April 9, 2016
As scientists learn more about psoriasis, there are more therapeutic treatment options for those that have this skin disease.
FDA dermatologist, Melinda L. McCord, M.D says that as we learn more about this disease, we gain the tools necessary to develop more effective treatments as we learn the factors that cause it.
In the past, the treatment for psoriasis was previously a gradual step-by-step approach. Today, doctors look to treat it at the first visit. There are systemic therapies as well as phototherapy o which are based on the needs of each individual patient.
McCord says that the treatment options offered tomorrow will be more personalized because new drugs in development will target individual areas of the immune system.
Psoriasis and Personalized Medicine
Psoriasis causes inflammation and a rapid overproduction of skin cells so it’s an immune system disorder. It creates pain, swelling, scaling, redness, and heat. There are about 7.5 million Americans that have it. It can also create emotional as well as physical discomfort.
The therapies for psoriasis include:
- Topical treatment which is medication applied to the skin
- Phototherapy or light treatment
- Systemic therapy which is injection or orally taking medications
Psoriasis has no cure so the goals of the treatments are to reduce the inflammation and to keep the skin cells from growing rapidly.
In the past, it was treated using a “step-wise approach.” This that had a mild case of the condition were given topical therapies by doctors and if there was no response to that, they received other treatments like phototherapy or systemic therapy. Those that had medium to severe psoriasis were treated with phototherapy or traditional systemic therapies. Common drugs used were methotrexate and cyclosporine, and then biological therapies were used which work on the immune system.
Over the years the strategy has changed to more of an approach that’s patent specific. Doctors and patients choose a treatment based upon the severity of the disease, the treatments effectiveness, risk factors, lifestyle considerations and associated diseases called co-morbidities.
The FDA has recently approved a biologic product for treating the condition which is called Stelara (ustekinumab). This contains an antibody produced in a laboratory and targets a specific part of the immune system. It blocks the action of two proteins which are interleukin 23, and 12. These contribute to inflammation and the overproduction of skin cells. Since these proteins are targeted, ustekinumab interrupts inflammation pathways.
Future drugs will target different pathways of the immune system which cause inflammation. Researchers are looking at interleukin 17 as well as molecules and proteins that interrupt cellular signaling. This can lead to the spread of inflammation issues.
McCord says that as we learn about immune pathways that leads to the development of psoriasis, we are able to target molecules and mare better therapeutic options available to those that have the condition. By understanding the disease, we can target those specific factors causing it.
There is no cure for psoriasis as it’s a chronic condition. Treatments may have to be used for a long time. The FDA therapies for the condition have bene evaluated and looked at over a long time frame