After Fits and Starts, New Hope for Psoriasis Patients

(HealthDay News) -- Psoriasis can be a maddening disease.

Patches of thick, inflamed skin covered with silvery scales form here and there on the patient's body, often on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. They usually itch or feel sore, and the more of the patches there are, generally, the worse the person suffers.

And because psoriasis is a genetic condition that causes inflammation by striking at the immune system, it can have other health effects. An estimated 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints, according to the National Psoriasis Foundation.

Psoriasis sufferers also have higher rates of cardiovascular disease and other systemic health problems, said Dr. Jennifer Cather, a Dallas dermatologist and a member of the Baylor University Medical Center's Division of Dermatology.

"Often patients think psoriasis is just a rash, [but] it is a systemic inflammatory disease with far-reaching affects," Cather said. "Patients should be aware of that and understand that controlling that systemic inflammation can help with other diseases."

That's a message doctors are looking to share during August, Psoriasis Awareness Month.

Until recently, there was little that could be done about the systemic damage done by psoriasis. Sufferers used topical creams to ease their itches or aches, or underwent expensive ultraviolet light treatments that disrupted the surface spread of psoriasis but did not address the underlying problems within the immune system.

But the past few years have seen the development of a new wave of drug treatments known as biologics. These medications do what previous treatments could not -- go after the root of the problem by influencing the immune system.

"It's really changed the way we can treat psoriasis," said Dr. Lawrence Green, assistant professor of dermatology at George Washington University School of Medicine in Washington, D.C. "It really has made life much more tolerable for patients."

Psoriasis occurs when the body's immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells, according to the National Psoriasis Foundation. Normal skin cells mature and fall off the body in 28 to 30 days. A psoriatic skin cell takes just three to four days to mature and move to the surface, and, instead of falling off, the cells pile up and form lesions.

According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis.

Biologics are made from human or animal proteins, and they treat psoriasis by going after the overactive immune cells causing the disease.

"They are based on natural processes," Green said. "They're similar to chemicals or compounds we already have in our system. They help lessen immune responses. They help soak up or diminish the extra inflammatory compounds."

Currently, five biologics are approved by the U.S. Food and Drug Administration for treatment of psoriasis, and three of those five are approved for psoriatic arthritis. Biologics are effective, and they also are more affordable than ultraviolet therapy, the other leading treatment for dealing with medium-to-severe cases of psoriasis, according to dermatologists.

Ultraviolet light kills the immune cells in the skin that are causing the problem, Cather said. The problem is, a person must come in three to five times a week for treatment, racking up hundreds of dollars in co-payments.

Biologics, by comparison, are self-administered through injection. The patient usually must inject the medication somewhere between twice-weekly to once every other week, Cather said.

Patients undergoing biologic therapy need to have periodic re-evaluations by their dermatologist to check for the development of new symptoms, including infections and potential cancers, according to guidelines issued earlier this year by the American Academy of Dermatology.

More information
To learn more about psoriasis, visit the U.S. National Library of Medicine.

New Psoriasis Pill Appears Effective

(HealthDay News) -- A new drug for patients with moderate to severe psoriasis appears to be safe and effective, a Canadian trial shows.

The results indicate higher doses of ISA247, which is a calcineurin inhibitor, significantly improve symptoms of psoriasis. Calcineurin is a protein that helps regulate inflammation.

"This is the first oral medication in 20 years to show promise for the treatment of moderate to severe plaque psoriasis," said lead researcher Dr. Kim Papp, from Probity Medical Research in Waterloo, Ontario.

The new drug is safer and easier to use than current treatments for psoriasis, the researchers said.

Psoriasis is an autoimmune skin disease. The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells. As many as 7.5 million Americans have psoriasis, according to the U.S. National Institutes of Health.

Currently, one of the most effective treatments for psoriasis is the calcineurin inhibitor drug ciclosporin. However, the drug's toxic effects on the kidneys prevent it from being used for long-term treatment, which is often needed because psoriasis tends to reappear once treatment is stopped.

Other drugs such as infliximab (Remicade) are safe and effective but are expensive and inconvenient to use. In addition, the long-term safety of the drug isn't known.

The report is published in the April 19 issue of The Lancet.

In the study, Papp's team randomly selected 451 patients with plaque psoriasis that affected at least 10 percent of the body, to receive the new drug or placebo. There were three groups of patients who received ISA247, but at different doses.

The researchers looked for a 75 percent reduction in what is called the psoriasis area and severity index score (PASI 75).

Papp's group found that after 12 weeks of treatment, 47 percent of patients who received the highest dose of ISA247 achieved PASI 75. Patients receiving lower doses achieved a 25 percent or a 16 percent improvement in their PASI score. Among patients in the placebo group, only four of 115 achieved PASI 75, the researchers reported.

"ISA247 is a reasonable oral medication for the treatment of psoriasis," Papp said. "It is reasonable because of reasonable efficacy, high tolerability and minimal metabolic effects."

In addition, because the effect of the drug correlates with its dose, it "can be titrated to suit patients response and tolerance without undue risk of adverse effects," Papp said.

One expert thinks the result of this trial needs to be duplicated in longer-term studies, and it needs to put in a head-to-head comparison with other psoriasis drugs.

"ISA247 may offer advantages compared with ciclosporin," said Dr. Luigi Naldi, from the Unit of Dermatology and GISED Study Centre at Ospedali Riuniti di Bergamo, Italy, and author of an accompanying editorial. "However, its efficacy and safety profile needs to be further evaluated in the context of longer-term comparative studies."

Naldi noted that these trials need to be done in real-life situations. In addition, the trial done by Papp is too short to really tell whether or not the drug is safe, since most patients taking the drug would have to use it for a long time to control their psoriasis, he said.

"The risk of chronic kidney toxicity induced by calcineurin inhibitors increases with treatment duration and cannot be reliably predicted with short-term data," Naldi said." An obvious comparator in the ISA247 trial would have been ciclosporin. Without such an internal comparison, the claim that ISA247 is safer than ciclosporin should be viewed cautiously, because it is based on external comparisons," he said.

More information
For more on psoriasis, visit the U.S. National Library of Medicine.