference in San Francisco, sponsored by the National Psoriasis Foundation.
Among some drugs and treatments already on the market that are, or may, be used for psoriasis:
- Protopic: This ointment is currently used to treat a skin condition called atopic dermatitis. But it is proving to be helpful in sensitive areas affected by psoriasis, such as under the breasts and in the groin area.
- Olux: Various medications are mixed with this special foam in order to be applied to the skin. Its benefits are that it feels pleasant on the skin and is well absorbed, ensuring that the medication will also absorb well.
- Xtrac: A few zaps with this special laser appear to effectively remove small psoriasis plaques.
- Remicade: This intravenous injection is already used for other autoimmune diseases. It works by blocking a substance called tumor necrosis factor, which is involved in inflammation. Short-term results have been very promising for psoriasis, and the early results of ongoing long-term studies also look good.
- Retinoids and UV: Vitamin A based drugs, called retinoids, have been shown to dramatically reduce psoriasis when combined with tanning bed therapy, which exposes the body to UV light.
Here's some of what psoriasis sufferers have to look forward to in the near future:
- Amevive: In early clinical trials, once weekly injections with this new product, belonging to a class of drugs called biologics, blocks immune cells involved in psoriasis, produced at least a 75% improvement in nearly half of those who tried it.
- Xanelim: In clinical trials, this product, which is also a biologic, worked by preventing certain immune cells from passing into the skin and producing psoriasis.
- ABX IL8: This is an artificially produced human antibody that has shown dramatic results in a 12-week study.
- ISIS 2302: This ointment actually targets the genes responsible for producing substances involved in psoriasis.
- IDEC 114: This intravenous injection works in a similar fashion to Xanelim and has provided remarkable results with virtually no side effects.
- ASM 981: Also targeting the immune system, this pill has safely produced an average 75% reduction in psoriasis symptoms.
According to Mark Lebwohl, MD, chairman in the department of dermatology at Mt. Sinai Medical Center in New York and also one of the presenters at the press conference, some of these drugs are still in their infancy, but all early findings of safety and effectiveness are very encouraging. In fact, the drugs appear so safe that they will probably soon be used in combination with each other and at higher doses, providing even more dramatic results than have been seen so far. Most are expected to be on the U.S. market and approved for psoriasis within a year or two.