New Treatment Options for Psoriasis
Psoriasis is a serious autoimmune disease that causes a rapid buildup of cells on the surface of your skin, triggering the formation of red, scaly plaques. Psoriasis can also result in the development of psoriatic arthritis, cardiovascular disease, and other inflammatory diseases. Basically, if you have psoriasis, your immune system is in overdrive.
Thankfully, treatment options for psoriasis, especially for patients with moderate to severe psoriasis, have been revolutionized in the past 15 years with the introduction of biologics, a type of genetically-engineered medication meant to inhibit specific functions of the immune system. Since then, treatment options for psoriasis have become more and more targeted, and more and more effective.
First Treatment Methods
Before the emergence of biologics, psoriasis patients were treated with immunosuppressants, like cyclosporine and methotrexate, meant to suppress the immune system overall. Some even underwent chemotherapy.
While these treatment methods mitigate psoriasis symptoms, they often come with more severe side effects and a higher chance of developing other infections, because they wipe out the entire immune system. Then, researchers began to take a closer look at what exactly is happening inside the body during psoriasis.
A Closer Look
There are certain pathways of the immune system that react when you get a cut or scrape, sending cells to the surface of your skin to fight off possible infections and heal the wound. In people with psoriasis, these specific pathways have an overactive immune response. Sometimes, there’s not even an injury to trigger sending cells to the skin, but their system still goes into healing mode.
Once researchers discovered which specific inflammatory pathways were involved with psoriasis, they began to single out those pathways in treatment options, rather than the entire immune system. Yes, targeting these select pathways still comes with the risk of developing an infection, but the list of infections has been significantly reduced, and doctors are better able to monitor for infections because they know which ones they’re looking for.
TNF Alpha Blockers
The first biologic, approved by the Federal Drug Administration (FDA) in 2004, that targeted specific passageways involved in psoriasis was Enbrel (etanercept). Enbrel and similar drugs like Humira (adalimumab) and Remicade (infliximab) are classified as tumor necrosis factor-alpha (TNF-alpha) blockers. These TNF-alpha blockers come in an injectable form or intravenous infusions given by your doctor, and injection frequency varies from once or twice a week to every 6-8 weeks.
TNF-alpha is a cytokine, or protein inside your body that encourages inflammation to occur. If you have psoriasis, you likely have a surplus of TNF-alpha production in your skin, and sometimes even your joints. By closing down pathways containing these cytokines, TNF-alpha blockers help postpone or even end the inflammation that causes psoriasis flares. Once physicians started this specific targeting with TNF-alpha blockers, we saw a much higher response rate in psoriasis patients--with up to 75% improvement.
Interleukin-12 and 23 Blockers
The second class of biologics to hit the market are known as interleukin-12 and 23 (IL-12/23) blockers. Like TNF-alpha, interleukins are proteins involved in the inflammation and immune response. The main difference between TNF-alpha blockers and IL-12/23 blockers is the former targets one pathway in the immune system, while the latter targets two pathways. As an added benefit, the interleukin blockers only have to be injected quarterly. The most common IL-12/23 blocker is Stelara (ustekinumab).
A more recent group of biologics, IL-17 blockers, have proven even more effective than previously introduced drugs - and faster. In fact, patients report drastic improvement after just two to four weeks. This is because the IL-17 blockers block more essential pathways associated with psoriasis. In other words, they address the core of the issue better than ever before. The first IL-17 blocker to be approved by the FDA is called Cosentyx (secukinumab). While the injections are more frequent than IL-12/23 blockers (weekly for the first five weeks, and then monthly), the results thus far have been extremely successful. Taltz (Ixekizumab) is the newest IL-17 blocker approved by the FDA. This drug works like Cosentyx, but with fewer number of injections for the first 12 weeks.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Paul Yamauchi, MD, is a clinical assistant professor in the division of dermatology at the David Geffen School of Medicine at UCLA, and has been practicing dermatology for 16 years. View his Healthgrades profile >
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